The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Background

Previous observational studies have shown comorbidity between psoriasis and psychological disorders. However, the evidence of the efficacy of psychological interventions, including cognitive behavioral therapy (CBT) and other treatments, on psoriasis is still debated.

Objectives

The aim of this study was to systematically review the psychological interventions used in the treatment of psoriasis and to meta-analyze the efficacy of psychological interventions on psoriasis with respect to area and severity reduction.

Materials and methods

A systematic review and meta-analysis were conducted. PubMed, Web of Science, EMbase, and major Chinese academic journal databases were searched for articles published before January 2018. Studies of randomized controlled trials (RCTs) that applied psychological interventions in the treatment of psoriasis and used area and severity as the outcome measures were meta-analyzed. The pooled mean difference between groups was estimated using either fixed-effects models or random-effects models in the presence of heterogeneity. Subgroup analysis was performed by method of intervention and severity of psoriasis.

Results

Out of the 4,152 potentially relevant studies, 8 RCTs were included. The pooled mean difference was −1.36 (95% CI: −2.52 to −0.19; P=0.02). The pooled estimate was −1.80 (95% CI: −2.57 to −1.03; P<0.001) for CBT intervention and was −0.70 (95% CI: −2.39 to 0.99; P=0.42) for non-CBT intervention. The pooled estimates for mild and moderate-to-severe psoriasis were −1.95 (95% CI: −3.91 to 0.00; P=0.05) and −0.61 (95% CI: −1.61 to 0.38; P=0.23), respectively.

Conclusion

CBT is effective in the treatment of psoriasis in terms of area and severity reduction. Systemic treatment does not further enhance the efficacy of CBT. The effect of the psychological intervention is stronger in patients with moderate-to-severe psoriasis.

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Most cited references 40

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The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study.

Paul Crits-Christoph, Joel Gelfand, Shanu K Kurd … (2010)

To determine the incidence of depression, anxiety, and suicidality in patients with psoriasis compared with the general population. A population-based cohort study using data collected as part of patient's electronic medical record from 1987 to 2002. General Practice Research Database. Analyses included 146 042 patients with mild psoriasis, 3956 patients with severe psoriasis, and 766 950 patients without psoriasis. Five controls without psoriasis were selected from the same practices and similar cohort entry dates as patients with psoriasis. Clinical diagnoses of depression, anxiety, and suicidality among patients. The adjusted hazard ratios (HRs) for receiving a diagnosis of depression, anxiety, and suicidality in patients with psoriasis compared with controls were 1.39 (95% confidence interval [CI], 1.37-1.41), 1.31 (95% CI, 1.29-1.34), and 1.44 (95% CI, 1.32-1.57), respectively. The adjusted HR of depression was higher in severe (HR, 1.72; 95% CI, 1.57-1.88) compared with mild psoriasis (HR, 1.38; 95% CI, 1.35-1.40). Younger patients with psoriasis had elevated HRs of outcomes compared with older patients with psoriasis. Patients with psoriasis have an increased risk of depression, anxiety, and suicidality. We estimate that in the United Kingdom, in excess of 10 400 diagnoses of depression, 7100 diagnoses of anxiety, and 350 diagnoses of suicidality are attributable to psoriasis annually. It is important for clinicians to evaluate patients with psoriasis for these conditions to improve outcomes. Future investigation should determine the mechanisms by which psoriasis is associated with psychiatric outcomes as well as approaches for prevention.

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The Inflammatory Response in Psoriasis: a Comprehensive Review.

Yaxiong Deng, Christopher Chang, Qianjin Lu (2016)

Psoriasis is a chronic inflammatory autoimmune disease characterized by an excessively aberrant hyperproliferation of keratinocytes. The pathogenesis of psoriasis is complex and the exact mechanism remains elusive. However, psoriasis is thought to result from a combination of genetic, epigenetic, and environmental influences. Recent studies have identified that epigenetic factors including dysregulated DNA methylation levels, abnormal histone modification and microRNAs expressions are involved in the development of psoriasis. The interplay of immune cells and cytokines is another critical factor in the pathogenesis of psoriasis. These factors or pathways include Th1/Th2 homeostasis, the Th17/Treg balance and the IL-23/Th17 axis. Th17 is believed particularly important in psoriasis due to its pro-inflammatory effects and its involvement in an integrated inflammatory loop with dendritic cells and keratinocytes, contributing to an overproduction of antimicrobial peptides, inflammatory cytokines, and chemokines that leads to amplification of the immune response. In addition, other pathways and signaling molecules have been found to be involved, including Th9, Th22, regulatory T cells, γδ T cells, CD8(+) T cells, and their related cytokines. Understanding the pathogenesis of psoriasis will allow us to develop increasingly efficient targeted treatment by blocking relevant inflammatory signaling pathways and molecules. There is no cure for psoriasis at the present time, and much of the treatment involves managing the symptoms. The biologics, while lacking the adverse effects associated with some of the traditional medications such as corticosteroids and methotrexate, have their own set of side effects, which may include reactivation of latent infections. Significant challenges remain in developing safe and efficacious novel targeted therapies that depend on a better understanding of the immunological dysfunction in psoriasis.

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Assessing the quality of randomized trials: reliability of the Jadad scale.

D Fergusson, F McAlister, Gary G. Wells … (1999)

An instrument was developed and validated by Jadad, et al. to assess the quality of clinical trials using studies from the pain literature. Our study determined the reliability of the Jadad scale and the effect of blinding on interrater agreement in another group of primary studies. Four raters independently assessed blinded and unblinded versions of 76 randomized trials. Interrater agreement was calculated among combinations of four raters for blinded and unblinded versions of the studies. A 4 x 2 x 2 repeated measures design was employed to evaluate the effect of blinding. The interrater agreement for the Jadad scale was poor (kappa 0.37 to 0.39), but agreement improved substantially (kappa 0.53 to 0.59) with removal of the third item (an explanation of withdrawals). Blinding did not significantly affect the Jadad scale scores. A more precise description of how to score the withdrawal item and careful conduct of a practice set of articles might improve interrater agreement. In contrast with the conclusions reached by Jadad, we were unable to demonstrate a significant effect of blinding on the quality scores.

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Author and article information

Journal

Journal ID (nlm-ta): Psychol Res Behav Manag

Journal ID (iso-abbrev): Psychol Res Behav Manag

Journal ID (publisher-id): Psychology Research and Behavior Management

Title: Psychology Research and Behavior Management

Publisher: Dove Medical Press

ISSN (Electronic): 1179-1578

Publication date Collection: 2019

Publication date (Electronic): 07 February 2019

Volume: 12

Pages: 97-106

Affiliations

[1 ]Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China, xysm2011@ 123456yeah.net ; shenmx1988@ 123456csu.edu.cn

[2 ]Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China, xysm2011@ 123456yeah.net ; shenmx1988@ 123456csu.edu.cn

[3 ]Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China, xysm2011@ 123456yeah.net ; shenmx1988@ 123456csu.edu.cn

[4 ]Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China

Author notes

Correspondence: Xiang Chen; Minxue Shen, Department of Dermatology, Central South University, Xiangya Hospital, 87 Xiangya Road, Changsha, Hunan 410008, China, Tel +86 159 7316 4022, Email xysm2011@ 123456yeah.net ; shenmx1988@ 123456csu.edu.cn

[*]

These authors contributed equally to this work

Article

Publisher ID: prbm-12-097

DOI: 10.2147/PRBM.S195181

PMC ID: 6369842

PubMed ID: 30799963

SO-VID: 2542f5df-d1cd-43dd-b3ce-4f89af4e46e0

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Background

Objectives

Materials and methods

Results

Conclusion

Related collections

Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 40

The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study.

The Inflammatory Response in Psoriasis: a Comprehensive Review.

Assessing the quality of randomized trials: reliability of the Jadad scale.

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