Psoriasis and psycho-dermatology.

INTRODUCTION: Psoriasis is a common, long-term skin condition associated with high levels of psychological distress and considerable life impact. The impact of psoriasis, beyond the skin, is often not recognised and under-treated. METHODS: This paper explores the relationship between psychological distress and psoriasis including reference to the 'brain-skin access'. The life impact of psoriasis is discussed and pharmacological interventions which affect distress associated with psoriasis and psychological interventions are reviewed. Evidence from peer-reviewed journals and controlled trials inform the text. RESULTS: Psoriasis has a profound impact on mental health and well-being which is under-recognised by clinicians. The sympathetic adrenal medullary axis and hypothalamic pituitary adrenal axis are likely to be involved in the onset of psoriasis and there may also be an effect from inflammation in the skin on the central release of corticotrophin-releasing hormone. Psoriasis can be stigmatising and may affect all aspects of life including relationships, employment, social life and leisure activities. There is some evidence for psychological interventions being effective in the management of distress associated with psoriasis and psoriasis itself. Studies, however, have used disparate outcomes and methods and largely involve low numbers of patients. There is very limited access to psychological support for the patients with psoriasis despite evidence of high levels of psychological distress and considerable life impact. CONCLUSIONS: Psoriasis is a long-term skin condition associated with high levels of distress and considerable life impact, both of which are under-recognised. Routine screening for distress with access to effective treatment is required. There is a need for high-quality studies to assess the effect of psychological intervention in patients with psoriasis both to inform guidance and facilitate the provision of effective psychological support services.