Some psychosomatic aspects of psoriasis.

The contribution of psychosomatic factors toward the morbidity associated with psoriasis should be evaluated in the context of the patient's developmental stage and life situation. The skin, as a sensory organ, plays a critical role in an individual's physical and emotional growth in early life. The skin also plays an integral role as an organ of communication throughout life and greatly affects an individual's body image and self-esteem. If these factors are not taken into consideration, the morbidity associated with psoriasis may increase, or the patient may remain dissatisfied with treatment even in the face of clinically satisfactory treatment outcome. Some recent studies indicate that the adverse impace of psoriasis upon the quality of life can result in significant chronic stress, which may in turn exacerbate the psoriasis in a subgroup of patients. As disease-related stress is present in every patient to some degree, the dermatologist should regularly assess the psychosocial impact of the disease. Certain personality factors, such as a tendency to want the approval of others and difficulty with assertion of angry feelings, may make the patient with psoriasis more vulnerable to stress and contribute toward the stress reactivity of the disease. The presence of depression in psoriasis may modulate itch perception, exacerbate pruritus, and lead to difficulties with initiating and maintaining sleep. Helping the patient to develop assertiveness skills in addition to supportive psychotherapy may facilitate the patient's capacity to cope with the daily stresses associated with psoriasis. Treatment of depressive symptoms may prove to be a helpful adjunct in the management of pruritus and sleep difficulties in psoriasis.