Skin diseases as a cause of depression

We should monitor the emotional health of patients with psoriasis to prevent them from developing psychiatric disorders that affect their quality of life.

Skin diseases as a cause of depression
Skin imperfections affect people's self-esteem and quality of life. Photo by ahmad gunnaivi / Unsplash

Psoriasis is a non-contagious and permanent skin condition, characterized by silvery scaly patches with a red outline, which can be triggered by almost any stimulus that traumatizes and causes inflammation of the skin, such as scratching, injections, blows, mosquito bites and stress, among others.

The presence of this disease is due to the participation of several factors, such as genetic alterations, age, gender, geographic area, and race (Caucasians). In addition, it is the main autoimmune skin disease in which the body's defense mechanisms act against the body itself, with a reported incidence of up to 3% worldwide.

Likewise, it has been observed that skin blemishes alter the quality of life of the patient by presenting desquamation, bleeding, itching, and burning, generating in them a tendency to hide their dermatological lesions and causing psychological disorders, a product of the shame caused by stigmatization and exclusion from society.

These lesions appear, above all, in areas where the skin rubs, for example, elbows, armpits, neck, palms of the hands, soles of the feet, and genitals. The anxiety and stress that usually accompany these patients worsen the physical manifestations of the disease, making the symptoms more intense as a vicious circle that affects their emotional well-being, and could be the cause of psychiatric diseases such as depression.

Depression is defined as a prolonged sadness that causes loss of interest and leads to social isolation, distortion of body image, and even suicide. In Mexico, INEGI states that 22.1% of women and 12.5% of men had symptoms such as deep sadness, low self-esteem, and suicidal thoughts, for this reason, schizoid disorders, depression, anxiety or phobias are present in up to 15% of the population, depression being one of the most frequent among 18 to 65 years old, with an incidence of 4.8%.

The disease and its affectations

Depression, psoriasis, and the mechanisms that integrate them are very complex and the available information is contradictory and limited. The most accepted theories are described below:

Psoriasis is an autoimmune disease that promotes the secretion of proinflammatory cytokines, which are substances released by dendrites, macrophages, neutrophils, and other immune cells of the skin and other tissues, in high concentrations cause high levels of the neurotransmitter setonin that depresses the nervous system.

The main cytokine is TNF-a which in psoriasis promotes rapid skin growth and inflammation that we observe as reddish scales, while in depression it plays a role in the synthesis of neurotransmitters and myelin sheaths. Thus, abnormal levels also contribute to impaired communication between neurons.

Vitamin D3 deficiency is a little-discussed theory; this vitamin is involved in the differentiation and division of keratinocytes and its administration in patients with psoriasis is positively related to a reduced appearance of squamous plaques. In turn, this component is found in neurotransmitters, and its low levels have also been related to promoting high concentrations of proinflammatory cytokines and low concentrations of regulatory T cells that cause psoriatic patches.

In conclusion, both conditions share mechanisms affecting the immune system that dual treatment may or may not diminish the clinical manifestations of the diseases. To the same end, we should monitor the emotional health of patients with psoriasis to prevent them from developing psychiatric disorders that affect their quality of life.

By UAG student Yevgeny Alexei Palacios Alvarado, Dr. Karina Janett Juárez Rendón and Dr. Clara Ibeth Juárez Vázquez