From healthcentral.com
A groundbreaking new study found a relationship between high stress early in life and higher rates of the inflammatory skin disease
It's not exactly breaking news that mental health and psoriasis are closely linked. The skin disease leads to higher rates of anxiety, for one, and mental health conditions, like depression, can be a risk factor for psoriasis. But a new study out of the University of Birmingham in the UK brings us closer to understanding how, exactly, mental health affects your risk of developing psoriasis.
The researchers found that people with a history of childhood trauma, be it emotional, mental, or physical, were at a greater risk of developing psoriasis later in life. “Anecdotally, we understood that there was some connection between stress and conditions such as psoriasis,” says Lara Wine Lee, M.D., an associate professor of paediatrics and dermatology at Medical University of South Carolina in Charleston, SC, who was not a researcher on the study. “I think that this [study] supports giving more thought to mental health in psoriasis patients.”
The Connection Between Childhood Abuse and Psoriasis
The retrospective study used data from primary-care providers in the UK; the researchers first identified people who’d experienced abuse in childhood and compared them with those who didn’t have a reported history of abuse, analysing who among both groups developed immune-mediated inflammatory disorders. The more than 200,000 patients exposed to childhood trauma were at an increased risk of developing both rheumatoid arthritis (39% higher risk) and psoriasis (16% higher risk).
The connection seems rooted in the immune system. For context, psoriasis causes the immune system to malfunction, triggering an inflammatory response and the abnormal production of skin cells, leading to build-up on skin that appears as itchy patches or plaques. Chronic stress—the type you experience in an abusive household—can also trigger an inflammatory response which may interfere with immune-system function over time, according to Joht Chandan, Ph.D., a lead author of the study and a clinical professor of public health at the University of Birmingham in the UK. This creates the perfect conditions for psoriasis to develop.
The findings are in lockstep with what experts already suspected. “Stress is pro-inflammatory, meaning that as people experience stress, there is inflammation in the body,” says Jeffrey Cohen, M.D., who wasn’t involved in this study, but who researches the relationship between psoriasis and other medical conditions as the director of the Psoriasis Treatment Program at Yale Medicine. “Inflammation can then be seen in the skin—and, through the activation of specific pathways, can lead to skin conditions like psoriasis.”
Why Psoriasis May be Sensitive to Childhood Trauma
The findings, which looked at a variety of inflammatory diseases like irritable bowel syndrome and lupus, found an especially strong correlation between childhood abuse and an increased risk of developing psoriasis and rheumatoid arthritis.
Interestingly, rheumatoid arthritis is different from psoriatic arthritis, which appears in 30% of psoriasis patients. But both psoriasis and rheumatoid arthritis patients tend to have elevated levels of specific inflammatory markers that, incidentally, also tend to be higher in people with a history of early-life trauma, according to Dr. Chandan. Also, “it’s possible that the specific tissues affected by these conditions—the skin and joints—are more vulnerable to the long-term effects of immune dysregulation driven by early adversity,” he says.
Dr. Wine Lee, for her part, also thinks that the methodology of the study (which looked at past data using medical codes) may have led to rheumatoid arthritis being a highly impacted disease. “I wonder if some of those rheumatoid arthritis patients actually are psoriatic arthritis patients—and whether they’re talking about inflammatory arthritis in general,” she says. In other words, since it relies on coding (which doesn’t always allow for nuance), then there’s a chance different types of arthritis were either conflated with others or grouped under a single medical code.
The reliance on coding also leaves some gaps in the research, meaning some cases of childhood abuse may not have been included if they went unreported or weren’t severe. Plus, according to Dr. Chandan, they were limited in doing follow-up research with patients and therefore couldn’t account for inflammatory diseases that arose later in life. So, the findings don’t show the full impact of childhood trauma on medical conditions.
How This Could Change Psoriasis Care
For one, it points to the need for more research about how mental health can affect your risk of developing other diseases. “I think we do a really poor job considering how either trauma, stress, mental health, or comorbidities contribute to disease control,” says Dr. Wine Lee. “And I'd just love to have a better idea of how to incorporate it into my treatment plans.” After all, what kind of mental-health support is needed? And for how long? No research has looked at these questions—or determined the answers—quite yet.
But in adding to the growing understanding that mental health and skin conditions are very closely linked, these findings can still lead to greater awareness—which can benefit both patients and providers in the long run. “If a dermatologist is aware that individuals with psoriasis and eczema are at an increased risk of depression, they may more readily detect signs of depression,” says Dr. Cohen. “This, in turn, can lead to appropriate referrals and care for individuals in need.” Meanwhile, people who have a history of mental-health concerns or high stress might feel more empowered to talk about early symptoms or seek professional help from a dermatologist, “which can facilitate earlier diagnosis and treatment,” he says.
Ultimately, the goal may be to supplement traditional dermatology treatments with mental-health therapies, “particularly for patients presenting with early signs of immune-mediated diseases,” says Dr. Chandan. “Integrating mental health support into treatment pathways may not only help manage psychological distress but also potentially mitigate the inflammatory processes that contribute to disease progression.” It may make all the difference in how people live with these diseases.
https://www.healthcentral.com/news/psoriasis/how-childhood-trauma-links-to-psoriasis-risk
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