Psychological and psychophysiological aspects of psoriasis.

In emphasizing the need for a biopsychosocial model of illness, Engel says, "to provide the basis for understanding the determinants of disease and arriving at rational treatment and patterns of health care, a model must also take into account the patient, the social context in which he lives, and ... the physician role." Psoriasis is a disease entity that epitomizes this stance, complex in its pathophysiology and psychosocial and cultural ramifications. Psychoneuroimmunologic pathways between stressful life experience and onset and exacerbation are starting to be explored, a likely focus for future interdisciplinary research. Whether the stress of having psoriasis acts as a stressful life event is not clear, but seems likely. The impact of psoriasis on the patient's inner life as well as relationship to the outer world has been reviewed but must be addressed with improved patient education, various psychological therapies as needed, especially for patients with recalcitrant disease, and with greater attention to the therapeutic alliance between patient and physician.