A systematic review on shared biological mechanisms of depression and anxiety in comorbidity with psoriasis, atopic dermatitis, and hidradenitis suppurativa

Abstract

Background Mental disorders in comorbidity with chronic skin diseases may worsen disease outcome and patients’ quality of life. We hypothesized the comorbidity of depression, anxiety syndromes, or symptoms as attributable to biological mechanisms that the combined diseases share. Methods We conducted a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement searching into PubMed, PsycInfo, and Scopus databases. We examined the literature regarding the comorbidity of psoriasis (Ps), atopic dermatitis (AD), or hidradenitis suppurativa with depression and/or anxiety in adults ≥18 years and the hypothetical shared underlying biological mechanisms. Results Sixteen studies were analyzed, mostly regarding Ps and AD. Brain-derived neurotrophic factor/tropomyosin receptor kinase B signaling and nuclear factor kappa-light-chain-enhancer of activated B cells/p38 mitogen-activated protein kinase pathways arose as shared mechanisms in Ps animal models with depression- and/or anxiety-like behaviors. Activated microglia and neuroinflammatory responses emerged in AD depressive models. As to genetic studies, atopic-dermatitis patients with comorbid anxiety traits carried the short variant of serotonin transporter and a polymorphism of the human translocator protein gene. A GA genotype of catechol-O-methyltransferase gene was instead associated with Ps. Reduced natural killer cell activity, IL-4, serotonin serum levels, and increased plasma cortisol and IgE levels were hypothesized in comorbid depressive AD patients. In Ps patients with comorbid depression, high serum concentrations of IL-6 and IL-18, as well as IL-17A, were presumed to act as shared inflammatory mechanisms. Conclusions Further studies should investigate mental disorders and chronic skin diseases concurrently across patients’ life course and identify their temporal relation and biological correlates. Future research should also identify biological characteristics of individuals at high risk of the comorbid disorders and associated complications.

Depression and anxiety in hidradenitis suppurativa patients: a cross-sectional study among Polish patients

“…Psychiatric comorbidities seem to be common among patients suffering from chronic inflammatory diseases, including psoriasis, atopic dermatitis and HS [11,12]. Our study, based on the Polish cohort of HS patients clearly confirmed these findings.…”

A Multivariate Analysis of Depression Prevalence in Psoriasis Patients: A Cohort Study

“…Our overall clinical judgment was that the severity of psoriasis occurred in parallel with depressive symptoms, thus indicating a possible correlation between psoriasis and depression [ 48 ]. In fact, psoriasis and depression are reported to share biological mechanisms such as the high levels of proinflammatory cytokines interleukin (IL)-1 and IL-6, thus showing that an inflammatory process might be involved in both diseases progressing [ 49 , 50 ].…”

NLRP3 neuroinflammatory factors may be involved in atopic dermatitis mental disorders: an animal study

“…In recent years, there has been increasing evidence showing the bidirectional relations between psychological factors and AD ( Fabrazzo et al, 2021 ; Huet et al, 2022 ). However, there are very few animal experimental studies on this subject, leaving two key points unclear, namely, the characteristics of negative mental states and their underlying mechanism in AD mice.…”