PSYCHOLOGICAL AND PSYCHOPHYSIOLOGICAL ASPECTS OF PSORIASIS

Psoriasis is a chronic skin disorder of unknown cause, which is complex on psychologic, social, and cultural levels. Many studies document the impact of psoriasis, which can be associated with painful feelings of embarassment and stigmatization, anticipation of being rejected, and at times interference with work, relationships, and daily activities. Depression can be an important issue for psoriasis patients, and screening for it by the clinician is of utmost importance; it may be associated with severe pruritus and may alter itch perception. Four clusters of studies bearing on stress and the onset and exacerbation of psoriasis are discussed, especially those involving a life-event methodology and those that attempt to define a psychoendocrine or psychoneuroimmunologic pathway. Treatment approaches to psychosocial issues may involve group therapies, individual psychotherapy, and behavior therapy; of greatest importance are improved patient education and an empathic doctor-patient relationship.