Effect of cognitive behavioral therapy on anxiety and depression in patients with psoriasis: A protocol for systematic review and meta-analysis

Psychological Health in the Management of Patients with Psoriatic Arthritis: An Intricate Relationship

Psoriatic arthritis (PsA) is a chronic inflammatory disease that profoundly impacts both physical and psychosocial well-being. The disease can lead to a range of emotional difficulties, including anxiety, depression, and diminished self-esteem. The visible skin manifestations of psoriasis, coupled with the persistent pain and functional limitations of arthritis, can significantly affect body image and self-worth. Furthermore, the physical limitations and fatigue associated with PsA can affect social interaction, leading to isolation and exacerbating emotional distress. PsA can also disrupt work productivity as a result of pain, fatigue, and impaired physical function. Recognizing and addressing the psychosocial impact of PsA is paramount for comprehensive patient care. A multidisciplinary approach involving rheumatologists, psychologists, and other healthcare professionals is essential. Cognitive behavioral therapy, mindfulness-based stress reduction, and other psychological interventions can help patients with coping strategies for stress, anxiety, and depression. Support groups and peer-to-peer networks can provide invaluable emotional and practical assistance. Comprehensive disease management programs that address both physical and psychosocial needs could also be crucial for improving patient outcomes and overall quality of life. By acknowledging and addressing these concerns in conjunction with the physical symptoms, rheumatologist can facilitate improved patient outcomes and a better quality of life. This narrative review explores the intricate relationship between psychological health and PsA, highlighting the impact of psychological factors on disease outcomes and the potential benefits of integrating psychological interventions into routine clinical practice.

The Impacts of Seasonal Factors on Psoriasis

Psoriasis is a chronic inflammatory skin condition driven by immune system dysfunction, genetic predisposition and environmental factors. Patients with psoriasis experience a well-known clinical phenomenon of 'winter severity and summer relief', in which seasonal environmental factors play critical roles in the onset and progression of psoriasis. These factors include temperature, humidity, infection, light exposure and psychological stress. Seasonal changes in temperature and humidity can compromise skin barrier function and exacerbate inflammatory responses, thereby worsening psoriasis symptoms. Notably, during the winter, decreased light exposure leads to reduced vitamin D (VD) levels, reaching their lowest levels from late winter to early spring. This decline in VD levels is associated with increased disease activity, greater disease severity and more frequent flare-ups in patients with psoriasis. During the winter, influenza and Streptococcus pneumoniae infections are more prevalent, which can further exacerbate psoriasis symptoms. Moreover, the environmental conditions in winter can trigger or intensify feelings of depression, which may adversely affect psoriasis through the brain-skin axis. In this comprehensive review, we thoroughly examined the influence of seasonal environmental factors on the incidence, recurrence and severity of psoriasis. By clarifying these complex relationships, we aimed to support the future development of more personalised and effective treatment and management strategies for patients with psoriasis.

The role of smoking in psoriasis

Psoriasis has a clear and strong connection with smoking in both its pathogenesis and clinical course. Smoking can cause a serious worsening of both the disease itself and the systemic complications such as cardiovascular events, psoriatic arthritis (PsA), cancer and depression. Smoking also seems to alter the gut microbiota and thus promote psoriasis itself. The aim of our article is to review all the most interesting discoveries on its role and thus provide a good picture of the current state of knowledge. Furthermore, we provide some alternative and healthier coping mechanisms for stress and depression related to the disease such as exercise, meditation, balneotherapy and acupuncture.

Unmet Needs in Psychodermatology: A Narrative Review

Psychodermatology, the multidisciplinary field that explores the intricate interplay between the mind and the skin, has gained increasing recognition over the past decade. However, several knowledge gaps and unmet needs persist in the field. The objective of this narrative review was to investigate the unmet needs in the field of psychodermatology as they pertain to medical training, treatment, research, and care access. PubMed was searched from inception through December 2023 to identify articles related to psychodermatology. Findings revealed several unmet needs within the field of psychodermatology. First, there is a need for further investigation into the pathophysiology that links psychological stress to cutaneous disease including the development of novel therapies targeting key neuropeptides. Second, the existing literature focuses primarily on the pharmacologic treatment of body dysmorphic disorder and body-focused repetitive behaviors, as well as delusional parasitosis, for which the first-line agents are selective serotonin reuptake inhibitors and atypical antipsychotics, respectively. However, additional research into the efficacy and safety of the remaining psychotropic medications and the treatment of other common psychocutaneous diseases is required. Finally, there exists a significant gap in knowledge amongst clinicians tasked with treating psychocutaneous diseases. Dermatologists report low rates of training in psychodermatology and discomfort with prescribing psychotropic medications. In conclusion, increasing resources for dermatologist education on psychotropic agent use, development of new drugs targeting stress-induced skin conditions, and research on the psychocutaneous applications of current medications may greatly improve the quality and access of psychodermatology care.