Clinical Severity May Not Correlate With Psychological Burden of Psoriasis, Study Finds

Psoriasis is more than a skin-deep condition, and its impact extends beyond visible plaques, causing psychological distress, social stigma, and diminished quality of life, according to a recent study.1

The impact of psoriasis on quality of life goes beyond clinical measures, such as psoriasis area severity index (PASI) and body surface area (BSA), a study finds. | Andrey Popov - stock.adobe.com

The comprehensive review, published in Psoriasis: Targets and Therapy, evaluated the multifaceted burden of psoriasis, critically evaluating current and emerging therapies while advocating for a more holistic, patient-centered approach to care.

“Despite the profound impact, the psychosocial effects of psoriasis are frequently underestimated by health care providers,” wrote the researchers. “Acknowledging and addressing the factors that contribute to depression and suicidal ideation in patients with psoriasis is crucial for enhancing the quality of care and developing treatment plans that encompass psychosocial interventions.”

Psoriasis significantly impacts patients’ psychological and social well-being, often more than its physical symptoms, according to the researchers. Visible lesions can lead to stigma, low self-esteem, and social withdrawal, contributing to high rates of depression, anxiety, and even suicidal thoughts.

A study published in Psychiatry Research found that about 1 in 5 people with psoriasis also have depression or anxiety, highlighting a significant mental health burden among the 125 million people affected by the skin condition worldwide.2 By analyzing 56 studies from 1986 to 2022, researchers found global prevalence rates of 20% for depression, 21% for anxiety, and 0.77% for suicide among patients with psoriasis.

“Owing to changes in the appearance of the skin, patients with psoriasis are more likely to experience a high psychosocial burden, including comorbid depression, anxiety, and suicidal ideation,” wrote the researchers. “Moreover, the medical community and public have acknowledged that mental health greatly impacts the quality of life in patients with psoriasis.”

These mental health challenges can occur regardless of disease severity and often lead to poor treatment adherence and worsened symptoms.1 Additionally, feelings of shame, guilt, and social withdrawal are common and may lead to substance use or treatment nonadherence, creating a cycle that worsens both psychological and physical symptoms. Health-related quality of life is frequently impaired, with impacts on daily activities, work productivity, and intimate relationships, according to the researchers. Tools such as the Dermatology Life Quality Index and Work Productivity and Activity Impairment questionnaire highlight this disruption.

A study published in the Journal of Clinical Medicine found that higher illness acceptance among individuals with psoriasis was linked to lower disease severity, reduced itch intensity, and better quality of life.3 Conducted among 166 patients in Poland, the study used psychological and clinical assessments to explore the relationship between disease acceptance and patient outcomes. Nearly 60% of participants reported that psoriasis significantly disrupted daily life.

Therefore, effective psoriasis management requires a comprehensive, patient-centered approach that addresses the disease’s complex pathophysiology and its significant psychological and social impact.1 Advances in understanding the gut-skin axis and microbiome further broaden therapeutic possibilities, though challenges remain in treatment variability and access.

“The psychological burden of psoriasis, evidenced by high rates of depression, anxiety, and social isolation, emphasizes the critical need for integrated care approaches,” wrote the researchers. “Quality of life assessment tools play a vital role in evaluating treatment outcomes and guiding therapeutic decisions, moving beyond mere skin clearance to address the overall well-being of patients.”

References

1. Ponikowska M, Vellone E, Czapla M, et al. Challenges psoriasis and its impact on quality of life: Challenges in treatment and management. Psoriasis: Targets and Therapy. 2025;Volume 15:175-183. doi:10.2147/ptt.s519420

2. Kaltwasser J. Prevalence of mental health comorbidities in psoriasis probed in new study. AJMC®. February 1, 2023. Accessed May 7, 2025. https://www.ajmc.com/view/prevalence-of-mental-health-comorbidities-in-psoriasis-probed-in-new-study

3. Steinzor P. How psoriasis acceptance impacts severity, itch, and quality of life. AJMC. January 10, 2025. Accessed May 7, 2025. https://www.ajmc.com/view/how-psoriasis-acceptance-impacts-severity-itch-and-quality-of-life