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Dépression et psoriasis : quel est le lien biologique ?

What is the biological link between depression and psoriasis?

Psoriasis is a chronic inflammatory disease that impacts daily quality of life. Psychiatric comorbidity in individuals suffering from this skin disease is estimated to be around 30%. Depression is the commonly encountered condition. What is the biological link between depression and psoriasis? Learn more in this article.

In brief, psoriasis.

The psoriasis is a systemic and chronic inflammatory skin eruption. It presents itself as red and thick plaques that shed. Psoriasis is characterized by an excessive renewal and accumulation of epidermal cells, leading to a local inflammation. This disease tends to affect adults, with a peak onset generally between the ages of 20 and 40.

Histological analyses show an increase in the thickness of the epidermis (acanthosis) and incomplete differentiation of keratinocytes (parakeratosis).Its manifestation is triggered by the combination of several risk factors. These include the immune system, genetic predisposition, and environmental factors. The skin symptoms of psoriasis can affect any area of the body, from the ears to the tongue, including the genital areas. However, the scaly plaques are generally located on the scalp, elbows, and knees. They are sometimes accompanied by a rheumatism.

What is the biological link between depression and psoriasis?

Biological changes are involved in the association between depression and psoriasis. During psoriasis, the following changes are observed:

  • The blood levels of Interleukin 12 (IL-12), IL-1 alpha, IL-2, and IL-6 increase;

  • The level of Substance P is revised upwards;

  • The levels of Tumor Necrosis Factor α (TNF-α) and interferon α are elevated;

  • The level of serotonin, also known as the happiness hormone, decreases.

The cytokines IL-2, IL-6, TNF-α and interferon α are known to play a role in the onset of depression symptoms. Cytokines can influence the hypothalamic-pituitary-adrenal (HPA) axis, which regulates the stress response. Prolonged activation of this axis can lead to excessive production of cortisol, a stress hormone, which can disrupt emotional balance and lead to depression.

What are the consequences of psoriasis on depression?

Psychiatric disorders are likely to develop in cases of psoriasis affliction. They particularly develop in a younger population. Indeed, 25 to 30% of children with psoriasis without a psychiatric history are prone to depression, anxiety, and even bipolar disorder. Thus, the disease affects the patient's personality. It interferes not only in daily life, but also in emotional and professional choices.

Emerging in the field of QoL (Quality of Life), the main psychological impacts of psoriasis are a lack of self-confidence and a feeling of stigmatization. Moreover, psoriasis patients constantly feel repulsive, which exacerbates anxiety and depression. Suicidal thoughts become frequent. Studies reveal that they are estimated to be between 2.5 and 9%, and particularly affect young people, women, and hospitalized patients.

What to do in case of depression linked to psoriasis?

There are measurement scales in place to define the contours of depression related to psoriasis. Among them, we can mention:

  • The Primary Care Screener for Affective Disorders (PCSAD);

  • The General Health Questionnaire-12 (GHQ-12);

  • The Patient Health Questionnaire-9 (PHQ-9);

  • The Beck Depression Inventory (BDI);

  • The Hospital Anxiety and Depression Scale (HADS);

  • The Mini International Neuropsychiatric Interview (MINI).

Once depression is identified, the dermatologist refers the patient to a mental health professional. This could be a psychiatrist or a psychodermatologist. Depending on the severity of the depression, they prescribe either a non-pharmacological care, such as cognitive-behavioral therapy, or a pharmacological treatment. Regarding the latter, we can mention benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), doxepin, and buspirone.

Sources

MISERY L. Dépression et psoriasis. Annales de dermatologie et de vénéréologie (2012).

CHAMOUN A. & al. Psoriasis et dépression. Revue Médicale de Bruxelles (2015).

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