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PSORIASIS AS A PSYCHOPHYSIOLOGICAL DISEASE...PSORIASIS AS A PSYCHOPHYSIOLOGICAL DISEASE IN A MALE...
Transcript of PSORIASIS AS A PSYCHOPHYSIOLOGICAL DISEASE...PSORIASIS AS A PSYCHOPHYSIOLOGICAL DISEASE IN A MALE...
PSORIASIS AS A PSORIASIS AS A PSORIASIS AS A PSORIASIS AS A
PSYCHOPHYSIOLOGICAL DISEASE PSYCHOPHYSIOLOGICAL DISEASE PSYCHOPHYSIOLOGICAL DISEASE PSYCHOPHYSIOLOGICAL DISEASE
Valentina Saint-Georges
Clinical Hospital Centre
Department of Dermatovenereology
Rijeka, Croatia
PSORIASIS
DEFINITION:
• inflammatory erythro-squamous chronic disease marked
by periods of exacerbations and remissions affecting
skin, scalp, nails and joints
• classified as a psychosomatic disease with a genetic
predisposition
• worldwide incidence of 1-3%
COMMON CLINICAL PICTURE
Psoriasis vulgaris: erythro-squamous plaques
COMMON CLINICAL PICTURE
Psoriatic Arthritis
ETIOPATHOGENESIS OF
PSORIASIS
�multifactorial disease presumed to be genetically conditioned
�classified as a psycho-physiological disease
�environmental, psychological, and immunological factors can
trigger the onset and/or exacerbation
�a defective hypothalamo-pituitary-adrenal (HPA) axis response
to psychological stress may lead to immune dysregulation
which ultimately creates inflammation and autoimmunity in
adulthood
PSORIASIS AS A
PSYCHOPHYSIOLOGICAL DISEASE IN
A MALE PATIENT
�68-year old male patient
�Arterial hypertension
(50yrs of age)
�Spondyloarthritis
(55yrs of age)
�Psoriasis vulgaris
(58yrs of age)
�Diabetes Mellitus Type 2
(63yrs of age)
�Anxiety
�Alexithymia
�PTSD as a result of living
through civil war
Physical Diseases Psychological Factors
PATIENT BEFORE TREATMENT
�patient has frequently recurring psoriatic flares and severe
anxiety, believed to be caused by exposure to traumatic
stressors
�lack of emotional regulation manifests in the form of skin
and joint symptoms
�numerous psychosomatic diseases were long-standing
along with family predisposition
RETROSPECTIVE LINK BETWEEN
NEGATIVE LIFE EVENTS AND
PSORIASIS
Early traumatic experiences
• leaving home at 14 years of age
•emotional neglect
Traumatic Life Events
•PTSD due to civil war
Psychological distress
•anxiety
•alexithymia
Multiple Chronic Physical Diseases
•Arterial Hypertension
•Spondyloarthritis
•Diabetes Mellitus Type II
•PSORIASIS
E Simonić,M Kaštelan,S Peternel,M Pernar, I Brajac,I Rončrvić- Gržeta,I Kardum. Childhood and
adulthood traumatic experiences in patients with psoriasis. J Dermatology 2010;37:793-800
According to a study conducted by Dr. E. Simonić and colleagues at the Clinical
Medical Centre in Rijeka, Croatia, childhood and adulthood negative life events coupled
with the lack of positive experiences could increase the vulnerability for psoriasis onset.
PATIENT AFTER TREATMENT
TREATMENT PLAN
• adding a sedative component to
his anti-hypertensive therapy
• local corticosteroid application
on affected skin
• neutral cream application on
and around affected skin
• all other long-standing systemic
therapy for his co-morbidities
remained unaltered
PATIENT OUTCOME
• further benefit would come from
psychologist-led support to
deal with psychosocial aspects
influencing his overall physical
health
• current therapy has significantly
improved the symptoms
associated with psoriasis and
psoriatic arthritis
THIS CASE HIGHLIGHTS� traumatic experiences may be broad spectrum risk factors influencing risks of multiple
chronic physical diseases in later life
� hereditary factors in combination with childhood traumatic events might be important
risk factors for developing psoriatic arthritis
� cutaneous psoriatic patients who have endured negative life events are more likely to
develop psoriatic arthritis in later life, along with other chronic autoimmune
inflammatory diseases *
� psychological distress may contribute to a variety of disorders in psoriatic patients - such
as psoriatic arthritis
� patients with psoriasis show higher alexithymia, implying that lack of emotional
regulation may lead to the phenomena that painful emotions are primarily experienced
in the form of skin and joint symptoms
� a combined and individually adjusted therapy, together with a psychotherapeutic
approach may lead to a long-lasting success in treating psoriasis and psoriatic arthritis
E Simonić, S Peternel, L stojnić-Soša, I Rončević-Gržeta, L Prpić-Massari, D Periša, L Čabrijan. Negative and
Positive Life Experiences in Patients with Psoriatic Arthritis. Rheumatology International 33/2013/6;1587-1593
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