Stress and its role in the development of psoriasis

Stress has a very adverse effect on the human body, reducing immunity and exposing it to all sorts of diseases. There are so-called "stress diseases" that do not need much to develop - just enough to get nervous.

Today, it is believed that the basis of the stress response is the activation of a complex of mechanisms that implement it (stress-realization), as well as which suspend it (stress-limiting) systems. The stress system is a complex regulatory complex that coordinates homeostasis under normal conditions, and has the main effect in triggering and coordinating changes in the body's internal environment. It consists of a central and peripheral circuit, which includes components of the nervous, endocrine and immune systems. They provide the body with adaptive properties. The hypothalamus and pituitary gland represent the central chain of the stress-realization system, the peripheral one is represented by sympathoadrenal mechanisms, as well as components of the endocrine system.

The body's response to a change in homeostasis was first studied in 1936 by the Canadian physiologist Hans Selye. In a detailed study, it was found that the stress response is triggered in a variety of pathological conditions (surgery, trauma, sepsis, burns). This confirmed the opinion about stress as a general non-specific process of adaptation of the body.

As you know, stress is a provoking and aggravating factor in the occurrence of psoriasis in 15-85% of cases. However, the neurogenic theory does not explain or prove all cases of psoriasis. Because in the difficult time of the war, there were fewer patients with psoriasis than in peacetime.

So, in children, arthropathic psoriasis cannot be compared with stress the day before. But one question remains relevant - is the pathology in the nervous system of patients with psoriasis a cause or a consequence? Along with this, the relationship between the duration, nature, severity and consequences of the disease gives reason to think that it is precisely the violation of neurodynamics that plays a pathogenetic role in the development of psoriasis.

A study was conducted to determine the causes of psoriasis and the role of stress in it.

We observed patient M., 37 years old, who has been suffering from psoriasis for 13 years.

The patient consulted a dermatologist in September 2009. 8 years ago was diagnosed with widespread vulgar plaque-like psoriasis. Moderate degree of infiltration, not severe form, stationary stage, photosensitive, winter type, moderately recurrent course. Chronic course of asymmetric oligoarthritis of the proximal interphalangeal joint of the index finger of the right hand FN I-II. Chronic gastritis. Chronic cholecystitis.

From the anamnesis it turned out that the patient has been suffering from psoriasis since the age of 12. The onset of the disease and further exacerbations are associated with nervous tension. He associates dystrophic changes in the joint of the index finger with the injection of a steroid (kenalog) due to another exacerbation. The patient has no bad habits. She noted frequent allergic reactions to medicines and food. Heredity - the patient's father suffered from psoriasis. The exacerbation was noted 1 time for 2 years in the winter. Repeatedly treated according to the protocols, but the effectiveness of the treatment was not noted. After taking methotrexate, recommended as a disease-modifying therapy, alopecia developed. The blood formula has also changed. For 7 years she took diclofenac sodium orally. Exacerbations lasted 2-3 months.

Some time later, the patient fell, got stressed and seriously injured her left knee joint. After that, the psoriasis worsened again. The patient was hospitalized.

She underwent all the diagnostic procedures regulated by the Ministry of Health of Ukraine No. 312 dated 08.05.2009. Diagnosed with widespread psoriasis (psoriatic erythroderma).

Torpid current. The degree of infiltration is pronounced, severe form, progressive stage, mixed type, moderately recurrent course. Asymmetric psoriatic polyarthritis with dominant damage to peripheral joints, rapid progression, severe course. FNIII, FAS 2b. Psoriatic onychodystrophy. Reactive hepatitis.

The patient was prescribed a combined treatment regimen:

• detoxification (rheosorbilact 200.0 every other day IV, No. 2);
• antihistamines (desloratadine 1g 2 times a day);
• sedatives;
• hepatoprotectors ("Gepabene" 2 caps. 2-3 times a day);
• drugs to improve microcirculation (Reopoliglyukin 10% 400 ml №4 every other day with pentoxifylline 100 IV, Solcoseryl 2.0 ml IM)
• symptomatic therapy (diclofenac sodium 75 mg 1-2 times a day).

During treatment, all of the patient's tests improved, except for ESR and ALT. But the results of tests on the account of the stress-realization immunoneuroendocrine system, despite the stabilization of the activity of the psoriatic process and the clinic, indicated the unsatisfactory functioning of the adaptive reaction of the patient's body.

After 28 days of treatment in the hospital, the patient was discharged with residual secondary pigmentation and referred for sanatorium treatment in the city of Nemirov. After each nervous tension, the patient noted a relapse.

At the second preventive examination in a year - stable remission.

The patient was also examined for psychosomatic state and stress-realizing immunoneuroendocrine system at the beginning of the progression of psoriasis and during remission. The condition of the patient was compared with healthy people.

According to the results of the study, it turned out that patient M. has severe disorders in her psycho-emotional state, which hinders her in the process of social adaptation and realization of herself as an individual. An increase in all mediators of the stress reaction was also revealed, which indicated the intensity of the stress-realization mechanisms, despite the stabilization of the process on the skin. That is, it turns out a vicious circle - overexertion leads to a relapse, which in turn causes even more stress.

According to experts, the main reason for this is the persistent deformation of the joints of the hands. Their functional inferiority and cosmetic defect reduce self-esteem, thus provoking another exacerbation of psoriasis. Interestingly, during the exacerbation of the process in the blood of patient M., a sharp increase in the concentration of IL-8, IL-10, TNF-A, ACTH was observed with a simultaneous decrease in the level of IL-1B, IL-17. These changes are key in the development of the psoriatic process.

All stress reactions have a similar course and, regardless of the causes of stress (mental stress, changes in metabolic processes in the body, burns, childbirth, trauma, sepsis), it is accompanied by tension in stress-realizing systems, in particular the hypothalamic-pituitary-adrenal system. The lack of stress-limiting mechanisms leads to the fact that the stress reaction, which is initially adaptive, begins to take part in pathological processes.

This proves that a few stressful situations are enough for the development of any disease. Therefore, you should try to avoid them. Health to you and your patients!

Recall that during the 23rd International Congress of Dermatology in Vancouver, Canada, Novartis presented the results of clinical studies proving the effectiveness of Cosentyx®; in the treatment of psoriasis of the hands, feet and nails.