By Gwamaka Mwakyusa – Art in Tanzania internship
Skin diseases such as acne, psoriasis, and eczema are associated with a significant impairment in the quality of the patient’s daily life. Several instruments assess quality-of-life (QoL) in adults and children with skin disease and help us understand its impact. Three groups of investigators have recently examined the psychosocial effects of skin disorders.
Smidt and colleagues developed and tested a new instrument specifically designed to assess these issues in adolescents, who are particularly vulnerable to issues of self-esteem. Skindex-Teen addresses such age-specific matters as sports participation, peer relationships, and clothing choices. In the 200 patients studied, acne was the most common skin condition. The reliability of the 21-item scale was greater than 0.4, and test-retest reliability was supported by acceptable intraclass correlation coefficients for the total score, physical symptoms scale score, and psychosocial functioning scale score.
Numerous observations and limited studies have suggested that psoriasis increases stress and depression. Kurd and colleagues mined the British General Practice Research Database to assess the association of psoriasis with depression, anxiety, and suicidality in a large population. Compared with 766,950 patients without psoriasis, 149,998 psoriasis patients had significantly more clinically diagnosed psychiatric diseases. Additionally, among the psoriasis patients, those with most severe cutaneous disease was more likely to have depression, anxiety, and suicidality diagnoses.
Evers and colleagues analyzed the effects of psychological stressors on skin disease in patients with psoriasis. This report follows their earlier finding of clinical exacerbation of psoriasis in the month following stressful life events. The present longitudinal, prospective study assessed how stressors affect serum levels of cortisol, a key component of the hypothalamic-pituitary-adrenal (HPA) axis, in psoriasis patients. They found that peak levels of daily stressors were significantly associated with lower cortisol levels and that patients with persistent high stress had lower mean cortisol levels than patients with lower stress. The stress response involves activation of both the HPA axis and the autonomic nervous system, both of which interact with the immune system. Therefore, stressful events could exacerbate and prolong chronic inflammatory diseases such as psoriasis. Other investigators have reported a blunting of the HPA axis in some subjects with psoriasis, which could account for inadequate secretion of cortisol and a resulting exacerbation of clinical disease.