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Stress, Social Support, Emotional Regulation, and Exacerbation of Diffuse Plaque Psoriasis

Received July 6, 2004; revision received Nov. 29, 2004; accepted Feb. 4, 2005. From the Clinical Epidemiology Unit and the Second and Third Dermatological Clinics, Dermatological Institute IDI-IRCCS; and the Department of Psychiatric Sciences and Psychological Medicine and the Public Health Department, La Sapienza University, Rome. Address correspondence and reprints requests to Dr. Picardi, Clinical Epidemiology Unit, Dermatological Institute IDI-IRCCS, Via dei Monti di Creta, 104-00167 Rome, Italy; a.picardi{at}idi.it (e-mail).

The authors’ aim was to investigate the role of stressful events, perceived social support, attachment security, and alexithymia in triggering exacerbations of diffuse plaque psoriasis. Inpatients experiencing a recent exacerbation of diffuse plaque psoriasis (N=33) were compared with inpatients with skin conditions believed to have a negligible psychosomatic component (N=73). Stressful events during the last year were assessed with Paykel’s Interview for Recent Life Events. Attachment style, alexithymia, and perceived social support were assessed with the Experiences in Close Relationships questionnaire, the Toronto Alexithymia Scale, and the Multidimensional Scale of Perceived Social Support, respectively. Multiple logistic regression analysis was used to control for age, gender, education, marital status, and alcohol consumption. In relation to comparison subjects, the patients with psoriasis had lower perceived social support and higher attachment-related avoidance. Also, they were more likely to have high alexithymic characteristics. There were no differences between the patients with psoriasis and the comparison subjects in scores on the Experiences in Close Relationships anxiety scale, the total number of stressful events, and the number of undesirable, uncontrollable, or major events. Although caution should be applied in generalizing these findings to outpatients, this study suggests that alexithymia, attachment-related avoidance, and poor social support might increase susceptibility to exacerbations of diffuse plaque psoriasis, possibly through impaired emotional regulation. Several physiological mechanisms involving the neuroendocrine and the immune system might mediate the interplay between stress, personality, and diffuse plaque psoriasis.

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