Stress as an Influencing Factor in Psoriasis

Misha M. Heller, BA; Eric S. Lee, BS; John Y.M. Koo, MD


Skin Therapy Letter. 2011;16(5) 

In This Article

Stress Evaluation and Management

The best approach to evaluating if an individual is a stress responder is to simply ask the patient, "Do you believe stress frequently worsens the severity of your psoriasis?" If the patient answers "yes" to this question, a clinician may want to consider further evaluating the impact of stress on the patient's life. Useful questions may include: Have you experienced any recent stressful life events? Do you feel depressed or anxious? Do you have friends or family members that provide you with adequate social support? Do you feel you can manage the level of stress in your life? Ultimately, these questions should help guide a treating physician in determining if their patient is a stress responder. However, a clinician should be cognizant that the terms "stress responder" versus "non-stress responder" only refer to whether or not the patient's psoriasis worsens with emotional stress. These terms do not indicate whether or not the patient has an underlying diagnosable psychiatric disorder, which is a separate issue requiring an alternate clinical approach.

As such, it is important to determine if the patient meets the diagnostic criteria for major depression, generalized anxiety, or other psychiatric disorders, as described by the Diagnostic and Statistical Manual of Mental Disorders (4th edition) published by the American Psychiatric Association.[20] Obviously, all patients with diagnosable psychiatric disorders should be advised to seek appropriate mental health care. As for patients who are stress responders, but are otherwise psychologically well-functioning individuals, they should be made aware of the potential benefits of stress reduction in improving their skin condition. Some relatively easy and feasible stress reduction techniques are yoga, deep breathing exercises, and meditation, just to name a few. More intensive approaches to stress reduction, like psychotherapy or pharmacotherapy, may also be reasonable recommendations. Whether a patient is simply experiencing situational stress or suffering from a diagnosable psychiatric disorder, it may be advisable for that individual to consult a mental health professional as long as emotional factors (such as stress) play an important role in the natural history of their psoriasis.


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