“The skin is the body’s largest organism—it is its defense against the world—so it makes sense that the immune system is very active in the skin,” Tina Bhutani, M.D., M.A.S., a dermatologist and co-director of the University of California San Francisco (UCSF) Psoriasis and Skin Treatment Center and of the UCSF Dermatology Clinical Research Unit, tells SELF. But, she adds, researchers aren’t sure why some people get psoriasis and others don’t.
“We know patients have a genetic predisposition, but in addition, there’s something environmental that happens to trigger their psoriasis,” Dr. Bhutani explains. “In some, that might be an infection, in others that might be some kind of stressor, like a psychological or physical stress on the body.”
The relationship between psoriasis and mental health can be a vicious cycle.
Research has shown that psoriasis can contribute to or worsen various mental health conditions, including depression, anxiety, bipolar disorder, eating disorders, and more. If you have psoriasis, you might be intimately familiar with how this works—especially right now, given that basically all of us are feeling mental strain in unprecedented ways thanks to the new coronavirus.
While it’s a bit of a chicken-and-egg situation, Dr. Bhutani says that mental health conditions like anxiety or depression may kickstart the onset of psoriasis or trigger and exacerbate flare-ups. Beyond that, “There are studies showing that major stressful life events, such as a death in the family, can result in the new onset of psoriasis,” Joel Gelfand, M.D., MSCE (Master of Science in Clinical Epidemiology), professor of dermatology and epidemiology and director of the Psoriasis and Phototherapy Treatment Center at the Perelman School of Medicine at the University of Pennsylvania, tells SELF.
On the other hand is the fact that having psoriasis may contribute to you developing a mental health condition (or make it worse). “There are studies that show patients with psoriasis are more likely to develop issues such as anxiety and depression over time,” Dr. Gelfand says.
Anyone who has worried about not fitting in with narrow definitions of beauty can understand how having a visible skin condition could take a toll on someone’s mental health. “One can imagine how the physical [stigma] of psoriasis—especially when plaques affect exposed areas of the skin—can affect mood and interpersonal interactions in a negative way,” Evan Rieder, M.D., an assistant professor of dermatology at NYU Langone who is board-certified in both psychiatry and dermatology, tells SELF. “These can happen both through how someone with psoriasis views [themselves], but also through the reactions of others to their skin.”
Like many people with psoriasis, Jennifer Pellegrin, 36, knows all too well how the condition can impact a person’s social life and mental health. She was diagnosed with psoriasis when she was 15 and with psoriatic arthritis at 25, followed by depression a year later and then anxiety. “Psoriasis causes an exacerbation of my [mental health conditions],” she tells SELF in an email. “I go through days sometimes where I cancel all plans. I can be looking forward to going out, start to get ready, and boom: Anxiety hits. I feel hideous and won’t leave the house.”
In addition to the more obvious ways psoriasis and mental health can play off each other, experts have done a fair amount of research into the biological mechanisms that may connect psoriasis and various mental health conditions. A 2016 systematic review in The Journal of Clinical and Aesthetic Dermatology looked at 57 studies on the subject, noting that psychological stress and depression can boost the release of pro-inflammatory cytokines, which are molecules released as part of the immune response. The inflammation they cause seems capable of further exacerbating the symptoms of both psoriasis and conditions like depression. However, there’s conflicting research on this; some of the literature hasn’t found definitive associations between psoriasis and psychological issues like stress.