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23-12-2010 | Dermatology | Article

Persistent daily stress may worsen psoriasis outcome


Free abstract

MedWire News: Patients with psoriasis who have persistently high levels of daily stressors have decreased cortisol levels, making them particularly vulnerable to peak stress times that are related to subsequent worsening of the disease, report researchers.

"Clinicians should be aware of the possible effect of daily stressors on disease outcome and endocrine function, particularly when patients are going through stressful periods and for those subgroups of patients who are most vulnerable to the enduring influence of daily stressors," say Andrea Evers and colleagues from the Radboud University Nijmegen Medical Centre in The Netherlands.

Experimentally induced stress has been shown to blunt hypothalamic-pituitary-adrenal (HPA) axis activity in psoriasis patients, the researchers explain in the British Journal of Dermatology, which may result in increased inflammatory responses due to the diminished suppressive effect of cortisol.

Evers and colleagues have previously shown that increased peak levels of daily real-life stressors are associated with decreased cortisol levels, and increased psoriasis disease severity a month later.

In this study, the team studied serum cortisol levels, clinical indicators of psoriasis disease severity, and self-report measures of daily stressors (such as running late for an appointment or losing keys) over 6 months in 62 patients with psoriasis, aged an average of 52 years.

They found that patients who consistently experienced high enduring levels of daily stressors, as indicated by above-median total daily stressors levels, had lower average levels of cortisol than those with below-median total daily stressors levels, at 0.29 vs 0.37 µmol/l.

There was no difference in current disease severity between patients with high total daily stressors levels and those with lower levels, at a Psoriasis Area and Severity Index of 7.34 versus 5.84, respectively. And, while levels of daily stressors correlated negatively with cortisol levels, no correlation was seen between daily stressors and disease severity.

But based on their previous findings, the researchers say the decreased cortisol levels associated with high daily stressors levels "might reflect a general vulnerability to exacerbation of inflammation in these patients, such that relatively stressful periods may aggravate the course of psoriasis in these individuals in particular."

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Caroline Price