Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 25;64(1):e71.
doi: 10.1192/j.eurpsy.2021.2249.

A systematic review on shared biological mechanisms of depression and anxiety in comorbidity with psoriasis, atopic dermatitis, and hidradenitis suppurativa

Michele Fabrazzo  1 , Salvatore Cipolla  1 , Simona Signoriello  2 , Alessio Camerlengo  1 , Giulia Calabrese  3 , Giulia Maria Giordano  1 , Giuseppe Argenziano  3 , Silvana Galderisi  1
Affiliations

A systematic review on shared biological mechanisms of depression and anxiety in comorbidity with psoriasis, atopic dermatitis, and hidradenitis suppurativa

Michele Fabrazzo et al. Eur Psychiatry. .

Abstract

Background: Mental disorders in comorbidity with chronic skin diseases may worsen disease outcome and patients' quality of life. We hypothesized the comorbidity of depression, anxiety syndromes, or symptoms as attributable to biological mechanisms that the combined diseases share.

Methods: We conducted a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement searching into PubMed, PsycInfo, and Scopus databases. We examined the literature regarding the comorbidity of psoriasis (Ps), atopic dermatitis (AD), or hidradenitis suppurativa with depression and/or anxiety in adults ≥18 years and the hypothetical shared underlying biological mechanisms.

Results: Sixteen studies were analyzed, mostly regarding Ps and AD. Brain-derived neurotrophic factor/tropomyosin receptor kinase B signaling and nuclear factor kappa-light-chain-enhancer of activated B cells/p38 mitogen-activated protein kinase pathways arose as shared mechanisms in Ps animal models with depression- and/or anxiety-like behaviors. Activated microglia and neuroinflammatory responses emerged in AD depressive models. As to genetic studies, atopic-dermatitis patients with comorbid anxiety traits carried the short variant of serotonin transporter and a polymorphism of the human translocator protein gene. A GA genotype of catechol-O-methyltransferase gene was instead associated with Ps. Reduced natural killer cell activity, IL-4, serotonin serum levels, and increased plasma cortisol and IgE levels were hypothesized in comorbid depressive AD patients. In Ps patients with comorbid depression, high serum concentrations of IL-6 and IL-18, as well as IL-17A, were presumed to act as shared inflammatory mechanisms.

Conclusions: Further studies should investigate mental disorders and chronic skin diseases concurrently across patients' life course and identify their temporal relation and biological correlates. Future research should also identify biological characteristics of individuals at high risk of the comorbid disorders and associated complications.

Keywords: Anxiety; chronic inflammatory skin diseases; depression; shared biologic mechanisms.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flowchart showing study selection process of included articles.
See this image and copyright information in PMC

References

    1. Duric V, Clayton S, Leong ML, Yuan LL. Comorbidity factors and brain mechanisms linking chronic stress and systemic illness. Neural Plast. 2016;2016:5460732. doi:10.1155/2016/5460732. - DOI - PMC - PubMed
    1. Isik A, Koca SS, Ozturk A, Mermi O. Anxiety and depression in patients with rheumatoid arthritis. Clin Rheumatol. 2007;26(6):872–8. doi:10.1007/s10067-006-0407-y. - DOI - PubMed
    1. Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984–91. doi:10.1038/jid.2014.530. - DOI - PMC - PubMed
    1. Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. Am J Clin Dermatol. 2003;4(12):833–42. doi:10.2165/00128071-200304120-00003. - DOI - PubMed
    1. Vitiello B, Burnam MA, Bing EG, Beckman R, Shapiro MF. Use of psychotropic medications among HIV-infected patients in the United States. Am J Psychiatry. 2003;160(3):547–54. doi:10.1176/appi.ajp.160.3.547. - DOI - PubMed

Publication types

Substances