Childhood Trauma and Psychosocial Stress Affect Treatment Outcome in Patients With Psoriasis Starting a New Treatment Episode

Gloria-Beatrice Wintermann; Antonie Louise Bierling; Eva M J Peters; Susanne Abraham; Stefan Beissert; Kerstin Weidner

doi:10.3389/fpsyt.2022.848708

Childhood Trauma and Psychosocial Stress Affect Treatment Outcome in Patients With Psoriasis Starting a New Treatment Episode

Front Psychiatry. 2022 Apr 25:13:848708. doi: 10.3389/fpsyt.2022.848708. eCollection 2022.

Authors

Gloria-Beatrice Wintermann¹, Antonie Louise Bierling¹, Eva M J Peters^{2

3}, Susanne Abraham⁴, Stefan Beissert⁴, Kerstin Weidner¹

Affiliations

¹ Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Dresden, Germany.
² Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Giessen, Gießen, Germany.
³ Universitätsmedizin Charité, Berlin, Germany.
⁴ Department of Dermatology, University Hospital Carl Gustav Carus Dresden, Technische Universitaet Dresden, Dresden, Germany.

Abstract

Objective: Traumatic childhood experiences and psychosocial stress may predispose the evolvement of somatic diseases. Psoriasis is a multifactorial chronic inflammatory skin disease that often associates with current and past stress. Both may entail pathological alterations in major stress axes and a balance shift in the level of T helper type 1 (Th1) and 2 (Th2) cytokines, affecting the development and course of psoriasis. Until now, it is unclear whether traumatic stress experiences during the childhood or current stress are more frequent in psoriatic compared to skin-healthy individuals, and if they interact with treatment outcome.

Method: In a prospective cohort study, the impact of acute and early childhood stress on the course of dermatological treatment were studied in patients with moderate to severe psoriasis (PSO). Patients were examined before (T1) and about 3 months after (T2) the beginning of a new treatment episode. Assessments included clinical outcomes (Psoriasis Area and Severity Index-PASI, Structured Clinical Interview SCID-I) and patient-reported outcomes (PRO) (Childhood Trauma Questionnaire-CTQ, Perceived Stress Scale-PSS, itching/scratching, Dermatology Life Quality Index-DLQI, Hospital Anxiety and Depression Scale, Body Surface Area, Self-Administered PASI).

Results: N = 83 PSO patients (median age 53.7, IQR 37.8, 62.5) and n = 66 skin-healthy control subjects (HC) (median age 51.5, IQR 33.3, 59.2) participated. PSO had higher CTQ physical neglect than HC, as well as higher PRO levels. The positive impact of improved skin on the skin-related quality of life was moderated by the perceived stress. Acute stress at T1 had a positive effect both on the skin severity and the skin-related quality of life. CTQ total closely interacted with baseline psoriasis severity, and was associated with higher improvement from T1 to T2.

Conclusion: One might tentatively conclude, that chronic psychosocial stressors like childhood maltreatment may predispose the manifestation of psoriasis. The latter may be amplified by acute psychological stressors. In addition, the present evidence suggests that systemic therapies work well in PSO, with childhood trauma and acute psychosocial stress. Both should therefore be routinely assessed and addressed in PSO.

Keywords: anxiety; childhood trauma; depression; perceived stress; psoriasis; systemic therapy; therapy outcome.