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Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy.

Abstract

OBJECTIVE

To assess whether psychological distress affects treatment outcome in psoriasis.

DESIGN

Cohort study of patients with psoriasis receiving psoralen-UV-A (PUVA) photochemotherapy.

SETTING

Two university hospital dermatology departments.

PATIENTS

One hundred twelve patients with chronic plaque psoriasis.

MAIN OUTCOME MEASURES

We assessed clinical severity of psoriasis, psychological distress, and other potential confounders of treatment outcome such as skin phototype, family history of psoriasis, and alcohol intake before starting PUVA therapy. Clinical severity of disease and response to therapy were assessed at every fourth appointment.

RESULTS

Pathological or high-level worry was the only significant (P =.01) predictor of time taken for PUVA to clear psoriasis. Event curves of time to clearance significantly differed between high- and low-level worry groups (log rank test, 6.64; df = 1; P =.01). Patients in the high-level worry group cleared with PUVA treatment at a rate 1.8 times slower than that of the low-level worry group (ExpB = 1.81; 95% confidence interval, 1.13-2.90). Fiftieth percentile time to clearance of psoriasis in the high- and low-level worry groups showed a median difference of 19 days.

CONCLUSIONS

Psychological distress, in the form of excessive worrying, has a significant and detrimental affect on treatment outcome in patients with psoriasis. Patients with psoriasis who are classified as high-level worriers may benefit from adjunctive psychological intervention before and during treatment. These findings provide further evidence of the existence of a brain-skin axis.

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  • Authors+Show Affiliations

    ,

    Dermatology Centre, University of Manchester School of Medicine, and the Department of Behavioural Medicine, Hope Hospital, Salford, Manchester, England.

    , , , , , ,

    Source

    Archives of dermatology 139:6 2003 Jun pg 752-6

    MeSH

    Adult
    Aged
    Chronic Disease
    Cohort Studies
    Female
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    PUVA Therapy
    Psoriasis
    Remission Induction
    Severity of Illness Index
    Stress, Psychological
    Time Factors
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    12810506

    Citation

    Fortune, Donal G., et al. "Psychological Distress Impairs Clearance of Psoriasis in Patients Treated With Photochemotherapy." Archives of Dermatology, vol. 139, no. 6, 2003, pp. 752-6.
    Fortune DG, Richards HL, Kirby B, et al. Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy. Arch Dermatol. 2003;139(6):752-6.
    Fortune, D. G., Richards, H. L., Kirby, B., McElhone, K., Markham, T., Rogers, S., ... Griffiths, C. E. (2003). Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy. Archives of Dermatology, 139(6), pp. 752-6.
    Fortune DG, et al. Psychological Distress Impairs Clearance of Psoriasis in Patients Treated With Photochemotherapy. Arch Dermatol. 2003;139(6):752-6. PubMed PMID: 12810506.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy. AU - Fortune,Donal G, AU - Richards,Helen L, AU - Kirby,Brian, AU - McElhone,Kathleen, AU - Markham,Trevor, AU - Rogers,Sarah, AU - Main,Chris J, AU - Griffiths,Christopher E M, PY - 2003/6/18/pubmed PY - 2003/7/3/medline PY - 2003/6/18/entrez SP - 752 EP - 6 JF - Archives of dermatology JO - Arch Dermatol VL - 139 IS - 6 N2 - OBJECTIVE: To assess whether psychological distress affects treatment outcome in psoriasis. DESIGN: Cohort study of patients with psoriasis receiving psoralen-UV-A (PUVA) photochemotherapy. SETTING: Two university hospital dermatology departments. PATIENTS: One hundred twelve patients with chronic plaque psoriasis. MAIN OUTCOME MEASURES: We assessed clinical severity of psoriasis, psychological distress, and other potential confounders of treatment outcome such as skin phototype, family history of psoriasis, and alcohol intake before starting PUVA therapy. Clinical severity of disease and response to therapy were assessed at every fourth appointment. RESULTS: Pathological or high-level worry was the only significant (P =.01) predictor of time taken for PUVA to clear psoriasis. Event curves of time to clearance significantly differed between high- and low-level worry groups (log rank test, 6.64; df = 1; P =.01). Patients in the high-level worry group cleared with PUVA treatment at a rate 1.8 times slower than that of the low-level worry group (ExpB = 1.81; 95% confidence interval, 1.13-2.90). Fiftieth percentile time to clearance of psoriasis in the high- and low-level worry groups showed a median difference of 19 days. CONCLUSIONS: Psychological distress, in the form of excessive worrying, has a significant and detrimental affect on treatment outcome in patients with psoriasis. Patients with psoriasis who are classified as high-level worriers may benefit from adjunctive psychological intervention before and during treatment. These findings provide further evidence of the existence of a brain-skin axis. SN - 0003-987X UR - https://www.unboundmedicine.com/medline/citation/12810506/full_citation L2 - https://jamanetwork.com/journals/jamadermatology/fullarticle/vol/139/pg/752 DB - PRIME DP - Unbound Medicine ER -