Evaluating the Effectiveness of Psychological Interventions in Patients with Psoriasis: A Review

Abstract

Psoriasis is a common condition, often associated with substantial psychological morbidity. Stress is frequently implicated in the onset or exacerbation of psoriasis, giving rise to the possible use of psychotherapeutic modalities in treatment. This article reviewed the literature describing cases and trials of psychological interventions (i.e., psychotherapy, biofeedback, hypnosis, meditation, and emotional disclosure) in the treatment of patients with psoriasis. All six case reports/series demonstrated positive outcomes. Among the trials, seven out of 11 found significant physical improvement and four out of seven found significant psychological benefit. Psychological interventions appear to have the potential to serve as helpful adjuncts to conventional dermatological treatments, although further research is needed with emphasis on randomized controlled trials with more standardized, validated outcome measures.

Neuromodulation in Inflammatory Skin Disease

“…Increased neuronal density has been observed in skin affected by chronic inflammatory skin disease [ 17 , 18 ], and denervation of these areas has been shown to result in disease remission in psoriasis [ 19 ]. Additionally, stress is a common trigger for inflammatory skin disease [ 20 ], and behavioral and psychological interventions can reduce disease severity in these patients [ 21 , 22 ]. Thus, the nervous system likely plays an important role in the pathogenesis of inflammatory skin disease.…”

Vagus Nerve Stimulation

“…Various cognitive and psychological interventions have been evaluated, with psychotherapy, biofeedback, hypnosis, mindfulness, meditation, and emotional disclosure all demonstrating improvements in physical and psychological outcomes in PsO. 29 Given our current understanding of the immunomodulatory reflex, our thought is that that these cognitive interventions promote relaxation and thereby increase parasympathetic drive and exert an anti-inflammatory effect to improve disease severity in patients. The proven positive effects of mental relaxation techniques 29 offer a powerful adjunct treatment option that can be used for both maintenance and acute management of PsO and PsA.…”