Psychosocial burden and body mass index are associated with dermatology-related quality of life in psoriasis patients

Abstract

Background

Scientific evidence indicates that inflammatory processes may be involved in the progression of both psoriasis and depression via elevated peripheral proinflammatory cytokines.

Objectives

The aim of our study was to assess the association among psychological burden, depressive symptoms and proinflammatory mediators in psoriasis patients.

Materials and Methods

Forty psoriasis patients were recruited from the Department of Dermatology, University Hospital Essen. In addition to the Psoriasis Area and Severity Index (PASI), mental and physical health were explored using different questionnaires. Furthermore, proinflammatory cytokines were analysed.

Results

Patients in the high PASI group showed reduced Dermatology Life Quality Index (DLQI), higher body mass index (BMI), elevated CRP levels as well as impaired physical aspects of quality of life. Regression analyses revealed that somatic and anxiety symptoms accounted for more than 32% of the variance in DLQI, independent of PASI and cytokine levels.

Conclusion

The data indicate somatic and anxiety symptoms, as well as BMI, to be closely linked to dermatology-related quality of life.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Rapp SR, Feldman SR, Exum ML, et al. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 1999; 41: 401–47.

    CAS  PubMed  Google Scholar 

  2. 2.

    Fitz L, Zhang W, Soderstrom C, et al. Association between serum interleukin-17A and clinical response to to facitinib and etanercept in moderate to severe psoriasis. Clin Exp Dermatol 2018; 43: 790–7.

    CAS  PubMed  Google Scholar 

  3. 3.

    Patel N, Nadkarni A, Cardwell LA, et al. Psoriasis, depression, and inflammatory overlap: a review. Am J Clin Dermatol 2017; 18: 613–20.

    PubMed  Google Scholar 

  4. 4.

    Koo J, Marangell LB, Nakamura M, et al. Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression. J Eur Acad Dermatol Venereol 2017; 31: 1999–2009.

    CAS  PubMed  Google Scholar 

  5. 5.

    Tribo MJ, Turroja M, Castano-Vinyals G, et al. Patients with moderate to severe psoriasis associate with higher risk of depression and anxiety symptoms: results of a multivariate study of 300 Spanish individuals with psoriasis. Acta Derm Venereol 2019; 99: 417–22.

    PubMed  Google Scholar 

  6. 6.

    Connor CJ, Liu V, Fiedorowicz JG. Exploring the physiological link between psoriasis and mood disorders. Dermatol Res Pract 2015; 2015: 409637.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Breuer K, Goldner FM, Jager B, et al. Chronic stress experience and burnout syndrome have appreciable influence on health-related quality of life in patients with psoriasis. J Eur Acad Dermatol Venereol 2015; 29: 1898–904.

    CAS  PubMed  Google Scholar 

  8. 8.

    Karelson M, Silm H, Kingo K. Quality of life and emotional state in vitiligo in an Estonian sample: comparison with psoriasis and healthy controls. Acta Derm Venereol 2013; 93: 446–50.

    PubMed  Google Scholar 

  9. 9.

    Kumar V, Mattoo SK, Handa S. Psychiatric morbidity in pemphigus and psoriasis: a comparative study from India. Asian J Psychiatr 2013; 6: 151–6.

    PubMed  Google Scholar 

  10. 10.

    Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998; 139: 846–50.

    CAS  PubMed  Google Scholar 

  11. 11.

    Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med 2009; 361: 496–509.

    CAS  Google Scholar 

  12. 12.

    Christophers E, van de Kerkhof PCM. Severity, heterogeneity and systemic inflammation in psoriasis. J Eur Acad Dermatol Venereol 2019; 33: 643–7.

    CAS  PubMed  Google Scholar 

  13. 13.

    Leonard BE. Inflammation and depression: a causal or coincidental link to the pathophysiology? Acta Neuropsychiatr 2018; 30: 1–16.

    PubMed  Google Scholar 

  14. 14.

    Walker AK, Kavelaars A, Heijnen CJ, Dantzer R. Neuroinflammation and comorbidity of pain and depression. Pharmacol Rev 2014; 66: 80–101.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Dantzer R. Neuroimmune interactions: from the brain to the immune system and vice versa. Physiol Rev 2018; 98: 477–504.

    CAS  PubMed  Google Scholar 

  16. 16.

    Miller AH, Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol 2016; 16: 22–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Nadeem A, Ahmad SF, Al-Harbi NO, et al. IL-17A causes depression-like symptoms via NFkappaB and p38MAPK signaling pathways in mice: implications for psoriasis associated depression. Cytokine 2017; 97: 14–24.

    CAS  PubMed  Google Scholar 

  18. 18.

    Wittenberg GM, Stylianou A, Zhang Y, et al. Effects of immunomodulatory drugs on depressive symptoms: a mega-analysis of randomized, placebo-controlled clinical trials in inflammatory disorders. Mol Psychiatry 2019. doi: https://doi.org/10.1038/s41380-019-0471-8.

  19. 19.

    Shelton RC, Miller AH. Eating ourselves to death (and despair): the contribution of adiposity and inflammation to depression. Prog Neurobiol 2010; 91: 275–99.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Jensen P, Skov L. Psoriasis and obesity. Dermatology 2016; 232: 633–9.

    PubMed  Google Scholar 

  21. 21.

    Papp KA, Reich K, Paul C, et al. A prospective phase III, randomized, double-blind, placebo-controlled study of brodalumab in patients with moderate-to-severe plaque psoriasis. Br J Dermatol 2016; 175: 273–L286.

    CAS  PubMed  Google Scholar 

  22. 22.

    Kappelmann N, Lewis G, Dantzer R, et al. Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Mol Psychiatry 2018; 23: 335–43.

    CAS  PubMed  Google Scholar 

  23. 23.

    Malhotra SK, Mehta V. Role of stressful life events in induction or exacerbation of psoriasis and chronic urticaria. Indian J Dermatol Venereol Leprol 2008; 74: 594–9.

    CAS  PubMed  Google Scholar 

  24. 24.

    Wu JJ, Feldman SR, Koo J, Marangell LB. Epidemiology of mental health comorbidity in psoriasis. J Dermatolog Treat 2018; 29: 487–95.

    CAS  PubMed  Google Scholar 

  25. 25.

    Jin W, Zhang S, Duan Y. Depression symptoms predict worse clinical response to etanercept treatment in psoriasis patients. Dermatology 2019; 235: 55–64.

    PubMed  Google Scholar 

  26. 26.

    Lamb RC, Matcham F, Turner MA, et al. Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting. Br J Dermatol 2017; 176: 1028–34.

    CAS  PubMed  Google Scholar 

  27. 27.

    Dalgard FJ, Gieler U, Tomas-Aragones L, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol 2015; 135: 984–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Helmick CG, Lee-Han H, Hirsch SC, et al. Prevalence of psoriasis among adults in the US: 2003–2006 and 2009–2010 National Health and Nutrition Examination Surveys. Am J Prev Med 2014; 47: 37–45.

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Cohen BE, Martires KJ, Ho RS. Psoriasis and the risk of depression in the US population: National Health and Nutrition Examination Survey 2009–2012. JAMA Dermatol 2016; 152: 73–9.

    PubMed  Google Scholar 

  30. 30.

    Ng CY, Yang YW, Liu SH, et al. SF-36 healty survey on psoriasis quality-of-life: a study of 414 Taiwanese patients. J Dermatol 2015; 42: 159–65.

    PubMed  Google Scholar 

  31. 31.

    Henseler T, Schmitt-Rau K. A comparison between BSA, PASI, PLASI and SAPASI as measures of disease severity and improvement by therapy in patients with psoriasis. Int J Dermatol 2008; 47: 1019–23.

    PubMed  Google Scholar 

  32. 32.

    Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)-a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210–6.

    CAS  PubMed  Google Scholar 

  33. 33.

    Bullinger M, Blome C, Sommer R, et al. Health-related quality of life: a pivotal endpoint in benefit assessment of medical procedures. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58: 283–90.

    CAS  PubMed  Google Scholar 

  34. 34.

    Kroenke K, Spitzer RL, Williams JB, Lowe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345–59.

    PubMed  Google Scholar 

  35. 35.

    Grigoleit JS, Kullmann JS, Wolf OT, et al. Dose-dependent effects of endotoxin on neurobehavioral functions in humans. PLoS One 2011; 6: e28330.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Dowlati Y, Herrmann N, Swardfager W, et al. A meta-analysis of cytokines in major depression. Biol Psychiatry 2010; 67: 446–57.

    CAS  PubMed  Google Scholar 

  37. 37.

    Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med 2009; 71: 171–86.

    CAS  PubMed  Google Scholar 

  38. 38.

    Augustin M, Kruger K, Radtke MA, et al. Disease severity, quality of life and health care in plaque-type psoriasis: a multicenter cross-sectional study in Germany. Dermatology 2008; 216: 366–72.

    CAS  PubMed  Google Scholar 

  39. 39.

    Bangemann K, Schulz W, Wohlleben J, et al. Depression and anxiety disorders among psoriasis patients: protective and exacerbating factors. Hautarzt 2014; 65: 1056–61.

    CAS  PubMed  Google Scholar 

  40. 40.

    Singh S, Facciorusso A, Singh AG, et al. Obesity and response to anti-tumor necrosis factor-alpha agents in patients with select immune-mediated inflammatory diseases: a systematic review and meta-analysis. PLoS One 2018; 13: e0195123.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Puig L. Obesity and psoriasis: body weight and body mass index influence the response to biological treatment. J Eur Acad Dermatol Venereol 2011; 25: 1007–11.

    CAS  PubMed  Google Scholar 

  42. 42.

    Burden AD, Hilton Boon M, Leman J, et al. Diagnosis and management of psoriasis and psoriatic arthritis in adults: summary of SIGN guidance. BMJ 2010; 341: c5623.

    CAS  PubMed  Google Scholar 

  43. 43.

    Radtke MA, Mrowietz U, Feuerhahn J, et al. Early detection of comorbidity in psoriasis: recommendations of the National Conference on Healthcare in Psoriasis. J Dtsch Dermatol Ges 2015; 13: 674–90.

    PubMed  Google Scholar 

  44. 44.

    Coimbra S, Oliveira H, Reis F, et al. Interleukin (IL)-22, IL-17, IL-23, IL-8, vascular endothelial growth factor and tumour necrosis factor-alpha levels in patients with psoriasis before, during and after psoralen-ultraviolet A and narrowband ultraviolet B therapy. Br J Dermatol 2010; 163: 1282–90.

    CAS  PubMed  Google Scholar 

  45. 45.

    El-Moaty Zaher HA, El-Komy MHM, Hegazy RA, et al. Assessment of interleukin-17 and vitamin D serum levels in psoriatic patients. J Am Acad Dermatol 2013; 69: 840–2.

    PubMed  Google Scholar 

  46. 46.

    Zhou XY, Bao J, Huang B, Jin Y. Association between plasma interleukin-17 levels and risk of psoriasis: a meta-analysis. Clin Exp Dermatol 2017; 42: 161–6.

    CAS  PubMed  Google Scholar 

  47. 47.

    Bai F, Zheng W, Dong Y, et al. Serum levels of adipokines and cytokines in psoriasis patients: a systematic review and meta-analysis. Oncotarget 2018; 9: 1266–78.

    PubMed  Google Scholar 

  48. 48.

    Kim JW, Kim YK, Hwang JA, et al. Plasma levels of IL-23 and IL-17 before and after antidepressant treatment in patients with major depressive disorder. Psychiatry Investig 2013; 10: 294–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Terui T, Kobayashi S, Okubo Y, et al. Efficacy and safety of guselkumab, an anti-interleukin 23 monoclonal antibody, for palmoplantar pustulosis: a randomized clinical trial. JAMA Dermatol 2018; 154: 309–16.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wiebke Sondermann.

Additional information

Disclosures

Financial support from pharmaceutical industries or any other source: none.

Conflicts of interest

Wiebke Sondermann received travel expenses for attending meetings and/or (speaker) honoraria from Abbvie, Almirall, Bristol-Myers Squibb, Celgene, Janssen, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi Genzyme and UCB. Andreas Körber received travel expenses for attending meetings and/or speaker honoraria from MSD, Pfizer, Biogen, Abbvie, Novartis, LEO Pharma, Janssen, Celgene, Lilly, Almirall, Beiersdorf and Grünenthal. Oliver Fiege received travel expenses for attending meetings and/or (speaker) honoraria from AstraZeneca, Janssen-Cilag, Lilly, Otsuka, Pfizer and Takeda. Norbert Scherbaum received honoraria for several activities (advisory boards, lectures, manuscripts) from AbbVie, Hexal, Janssen-Cilag, MSD, Medice, Mundipharma, Reckitt-Benckiser/Indivior, and Sanofi-Aventis. During the last three years, he participated in clinical trials financed by the pharmaceutical industry. The other authors report no conflicts of interest.

Supplementary material

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sondermann, W., Schreiber, A., Körber, A. et al. Psychosocial burden and body mass index are associated with dermatology-related quality of life in psoriasis patients. Eur J Dermatol 30, 140–147 (2020). https://doi.org/10.1684/ejd.2020.3755

Download citation

Key words

  • depression
  • PHQ
  • proinflammatory cytokines
  • psoriasis
  • psychological burden
  • SF-36