Wintermann Gloria-Beatrice, Bierling Antonie Louise, Peters Eva M J, Abraham Susanne, Beissert Stefan, Weidner Kerstin
Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Dresden, Germany.
Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Giessen, Gießen, Germany.
Front Psychiatry. 2022 Apr 25;13:848708. doi: 10.3389/fpsyt.2022.848708. eCollection 2022.
Traumatic childhood experiences and psychosocial stress may predispose the evolvement of somatic diseases. Psoriasis is a multifactorial chronic inflammatory skin disease that often associates with current and past stress. Both may entail pathological alterations in major stress axes and a balance shift in the level of T helper type 1 (Th1) and 2 (Th2) cytokines, affecting the development and course of psoriasis. Until now, it is unclear whether traumatic stress experiences during the childhood or current stress are more frequent in psoriatic compared to skin-healthy individuals, and if they interact with treatment outcome.
In a prospective cohort study, the impact of acute and early childhood stress on the course of dermatological treatment were studied in patients with moderate to severe psoriasis (PSO). Patients were examined before (T1) and about 3 months after (T2) the beginning of a new treatment episode. Assessments included clinical outcomes (Psoriasis Area and Severity Index-PASI, Structured Clinical Interview SCID-I) and patient-reported outcomes (PRO) (Childhood Trauma Questionnaire-CTQ, Perceived Stress Scale-PSS, itching/scratching, Dermatology Life Quality Index-DLQI, Hospital Anxiety and Depression Scale, Body Surface Area, Self-Administered PASI).
= 83 PSO patients (median age 53.7, IQR 37.8, 62.5) and = 66 skin-healthy control subjects (HC) (median age 51.5, IQR 33.3, 59.2) participated. PSO had higher CTQ than HC, as well as higher PRO levels. The positive impact of improved skin on the skin-related quality of life was moderated by the perceived stress. Acute stress at T1 had a positive effect both on the skin severity and the skin-related quality of life. CTQ total closely interacted with baseline psoriasis severity, and was associated with higher improvement from T1 to T2.
One might tentatively conclude, that chronic psychosocial stressors like childhood maltreatment may predispose the manifestation of psoriasis. The latter may be amplified by acute psychological stressors. In addition, the present evidence suggests that systemic therapies work well in PSO, with childhood trauma and acute psychosocial stress. Both should therefore be routinely assessed and addressed in PSO.
童年创伤经历和心理社会压力可能使躯体疾病易于发展。银屑病是一种多因素慢性炎症性皮肤病，常与当前及过去的压力相关。两者都可能导致主要应激轴的病理改变以及1型辅助性T细胞（Th1）和2型辅助性T细胞（Th2）细胞因子水平的平衡改变，从而影响银屑病的发生发展及病程。目前尚不清楚，与皮肤健康个体相比，银屑病患者童年期的创伤性应激经历或当前压力是否更常见，以及它们是否与治疗结果相互作用。
在一项前瞻性队列研究中，研究了急性和童年早期压力对中度至重度银屑病（PSO）患者皮肤病治疗过程的影响。在新的治疗阶段开始前（T1）和开始后约3个月（T2）对患者进行检查。评估包括临床结局（银屑病面积和严重程度指数 - PASI、结构化临床访谈SCID - I）和患者报告结局（PRO）（儿童创伤问卷 - CTQ、感知压力量表 - PSS、瘙痒/搔抓、皮肤病生活质量指数 - DLQI、医院焦虑抑郁量表、体表面积、自我管理的PASI）。
83例PSO患者（中位年龄53.7，四分位间距37.8，62.5）和66例皮肤健康对照受试者（HC）（中位年龄51.5，四分位间距33.3，59.2）参与研究。PSO患者的CTQ得分高于HC，PRO水平也更高。感知压力调节了皮肤改善对皮肤相关生活质量的积极影响。T1时的急性压力对皮肤严重程度和皮肤相关生活质量均有积极影响。CTQ总分与基线银屑病严重程度密切相关，并与T1至T2的更大改善相关。
可以初步得出结论，童年期虐待等慢性心理社会压力源可能使银屑病易于表现出来。急性心理压力源可能会加剧这种情况。此外，目前的证据表明，对于伴有童年创伤和急性心理社会压力的PSO患者，系统治疗效果良好。因此，在PSO患者中，两者均应常规评估和处理。
