San Francisco Medical Center, University of California, San Francisco, CA, USA.
Brain Health Consultants, Houston, TX, USA.
J Eur Acad Dermatol Venereol. 2017 Dec;31(12):1999-2009. doi: 10.1111/jdv.14460. Epub 2017 Aug 9.
Psoriasis can be a socially isolating disease due to debilitating physical symptoms and the stigma patients feel because of the appearance of their skin. Mental health comorbidities such as anxiety, depression and suicidal ideation and behaviour (SIB) are prevalent in patients with psoriasis. Patients with mild psoriasis can experience psychiatric comorbidities; however, disorders such as depression and SIB are more common in patients with severe psoriasis or psoriatic arthritis. Psychiatric disorders can both result from and contribute to progression of psoriasis, suggesting that psoriasis and psychiatric conditions, such as depression, may have overlapping biological mechanisms. Proinflammatory cytokines such as interleukin (IL)-1 and IL-6 are elevated in both psoriasis and depression, indicating that the inflammatory process may be involved in the progression of both diseases. Elevated cytokine levels in the central nervous system cause physiologic and biochemical changes that may contribute to the development of depression. In this review of the literature, we discuss the evidence that supports the association of psoriasis with mental health disorders and the tools used to detect the presence of these comorbidities. Additionally, we review the most prominent hypotheses on the mechanisms by which the inflammatory response and elevated cytokines can cause depression. These results highlight the role that systemic inflammation plays in the various mental health comorbidities associated with psoriasis, including depression and SIB.
银屑病可导致患者出现身体衰弱的症状,且因皮肤外观而感到耻辱,进而使其产生社交孤立感。患有银屑病的患者常并发焦虑、抑郁和自杀意念及行为等精神健康共病。轻度银屑病患者可能会出现精神共病;然而,在重度银屑病或银屑病关节炎患者中,抑郁和 SIB 等疾病更为常见。精神障碍既可能是由银屑病导致的,也可能会导致银屑病的恶化,这表明银屑病和抑郁等精神疾病可能存在重叠的生物学机制。促炎细胞因子(如白细胞介素(IL)-1 和 IL-6)在银屑病和抑郁症中均升高,表明炎症过程可能与这两种疾病的进展均有关。细胞因子在中枢神经系统中的升高会引起生理和生化变化,从而可能导致抑郁的发生。在对文献的综述中,我们讨论了支持银屑病与精神健康障碍相关的证据,以及用于检测这些共病存在的工具。此外,我们还综述了炎症反应和细胞因子升高导致抑郁的主要假说。这些结果突出了全身炎症在与银屑病相关的各种精神健康共病(包括抑郁和 SIB)中的作用。
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