Psoriasis is perhaps the most studied of all dermatologic disorders, affecting over 7 million individuals in the United States alone. It is largely understood to be an inflammatory disorder with both genetic and environmental factors contributing to its development, occurring in all age groups (but primarily adults), and appearing equally in males and females. Plaque psoriasis, characterized by patches of raised, reddish skin covered with silvery-white scale, is the most common form of psoriasis: It affects about 80 to 90 percent of psoriasis patients. Psoriasis usually occurs on the scalp, knees, elbows, hands, and feet.
The Psoriasis-Depression Link Is Probably Related to Inflammation
It has also been known for some time that patients with psoriasis often exhibit a greater risk for medical co-morbidities, including high blood pressure, diabetes, obesity, high cholesterol, erectile dysfunction, heart disease … and the list goes on and on. The most recent to be highlighted is one of the most obvious: depression. The emotional burden of skin disease is extraordinary because your clinical symptoms are visible to the world, and it’s well-documented that a chronic skin disease has a tremendously negative impact on quality of life. The question I get is: Do the findings shared in the recent JAMA Dermatology study by Dr. Roger Ho demonstrate that psoriasis and clinical depression are simply a toll of this emotional impact? My answer is, “yes and no.” There is more to this story, and just like the many corresponding medical problems associated with psoriasis, depression is also likely a result of the cause of psoriasis: inflammation. The same inflammatory signals and molecules that create the skin lesions, joint pain, and increased risk for possibly every medical problem we know of can also cross the blood-brain barrier and impact a person’s mental and emotional state. The very same immune signals that are the foundation of psoriatic disease may in fact activate the brain circuitry that mediates various negative behavioral responses, such as depression.
Depressed? There Are Reasons to Be Hopeful
Why is this important? So happy you asked! We have a fleet of medications, with more on the way, that selectively target these very signals in order to prevent, treat, and manage psoriasis. It’s likely that, as these medications improve psoriasis, they will also improve the laundry list of co-morbidities associated with it. As always, more research is needed to fully grasp the psoriasis-depression connection. But don’t worry: There’s a lot of excitement in this area, and it will be pursued. Stay tuned!
