Psoriasis and psychiatry: an update.

Psychosocial factors are important in the onset and/or exacerbation of psoriasis in 40%-80% of cases. Yet psoriasis has received little attention in the recent psychiatric literature. A subgroup of psoriatics appear to be "stress reactors" and these patients may have a better long-term prognosis. Identification of such patients early in the course of treatment and incorporation of specific psychosocial interventions in their overall treatment regimen may improve the course of illness. Psoriasis has also been associated with suicide and an increased prevalence of alcoholism. The disturbances in body image perception and the effect of psoriasis on interpersonal, social, and occupational functioning can further contribute to the overall morbidity, especially if psoriasis first occurs during a developmentally critical period like adolescence. Certain biochemical and physiologic correlates of psoriasis of interest to the psychiatrist such as exacerbation of psoriasis with lithium therapy and increased cutaneous blood flow are discussed. Finally, some practical guidelines are provided for psychosocial interventions in psoriasis.