Connection, Treatment, and When to Seek Help -

Many people with psoriasis also experience varying levels of psychological distress from the condition.

Researchers compiled data from systematic reviews, meta-analyses, and randomized control trials on depression, suicidality, anxiety, and psoriasis. According to their review of the findings, people with psoriasis are 1.5 times more likely to have depressive symptoms than those without.

While social factors like self-esteem issues or embarrassment over how psoriasis physically looks can worsen mental health issues, research suggests other factors can contribute to depression as well.

Inflammation

As in the case with many autoimmune diseases, one of the primary causes of psoriasis is inflammation. With psoriasis, the lack of regulation within the immune system that leads to inflammation can also play a role in the development of depression.

“There is growing evidence that chronic inflammation in psoriasis contributes to an inflammatory response in the brain and spinal cord (neuroinflammation), which plays a role in depression,” says Dr. Khan.

The psychiatrist says this is caused by small, pro-inflammatory proteins called cytokines. Within the cells, these proteins affect immune responses, and have been linked to changes in brain chemistry that can contribute to mood disorders. These cytokines impact brain communication in a way that’s aligned with inflammation.

“This is one reason why individuals with psoriasis and other inflammatory conditions may have higher rates of depression and anxiety,” Khan says.

Physical Discomfort

Psoriasis plaques (rashes) can vary in appearance depending on your skin tone, and are dry and scaly. These areas can also be uncomfortable, potentially causing burning, stinging, or itching.

For some people with psoriasis, this itching and discomfort can also affect sleep. Lack of sleep can worsen overall health, and poor sleep habits can also leave you more vulnerable to depression.

Reduced Self-Esteem and Isolation

A skin condition like psoriasis can lead to social withdrawal, Khan says. This is particularly true when affected areas are highly visible.

Hannah Kopelman, DO, a dermatologist with Kopelman Aesthetic Surgery and Kopelman Hair Restoration in New York City, says this is often the case with psoriasis, which commonly affects the scalp, elbows, arms, and knees.

People with psoriasis may also feel emotional discomfort and shame related to the condition.

Some with psoriasis feel concern about how the public or loved ones will react to their skin’s appearance. “One of the most common things with psoriasis is that people don’t want to leave their house because they’re depressed by their skin manifestations,” Dr. Kopelman says.

This impact on self-esteem can lead to social avoidance. “The social withdrawal, avoidance of intimate relationships, and anxiety about public perception can lead to feelings of loneliness, which is a significant risk factor for depression,” Khan says.

“Low self-esteem is common in individuals with psoriasis, particularly if they have experienced bullying, comments about their appearance, or rejection due to their condition,” he says.

Co-occurring Conditions

Psoriatic arthritis often acompanies psoriasis, and chronic pain can contribute to depression.

Because psoriatic arthritis has the potential to affect mobility, this can further contribute to social isolation and make someone less likely to engage in things that them bring joy, Kopelman says.

In addition to psoriatic arthritis, psoriasis comes with a higher risk for:

Navigating additional health concerns alongside a visible skin condition can prove overwhelming. This can ultimately lead to worsening depression.

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