TABLE 2.

The etiopathogenesis of anxiety disorders in psoriasis

ANXIETY LEADS TO PSORIASIS

PSORIASIS LEADS TO ANXIETY

Stress disturbs epidermal barrier3 Psoriatic plaques have increased stress-related neuropeptides18 Altered sympathetic nervous system (SAM) and dysregulation of both central and peripheral hypothalamuspituitary-adrenal axes13,17,18 Activated mast cells due to stress-related neuropeptides and upregulated SAM responses1,13 Stress-induced increase in natural killer cells and cutaneous lymphocyte associated antigen1 Increased dendritic epidermal serotonin transporter protein expression19

Chronic itch12 Lack of social support: higher risk10 Female patients: higher risk14 Personality traits/alexithymia3,15,16 Disfigurement13 Stigmatization13