The Mind Skin Connection: Psoriasis and Psychological Comorbidities
REFERENCES
1. Wu JJ, Feldman SR, Koo J, Marangell LB. Epidemiology of mental health comorbidity in psoriasis. J Dermatol Treat. 2018; 29: 487-495.
2. Ferreira BR, Pio-Abreu JL, Reis JP, Figueiredo A. Analysis of the prevalence of mental disorders in psoriasis: The relevance of psychiatric assessment in dermatology. Psychiatr Danub. 2017; 29: 401-406.
3. 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: 73-79.
4. Wu JJ, Penfold RB, Primatesta P, et al. The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis. J Eur Acad Dermatol Venereol. 2017; 31: 1168-1175.
5. Dowlatshahi EA, Wakkee M, Arends LR, Nijsten T. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J Invest Dermatol. 2014; 134: 1542-1551.
6. Korman AM, Hill D, Alikhan A, Feldman SR. Impact and management of depression in psoriasis patients. Expert Opin Pharmacother. 2016; 17: 147-152.
7. Fleming P, Bai JW, Pratt M, et al. The prevalence of anxiety in patients with psoriasis: a systematic review of observational studies and clinical trials. J Eur Acad Dermatol Venereol. 2017; 31: 798-807.
8. Dalgard FJ, Svensson Å, Gieler U, et al. Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations. Br J Dermatol. 2018; 179: 464-470.
9. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002; 52: 69-77.
10. Cather JC, Ryan C, Meeuwis K, et al. Patients’ perspectives on the impact of genital psoriasis: a qualitative study. Dermatol Ther (Heidelb). 2017; 7: 447-461.
11. Guenther L, Han C, Szapary P, et al. Impact of ustekinumab on health-related quality of life and sexual difficulties associated with psoriasis: results from two phase III clinical trials. J Eur Acad Dermatol Venereol. 2011; 25: 851-857.
12. Sampogna F, Puig L, Spuls P, et al. Prevalence of alexithymia in patients with psoriasis and its association with disease burden: a multicentre observational study. Br J Dermatol. 2017; 176: 1195-1203.
13. Sampogna F, Puig L, Spuls P, et al. Reversibility of alexithymia with effective treatment of moderate to severe psoriasis: longitudinal data from EPIDEPSO. Br J Dermatol. 2018; Sep 30. doi: 10.1111/bjd.17259. [Epub ahead of print]
14. Pompili M, Innamorati M, Trovarelli S, et al. Suicide risk and psychiatric comorbidity in patients with psoriasis. J Int Med Res. 2016; 44 (1 suppl): 61-66.
15. Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: A systematic review and meta-analysis. J Am Acad Dermatol. 2017; 77: 425-440.
16. Parisi R, Webb RT, Carr MJ, et al. Alcohol-related mortality in patients with psoriasis: a population-based cohort study. JAMA Dermatol. 2017; 153: 1256-1262.
17. Armstrong AW, Harskamp CT, Dhillon JS, Armstrong EJ. Psoriasis and smoking: a systematic review and meta-analysis.Br J Dermatol. 2014; 170: 304-314.
18. 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.
19. Farzanfar D, Dowlati Y, French LE, Lowes MA, Alavi A. Inflammation: a contributor to depressive comorbidity in inflammatory skin disease. Skin Pharmacol Physiol. 2018; 31: 246-251.
20. Siliq [package insert]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC.
21. Roman M, Chiu MW. Spotlight on brodalumab in the treatment of moderate-to-severe plaque psoriasis: design, development, and potential place in therapy. Drug Des Devel Ther. 2017; 11: 2065-2075.
22. Liu Y, Ho RC, Mak A. The role of interleukin (IL)-17 in anxiety and depression of patients with rheumatoid arthritis. Int J Rheum Dis. 2012; 15: 183-187.
23. 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: 294-299.
24. Hashim PW, Chen T, Lebwohl MG, Marangell LB, Kircik LH. What lies beneath the face value of a box warning: A deeper look at brodalumab. J Drugs Dermatol. 2018; 17: s29-s34.
25. 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: 273-286.
26. Papp K, Reich K, Paul C, et al. Improvements in depression and anxiety with brodalumab therapy in AMAGINE-1, a phase 3 study for moderate to severe plaque psoriasis. J Am Acad Dermatol. 2016; 74 (suppl 1): AB254.
27. Lebwohl MG, Papp KA, Marangell LB, et al. Psychiatric adverse events during treatment with brodalumab: Analysis of psoriasis clinical trials. J Am Acad Dermatol. 2018; 78: 81-89.
28. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16: 606-613.
29. Singh SM, Narang T, Dogra S, et al. Screening for depressive disorders in outpatients with mild to moderate psoriasis: a study from North India. Indian J Dermatol Venereol Leprol. 2015; 81: 148-150.
30. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003; 41: 1284-1292.
31. Bujara S. Mental health screening in dermatology: Uncovering comorbid psychopathology. Dermatology Advisor. November 2, 2017. Available at: https://www.dermatologyadvisor.com/general-dermatology/psychiatric-comorbidities-dermatology-patients/article/704709/
32. Strohal R, Kirby B, Puig L. Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common comorbidities in patients with moderate-to-severe psoriasis. J Eur Acad Derm Venereol. 2014; 28: 1661-1669.
33. Strober B, Gooderham M, Elke MGJ, et al. Depressive symptoms, depression, and the effect of biologic therapy among patients in Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Am Acad Dermatol. 2018; 78:70-80.
34. Armstrong AW, Siegel MP, Bagel J, et al. From the medical board of the National Psoriasis Foundation: treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017; 76: 290-298.
Overview
ACTIVITY DESCRIPTION Recent research suggests that the psychological effects of psoriasis are more complex than a simple response to living with a skin disease associated with stigma. Psychiatric conditions such as depression, anxiety, and suicidal ideation are now understood as comorbidities of psoriasis. This roundtable discussion brings together expert clinicians to discuss the psychological comorbidities of psoriasis. They also discuss how clinicians treating patients with psoriasis can screen for these comorbidities. The goal is to provide the best possible outcome for the whole patient. TARGET AUDIENCE This certified CME activity is designed for dermatologists, physician assistants, and nurse practitioners that treat patients with psoriasis.Supported from an educational grant from Ortho Dermatologics, Inc. Learning Objectives
Upon completion of this activity, the participant should be able to: - Describe the psychological comorbidities associated with psoriasis.
- Review the proposed role of systemic inflammation in the pathophysiology of the psychological comorbidities associated with psoriasis, and the implications these findings have for the treatment of psoriasis.
- Review and identify strategies to assess patients with psoriasis for psychological comorbidities.
Accreditation
Accreditation Statement Evolve Medical Education LLC (Evolve) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Credit Designation Statement Evolve designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Faculty and Disclosures
DISCLOSURE POLICY
The following faculty/staff members have the following financial relationships with commercial interests: Jerry Bagel, MD, has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Grant/Research Support: AbbVie; Boehringer-Ingelheim, Celgene, Eli-Lilly, Janssen, and Novartis. Speaker’s Bureau: AbbVie; Celgene, Eli-Lilly, Janssen, and Novartis. Richard G. Fried, MD, PhD, has no financial relationships with commercial interests. Leon Kircik, MD, has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Advisory Board: Aclaris, Allergan, Inc., Almirall, Anacor Pharmaceuticals, Biogen-Idec, Colbar, Celgene, Cipher, Connetics Corporation, EOS, Exeltis, Ferndale Laboratories, Inc., Galderma Laboratories, LP, Genentech, Inc., Intendis, Innocutis, Isdin, Johnson & Johnson, Nano Bio, OrthoNeutrogena, Promius, Quinnova, SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, Valeant Pharmaceuticals Intl/Ortho Dermatologics, and Warner-Chilcott. Consultant: Allergan, Inc., Almirall, Amgen, Inc., Anacor Pharmaceuticals, Colbar, Cipher, CollaGenex, Connetics Corporation, Exeltis, Galderma Laboratories, LP, Genentech, Inc., Intendis, Isdin, Johnson & Johnson, Laboratory Skin Care Inc., Leo, Medical International Technologies, Merck, Merz, Novartis AG, OrthoNeutrogena, Promius, PuraCap, SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, Taro, UCB, Valeant Pharmaceuticals Intl/Ortho Dermatologics, and ZAGE. Grant/Research Support: Acambis, Allergan, Inc., Amgen, Inc., Anacor Pharmaceuticals, Astellas Pharma US, Inc., Asubio, Berlex Laboratories, Biolife, Biopelle, Boehringer-Ingelheim, Breckinridge Pharma, Celgene, Centocor, Inc., Cellceutix, Coherus, CollaGenex, Combinatrix, Connetics Corporation, Coria, Dermavant, Dermira, Dow Pharmaceutical Sciences, Inc., Dusa, Eli Lilly, Exeltis, Ferndale Laboratories, Inc., Galderma Laboratories, LP, Genentech, Inc., GlaxoSmithKline, PLC, Health Point, LTD, Idera, Intendis, Johnson & Johnson, Leo, L’Oréal, 3M, Maruho, Merck, Medicis Pharmaceutical Corp., Nano Bio, Novartis AG, Noven Pharmaceuticals, Nucryst Pharmaceuticals Corp, Obagi, Onset, OrthoNeutrogena, Promius, QLT, Inc., PharmaDerm, Pfizer, Quinnova, Quatrix, SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, TolerRx, UCB, Valeant Pharmaceuticals Intl/Ortho Dermatologics, Warner-Chilcott, and XenoPort. Speaker’s Bureau: Abbott Laboratories, Allergan, Inc., Amgen, Inc., Assos Pharma, Astellas Pharma US, Inc., Cipher, CollaGenex, Connetics Corporation, Dermik Laboratories, Embil Pharmaceuticals, Exeltis, Galderma Laboratories, LP, Genentech, Inc., Innocutis, Innovail, Johnson & Johnson, Leo, L’Oréal, 3M, Onset, OrthoNeutrogena, PediaPharma, PharmaDerm, Serono, SkinMedica, Inc., Stiefel Laboratories, Inc., Sun Pharma, Taro, Triax, UCB, Valeant Pharmaceuticals Intl/Ortho Dermatologics, and Warner-Chilcott. Stock/Shareholder: Johnson & Johnson. Jashin J. Wu, M.D., has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant: AbbVie, Almirall, Amgen, Bristol-Myers Squibb, Celgene, Dermira, Dr. Reddy's Laboratories, Eli Lilly, Janssen, LEO Pharma, Novartis, Ortho Dermatologics, Promius Pharma, Regeneron, Sun Pharmaceutical, and UCB. Grant/ResearchSupport: AbbVie, Amgen, Eli Lilly, Janssen, and Novartis. Speaker’s Bureau: Celgene, Novartis, Sun Pharmaceutical, UCB, and Valeant Pharmaceuticals Intl/Ortho Dermatologics. Editorial Support Disclosures Erin K. Fletcher, MIT, director of compliance and education, Susan Gallagher-Pecha, director of client services and project management Evolve; and Kristen Richardson, writer have no financial relationships with commercial interests., Neil Shah, MD, peer reviewer, has no financial relationships with commercial interests.
It is the policy of Evolve that faculty and other individuals who are in the position to control the content of this activity disclose any real or apparent conflicts of interest relating to the topics of this educational activity. Evolve has full policies in place that will identify and mitigate all conflicts of interest prior to this educational activity.Disclaimer
Off-Label Statement This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Disclaimer The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Evolve, Practical Dermatology, or Ortho Dermatologics. System Requirements
- Supported Browsers (2 most recent versions):
- Google Chrome for Windows, Mac OS, iOS, and Android
- Apple Safari for Mac OS and iOS
- Mozilla Firefox for Windows, Mac OS, iOS, and Android
- Microsoft Edge for Windows
- Recommended Internet Speed: 5Mbps+
Publication Dates
Expiration Date:
Ready to Claim Your Credits?
You have attempts to pass this post-test. Take your time and review carefully before submitting.
Good luck!

