- L’obiettivo di questo studio trasversale è stato valutare l’effetto dell’intensità del prurito e della psoriasi anogenitale sull’impatto della malattia e delle comorbilità psicologiche, nonché l’identificazione di variabili associate alla presenza di depressione e ansia clinicamente significative.
- Il prurito determina un impatto significativo e comorbilità psicologiche, in particolare nei pazienti con psoriasi senza coinvolgimento anogenitale. Tuttavia, le strategie adattative (coping) utilizzate dai pazienti con psoriasi anogenitale possono essere disfunzionali per l’adattamento psicosociale globale.
- Una cura incentrata sul paziente può essere il miglior approccio per prevenire le comorbilità psicologiche.
Abstract
Objectives
While stress plays a paramount role on the onset/exacerbation of psoriasis, via overactivation of the hypothalamic-pituitary-adrenal axis and increased release of pro-inflammatory cytokines, cutaneous inflammatory response induces, in turn, anxiety/depression symptoms, via body disfigurement and stigmatisation. The intensity of pruritus and anogenital involvement are additional risk factors for psychological comorbidity.Aims were to (1) examine the effects of intensity of pruritus and anogenital psoriasis on disease burden and psychological comorbidity and (2) identify the variables associated with the presence of clinically significant depression, anxiety, and dysmorphic concerns.
Design
Cross-sectional study.
Setting
Conducted at the University Medical Center Hamburg-Eppendorf (UKE).
Participants
107 patients with psoriasis (mean age = 46.3, SD = 14.6 years; 53.3% male): 64 with none/mild pruritus; 43 with moderate/severe pruritus; 31 with anogenital psoriasis; 76 not affected in the anogenital area.
Primary/secondary outcomes measures
Disease severity was assessed with Psoriasis Area and Severity Index and intensity of pruritus was rated by patients. Patient-reported outcomes included the Dermatology Life Quality Index, ItchyQoL, Patient Benefit Index, Perceived Stigmatisation Questionnaire, and Relationship and Sexuality Scale. Psychological morbidity was assessed with the Patient Health Questionnaire, Generalised Anxiety Disorder, and Dysmorphic Concern Questionnaire.
Results
Patients with moderate/severe pruritus reported more quality of life impairments, depression, anxiety and dysmorphic concerns, and less treatment benefits than those with none/mild pruritus. Moderate/severe pruritus had a deleterious effect on depression and stigmatisation for patients without anogenital involvement. Less patient benefits were associated with a higher likelihood of clinically significant depression/anxiety.
Conclusions
Pruritus induces significant burden and psychological morbidity, particularly for patients without anogenital involvement. However, coping strategies used by patients with anogenital psoriasis might be dysfunctional for overall psychosocial adaptation. Patient-centred healthcare might be the best way to prevent psychological comorbidity.
Ethics approval
Ethics Committee of the Medical Association of Hamburg (process number PV6083, 28 May 2019).