Study of the Role of Stress, Depression and Anxiety in Development of Psoriasis along with Morphological and Biochemical Changes

Author(s): Shweta Chawla Grover*, Rani Bansal and Arvind Krishna

Abstract: Introduction: Psoriasis is a chronic, relapsing, cutaneous disease affecting about 2-3% of the world’s population and presents as erythematous, indurated, scaly plaques over the skin with involvement of nails and joints in some cases. Although psoriasis is not a life threatening disease, but the quality of life is severely affected and there is still no curative treatment. Many patients also have associated stress, depression and anxiety related problems. Aim of the study: To study the role of stress, anxiety and depression in development of psoriasis, to study the histopathological changes in psoriatic skin biopsies and serum serotonin levels in psoriasis. Materials and Methods: A total of 27 cases of biopsy diagnosed psoriasis cases and 27 controls were studied for clinical presentation, microscopic findings, for stress, depression and anxiety indices. The serum serotonin levels of psoriasis cases were compared with age and gender matched non-psoriatic healthy control individuals. Results: The patient age ranged from 17 to 55 years and there was a male predominance with male to female ratio of 3.5:1. Psoriasis was more common in the fourth and fifth decades. Psoriasis vulgaris was the most common clinical presentation. Consistent biopsy findings in most of the cases were presence of parakeratosis, dilated capillaries, elongated rete ridges with blunted edges, hypogranulosis and regular acanthosis. All three indices showed mean value signifying a Moderate degree of perceived stress, depression and anxiety in psoriasis group. The difference between serum serotonin levels in the patient group and control group was highly significant. Conclusion: Psoriasis is a chronic skin disorder affecting young to middle people and is more common in males. Psoriasis vulgaris was the most common clinical presentation. Consistent biopsy findings in most of the cases were presence of parakeratosis, dilated capillaries, elongated rete ridges with blunted edges, hypogranulosis and regular acanthosis. These patients are more likely to have mild to moderate degree of perceived stress, depression and anxiety. Many patients with psoriasis have elevated serum serotonin and are also likely to have depression. Prescription of serum serotonin reuptake inhibitors (SSRIs) has to be done cautiously in these patients.

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