NEW YORK – There is mounting evidence that stress and the way in which patients with psoriasis view themselves or perceive themselves to be seen affects the way that they respond to treatment, Dr. Christopher Griffiths said at a dermatology symposium sponsored by Cornell University.
“While the exact etiology of psoriasis remains unknown, there is a strong environmental component to the disease, including stress, especially in the genetically predisposed with the HLA-Cw6 gene,” said Dr. Griffiths of the dermatology center at Hope Hospital, University of Manchester (England), the largest center for psoriasis research and treatment in the world.
Psoriasis occurs in about 2% of the population. Whether stress causes psoriasis or psoriasis is the origin of stress is still a point of contention. Studies have shown that psoriasis ranks just ahead of chronic lung disease and depression when it comes to the impact reported on the daily lives of patients, with 46% reporting an impact on their daily lives, versus 44% and 35% with chronic lung disease and depression, respectively. Approximately 60% of patients with psoriasis report that stressful life events may either trigger or exacerbate their condition, Dr. Griffiths said.
With 53% of patients strongly affected by how they view themselves and 28% by how they see themselves viewed by others, “psoriasis strongly affects how patients see themselves and how they think others see them,” he said.
“Patients with psoriasis are constantly looking for environmental cues which might be signs of how others are viewing them,” Dr. Griffiths noted.
A study using the Penn State Worry Questionnaire to measure whether worry affected 88 patients' (57 males, 31 females) response to PUVA therapy showed a correlation between worry and treatment efficacy. Patients who were high or pathologic worriers were less likely to show a response to PUVA therapy than were patients in the normal or low worry categories. “Those patients who did respond took twice as long to respond to PUVA treatment if they were higher on the worry scale,” Dr. Griffiths said.
The average age of patients in the study was 43 years.
Dr. Griffiths also reported that managing psoriasis symptoms with adjuncts such as behavioral therapy measurably enhances response to standard therapy.
Psoriasis patients always look for environmental cues that might be signs of how others are viewing them. DR. GRIFFITHS