The Psychosocial Impact of Immune-Mediated Skin Diseases

The nervous system, immunology, and psychology all play a role in cutaneous disease. Patients with chronic inflammatory skinSkin disorders often have reduced quality-of-life, depression, and anxietyAnxiety. The central nervous systemCentral nervous system, especially the hypothalamic-pituitary- adrenal axis (HPA), can be overactivated in cutaneous disease and lead to overproduction of inflammatory cytokines. Patients with chronic dermatologic disorders often have stressStress, and anxietyAnxiety due to the stigma of their appearance and the physical symptoms of pruritus, burning, and stinging. These physical inflammatory symptoms further drive the psychological symptoms of stressStress and anxietyAnxiety. While many studies elucidate the psychological impact of skinSkin disease, few synthesize and explore the relationship of skinSkin disease with immunology, neurology, and psychology. Atopic dermatitisAtopic dermatitis, alopeciaAlopecia, psoriasisPsoriasis, pemphigusPemphigus, cutaneous lupus erythematosusCutaneous lupus erythematosus, lichen planusLichen planus, vitiligoVitiligo, and sclerosisSclerosis all embody the intersection of psychology, neurology, and immunology. The feeling of itch is transmitted from afferent C-fibers in the peripheral nervous system to the CNS, driving the release of neurotransmittersNeurotransmitter that increase inflammation. Patients with cutaneous disease often have poor sleepSleep quality due to symptoms of pruritus which plays a role in the development of psychological distress. Moreover, the systemic inflammation that is present in cutaneous disease can further increase depressive episodes in patients. Treating the cutaneous disorder often improves sleepSleep quality and psychologic burden in patients, and psychotherapyPsychotherapy may be helpful in treating both the physical symptoms and mental burden of cutaneous disease.