Occurrence of depression in patients with psoriasis – the role of inflammation, stress and mechanism of the vicious circle
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Department of Epidemiology and Clinical Research Methodology, Medical University, Lublin, Poland
Aleksandra Amalia Kuchnicka   

Department of Epidemiology and Clinical Research Methodology, Medical University, Lublin, Poland
J Pre Clin Clin Res. 2020;14(2):58–61
Psoriasis is a chronic skin disease which can have a detrimental impact on the patient’s life. The correlation between depression, psoriasis and inflammation is a subject of many publications. The depressive and psoriatic symptoms, unhealthy coping strategies and stigmatization might be presented in the mechanism of the vicious circle. The appropriate understanding of this phenomenon might be extremely useful for specialists to improve their bedside manner.

The aim of this review is to analyze the current data about the worldwide presence of the major depressive disorder – psoriasis, and the occurrence of depression in patients suffering from psoriasis. Research and analysis were based on searching sources such as PubMed, UpToDate and World Health Organization pages for the integrative publications collected mainly from last 10 years. The data about the origin of the psoriasis disease was taken from as 1979 publication.

State of knowledge:
The study demonstrated that the link between psoriasis and depression is bi-directional. The pro-inflammatory cytokine, such as IL-6, TNF-α, CRP and IL-17, are elevated in both cases, which provokes the exacerbation of sickness symptoms. The inflammation dangerously disturbs the functioning of neuronal system and human homeostasis.

According to the cited research, the prevalence of depressive disorders in psoriatic patients is higher in comparison to people without psoriasis. Inflammation plays an essential role by being a peculiar connector between psoriasis and depression. Stress and inflammation are crucial factors in pathogenesis of those two disorders and triggers the pathological mechanisms.

3-HK – 3-hydroxykynurenine, BBB – Blood-Brain Barrier; CPRD – Clinical Practice Research Datalink; CRH – Corticotrophin-releasing Hormone; CRP – C-Reactive Protein; CSF – Cerebral Spinal Fluid; DLQI – Dermatology Life Quality Index; GAD-7 – Generalized Anxiety Disorder Scale; GR – The Glucocorticoid Receptor; HPA – Hypothalamic-Pituitary-Adrenal; ICD – International Classification of Diseases; IFN-γ – Interferon-γ; IL1β – Interleukin 1β; IL6 – Interleukin 6; IL17 – Interleukin 17; IL22 – Interleukin 22; MDD – Major Depressive Disorder; TNFα – Tumor Necrosis Factor-α; PASI – Total Psoriasis Area Severity Index; PHQ-9 – Patient Health Questionnaire Depression Scale; PSS – Perceived Stress Scale; RR – Relative Risk; QA– Guinolinic Acid; WHO – Word Health Organization; YLDs – Years Lived with Disability; 5-HTT – The Serotonin Transporter
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