Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis

Psychological stress has long been recognized as a trigger for plaque psoriasis, and preliminary evidence suggests that psoriasis could be associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in impaired cortisol response to stress. This study aimed to investigate...

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Autores principales: Paolo Gisondi, Davide Geat, Francesco Bellinato, Laura Spiazzi, Elisa Danese, Martina Montagnana, Giuseppe Lippi, Giampiero Girolomoni
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Lenguaje:EN
Publicado: MDPI AG 2021
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Acceso en línea:https://doaj.org/article/7bb52b174c4e4807894b59b65396e95d
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spelling oai:doaj.org-article:7bb52b174c4e4807894b59b65396e95d2021-11-25T18:06:52ZPsychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis10.3390/jpm111110692075-4426https://doaj.org/article/7bb52b174c4e4807894b59b65396e95d2021-10-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1069https://doaj.org/toc/2075-4426Psychological stress has long been recognized as a trigger for plaque psoriasis, and preliminary evidence suggests that psoriasis could be associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in impaired cortisol response to stress. This study aimed to investigate psychological stress, anxiety, depression and salivary cortisol in psoriatic patients. A cross sectional study involving 126 adult patients with plaque psoriasis and 116 adult healthy controls was conducted. Demographic, clinical data, Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS) were collected. Cases and controls were asked whether they felt stressed in the last month, whilst psoriatic patients were also interrogated whether they found that psoriasis could have been worsened by stress. Moreover, 54 randomly selected subjects (27 psoriasis patients and 27 controls) underwent salivary cortisol testing at 8 am. PSS, HADS depression and anxiety subscales were significantly higher in psoriatic patients than in controls (17.2 ± 0.6 vs. 15.1 ± 0.8 <i>p</i> = 0.0289), (9.5 ± 0.3 vs. 6.2 ± 0.3 <i>p</i> < 0.001) and (8.2 ± 0.4 vs. 4.2 ± 0.3 <i>p</i> < 0.001), respectively. A higher rate of psoriatic patients reported feeling stress over the last month (45% vs. 19%, <i>p</i> < 0.001), and stress was considered a potential trigger for psoriasis flare-ups in 69% of cases. Psoriasis was strongly associated with higher PSS and HADS scores independently of sex, body mass index, diabetes, hypertension, dyslipidemia, and occupational status. Salivary cortisol was significantly lower in psoriatic patients compared to controls (9.6 ± 0.5 vs. 14.0 ± 1.1 nmol/L, <i>p</i> < 0.001). In conclusion, psoriasis was associated with higher psychological stress, anxiety and depressive symptoms, and with impaired cortisol response to stress.Paolo GisondiDavide GeatFrancesco BellinatoLaura SpiazziElisa DaneseMartina MontagnanaGiuseppe LippiGiampiero GirolomoniMDPI AGarticleHADSPSSpsoriasispsychological stresssalivary cortisolMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1069, p 1069 (2021)
institution DOAJ
collection DOAJ
language EN
topic HADS
PSS
psoriasis
psychological stress
salivary cortisol
Medicine
R
spellingShingle HADS
PSS
psoriasis
psychological stress
salivary cortisol
Medicine
R
Paolo Gisondi
Davide Geat
Francesco Bellinato
Laura Spiazzi
Elisa Danese
Martina Montagnana
Giuseppe Lippi
Giampiero Girolomoni
Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis
description Psychological stress has long been recognized as a trigger for plaque psoriasis, and preliminary evidence suggests that psoriasis could be associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in impaired cortisol response to stress. This study aimed to investigate psychological stress, anxiety, depression and salivary cortisol in psoriatic patients. A cross sectional study involving 126 adult patients with plaque psoriasis and 116 adult healthy controls was conducted. Demographic, clinical data, Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS) were collected. Cases and controls were asked whether they felt stressed in the last month, whilst psoriatic patients were also interrogated whether they found that psoriasis could have been worsened by stress. Moreover, 54 randomly selected subjects (27 psoriasis patients and 27 controls) underwent salivary cortisol testing at 8 am. PSS, HADS depression and anxiety subscales were significantly higher in psoriatic patients than in controls (17.2 ± 0.6 vs. 15.1 ± 0.8 <i>p</i> = 0.0289), (9.5 ± 0.3 vs. 6.2 ± 0.3 <i>p</i> < 0.001) and (8.2 ± 0.4 vs. 4.2 ± 0.3 <i>p</i> < 0.001), respectively. A higher rate of psoriatic patients reported feeling stress over the last month (45% vs. 19%, <i>p</i> < 0.001), and stress was considered a potential trigger for psoriasis flare-ups in 69% of cases. Psoriasis was strongly associated with higher PSS and HADS scores independently of sex, body mass index, diabetes, hypertension, dyslipidemia, and occupational status. Salivary cortisol was significantly lower in psoriatic patients compared to controls (9.6 ± 0.5 vs. 14.0 ± 1.1 nmol/L, <i>p</i> < 0.001). In conclusion, psoriasis was associated with higher psychological stress, anxiety and depressive symptoms, and with impaired cortisol response to stress.
format article
author Paolo Gisondi
Davide Geat
Francesco Bellinato
Laura Spiazzi
Elisa Danese
Martina Montagnana
Giuseppe Lippi
Giampiero Girolomoni
author_facet Paolo Gisondi
Davide Geat
Francesco Bellinato
Laura Spiazzi
Elisa Danese
Martina Montagnana
Giuseppe Lippi
Giampiero Girolomoni
author_sort Paolo Gisondi
title Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis
title_short Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis
title_full Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis
title_fullStr Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis
title_full_unstemmed Psychological Stress and Salivary Cortisol Levels in Patients with Plaque Psoriasis
title_sort psychological stress and salivary cortisol levels in patients with plaque psoriasis
publisher MDPI AG
publishDate 2021
url https://doaj.org/article/7bb52b174c4e4807894b59b65396e95d
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