Psychological Therapies in Management of Psoriatic Skin Disease: A Systematic Review

  • Azam A. Qureshi
  • Olabola Awosika
  • Francesca Baruffi
  • Monica Rengifo-Pardo
  • Alison EhrlichEmail author
Review Article



Psoriasis is a chronic, immune-mediated skin disease shown to have a multifaceted relationship with psychological factors. Because these factors have been shown to both worsen and result from psoriasis, an increasing number of studies have sought to investigate the efficacy of various psychological interventions in psoriasis management.


A systematic review of PubMed® and Scopus® databases was performed for studies investigating psychological interventions in psoriasis management published from 1 January 1990 through 4 November 2018. Primary articles published in English and conveying physical treatment outcomes were included, whereas articles not describing clinical outcomes were excluded. Studies supporting intervention efficacy were graded with a level of evidence according to the Scottish Intercollegiate Guidelines Network levels of evidence.


A total of 28 reports studying 27 unique sets of patients receiving psychological therapies in psoriasis management were identified, including three case reports and series and 24 clinical trials, investigating 1522 patients in total. Cognitive behavioral therapy and its variants, biofeedback, meditation and mindfulness-based therapies, hypnosis, music resonance therapy, motivational interviewing, emotional disclosure, and educational and multidisciplinary approaches have been studied in the treatment of psoriasis. Although 16 randomized controlled trials were included in this review, literature is limited by heterogeneity of methodology, analyses, and outcomes. Only 4 of 27 studies (three of which investigated cognitive behavioral therapy) were rated a level of evidence of 1+ or greater. Studies, overall, have sample sizes often < 50 patients, lack follow-up past 12 months, and have attrition rates > 20%.


Based on assigned levels of evidence, the most promising methods of psychological intervention in psoriasis include cognitive behavioral therapy, mindfulness-based therapies, motivational interviewing, and educational and interdisciplinary interventions. Further study is needed to determine the efficacy, practicality, and economic feasibility of these treatment options for patients with psoriasis.


Compliance with Ethical Standards


No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Olabola Awosika has received fellowship support from Janssen Pharmaceuticals and has no conflicts of interest that are directly relevant to the content of this article. Azam A. Qureshi, Francesca Baruffi, Monica Rengifo-Pardo, and Alison Ehrlich have no conflicts of interest that are directly relevant to the content of this article.s

Supplementary material

40257_2019_437_MOESM1_ESM.pdf (59 kb)
Supplementary material 1 (PDF 60 kb)


  1. 1.
    Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512–6.CrossRefGoogle Scholar
  2. 2.
    Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296:1735.CrossRefGoogle Scholar
  3. 3.
    Manolache L, Petrescu-Seceleanu D, Benea V. Life events involvement in psoriasis onset/recurrence. Int J Dermatol. 2010;49:636–41.CrossRefGoogle Scholar
  4. 4.
    Verhoeven EWM, Kraaimaat FW, De Jong EMGJ, Schalkwijk J, Van De Kerkhof PCM, Evers AWM. Individual differences in the effect of daily stressors on psoriasis: a prospective study. Br J Dermatol. 2009;161:295–9 (Elsevier Masson SAS).CrossRefGoogle Scholar
  5. 5.
    Fortune DG, Richards HL, Kirby B, McElhone K, Markham T, Rogers S, et al. Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy. Arch Dermatol. 2003;139:752–6.CrossRefGoogle Scholar
  6. 6.
    Pompili M, Snast I, Reiter O, Atzmony L, Leshem YA, Hodak E, Mimouni D, et al. P stress and psoriasis: a systematic review and meta-analysis. BJD. 2018;178:1044–55.CrossRefGoogle Scholar
  7. 7.
    Snast I, Reiter O, Atzmony L, Leshem YA, Hodak E, Mimouni D, et al. Psychological stress and psoriasis: a systematic review and meta-analysis. Br J Dermatol. 2018;178:1044–55.CrossRefGoogle Scholar
  8. 8.
    Stewart TJ, Tong W, Whitfeld MJ. The associations between psychological stress and psoriasis: a systematic review. Int J Dermatol. 2018;57:1275–82.CrossRefGoogle Scholar
  9. 9.
    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 Investig Dermatol. 2015;135:984–91.CrossRefGoogle Scholar
  10. 10.
    Lewinson RT, Vallerand IA, Lowerison MW, Parsons LM, Frolkis AD, Kaplan GG, et al. Depression is associated with an increased risk of psoriatic arthritis among patients with psoriasis: a population-based study. J Investig Dermatol. 2017;137:828–35 (the authors).CrossRefGoogle Scholar
  11. 11.
    Nerurkar L, Siebert S, McInnes IB, Cavanagh J. Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry. 2018;6:164–73.CrossRefGoogle Scholar
  12. 12.
    Piaserico S, Marinello E, Dessi A, Linder MD, Coccarielli D, Peserico A. Efficacy of biofeedback and cognitive-behavioural therapy in psoriatic patients: a single-blind, randomized and controlled study with added narrow-band ultraviolet B therapy. Acta Derm Venereol. 2016;96:91–5.CrossRefGoogle Scholar
  13. 13.
    Fordham B, Griffiths CEM, Bundy C. A pilot study examining mindfulness-based cognitive therapy in psoriasis. Psychol Health Med. 2015;20:121–7.CrossRefGoogle Scholar
  14. 14.
    Lambert J, Bostoen J, Geusens B, Bourgois J, Boone J, De Smedt D, et al. A novel multidisciplinary educational programme for patients with chronic skin diseases: ghent pilot project and first results. Arch Dermatol Res. 2011;303:57–63.CrossRefGoogle Scholar
  15. 15.
    Fortune DG, Richards HL, Kirby B, Bowcock S, Main CJ, Griffiths CEM. A cognitive-behavioural symptom management programme as an adjunct in psoriasis therapy. Br J Dermatol. 2002;146:458–65.CrossRefGoogle Scholar
  16. 16.
    Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing photo therapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625–32.CrossRefGoogle Scholar
  17. 17.
    Zachariae R, Øster H, Bjerring P, Kragballe K. Effects of psychologic intervention on psoriasis: a preliminary report. J Am Acad Dermatol. 1996;34:1008–15.CrossRefGoogle Scholar
  18. 18.
    Gaston L, Crombez JC, Lassonde M, Bernier-Buzzanga J, Hodgins S. Psychological stress and psoriasis: experimental and prospective correlational studies. Acta Dermato Venereol Suppl. 1991;156:37–43.Google Scholar
  19. 19.
    Linder D, Dall’olio E, Gisondi P, Berardesca E, De Gennaro E, Pennella AR, et al. Perception of disease and doctor-patient relationship experienced by patients with psoriasis: a questionnaire-based study. Am J Clin Dermatol. 2009;10:325–30.CrossRefGoogle Scholar
  20. 20.
    Hawro T, Maurer M, Hawro M, Kaszuba A, Cierpiałkowska L, Królikowska M, et al. In psoriasis, levels of hope and quality of life are linked. Arch Dermatol Res. 2014;306:661–6.CrossRefGoogle Scholar
  21. 21.
    Chen Y, Xin T, Cheng ASK. Evaluating the effectiveness of psychological and/or educational interventions in psoriasis: a narrative review. J Dermatol. 2014;41:775–8.CrossRefGoogle Scholar
  22. 22.
    Fordham B, Griffiths CEM, Bundy C. Can stress reduction interventions improve psoriasis? A review. Psychol Health Med. 2013;18:501–14.CrossRefGoogle Scholar
  23. 23.
    Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323:334–6 (BMJ Publishing Group).CrossRefGoogle Scholar
  24. 24.
    Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu Rev Clin Psychol. 2011;7:141–68.CrossRefGoogle Scholar
  25. 25.
    Van Beugen S, Ferwerda M, Hoeve D, Rovers MM, Spillekom-Van Koulil S, Van Middendorp H, et al. Internet-based cognitive behavioral therapy for patients with chronic somatic conditions: a meta-analytic review. J Med Internet Res. 2014;16(3):e88.CrossRefGoogle Scholar
  26. 26.
    van Beugen S, Ferwerda M, Spillekom-van Koulil S, Smit JV, Zeeuwen-Franssen MEJ, Kroft EBM, et al. Tailored therapist-guided internet-based cognitive behavioral treatment for psoriasis: a randomized controlled trial. Psychother Psychosom. 2016;85:297–307.CrossRefGoogle Scholar
  27. 27.
    Bundy C, Pinder B, Bucci S, Reeves D, Griffiths CEM, Tarrier N. A novel, web-based, psychological intervention for people with psoriasis: the electronic targeted intervention for psoriasis (eTIPs) study. Br J Dermatol. 2013;169:329–36.CrossRefGoogle Scholar
  28. 28.
    Shah R, Bewley A. Psoriasis: “The badge of shame”. A case report of a psychological intervention to reduce and potentially clear chronic skin disease. Clin Exp Dermatol. 2014;39:600–3.CrossRefGoogle Scholar
  29. 29.
    Koulil SS, Ferwerda M, van Beugen S, van Middendorp HT, van de Kerkhof PCM, An Riel PLCM, et al. Tailored therapist-guided internet-based cognitive-behavioural treatment for psoriasis and rheumatoid arthritis: two case reports. Acta Derm Venereol. 2018;98(2):225–33.CrossRefGoogle Scholar
  30. 30.
    Fortune DG, Richards HL, Griffiths CEM, Main CJ. Targeting cognitive-behaviour therapy to patients’ implicit model of psoriasis: results from a patient preference controlled trial. Br J Clin Psychol. 2004;43:65–82.CrossRefGoogle Scholar
  31. 31.
    Price ML, Mottahedin I, Mayo PR. Can psychotherapy help patients with psoriasis? Clin Exp Dermatol. 1991;16:114–7.CrossRefGoogle Scholar
  32. 32.
    Zachariae R, Bjerring P, Arendt-Nielsen L. Modulation of Type I immediate and Type IV delayed immunoreactivity using direct suggestion and guided imagery during hypnosis. Allergy. 1989;44:537–42.CrossRefGoogle Scholar
  33. 33.
    Zachariae R, Bjerring P. The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test. Arch Dermatol Res. 1990;282:539–43.CrossRefGoogle Scholar
  34. 34.
    Frank DL, Khorshid L, Kiffer JF, Moravec CS, McKee MG. Biofeedback in medicine: who, when, why and how? Ment Health Fam Med. 2010;7:85–91.Google Scholar
  35. 35.
    Goodman M. An hypothesis explaining the successful treatment of psoriasis with thermal biofeedback: a case report. Biofeedback Self Regul. 1994;19(4):347–52.CrossRefGoogle Scholar
  36. 36.
    Keinan G, Segal A, Gal U, Brenner S. Stress management for psoriasis patients: the effectiveness of biofeedback and relaxation techniques. Stress Med. 1995;11:235–41.CrossRefGoogle Scholar
  37. 37.
    Gotink RA, Chu P, Busschbach JJV, Benson H, Fricchione GL, Hunink MGM. Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS One. 2015;10:e0124344.CrossRefGoogle Scholar
  38. 38.
    Häuser W, Hagl M, Schmierer A, Hansen E. The efficacy, safety and applications of medical hypnosis. Dtsch Arztebl Int. 2016;113:289–96.Google Scholar
  39. 39.
    Boncz I, Farkas B, Hunyadi J. Experiences with group hypnotherapy of psoriatic patients. Aust J Clin Hypnother Hypn. 1990;11:15–20.Google Scholar
  40. 40.
    Tausk F, Whitmore E. A pilot study of hypnosis in the treatment of patients with psoriasis. Psychother Psychosom. 1999;68:221–5.CrossRefGoogle Scholar
  41. 41.
    Lazaroff I, Shimshoni R. Effects of medical resonance therapy music on patients with psoriasis and neurodermatitis—a pilot study. Integr Physiol Behav Sci. 2000;35:189–98.CrossRefGoogle Scholar
  42. 42.
    Larsen MH, Krogstad AL, Aas E, Moum T, Wahl AK. A telephone-based motivational interviewing intervention has positive effects on psoriasis severity and self-management: a randomized controlled trial. Br J Dermatol. 2014;171(6):1458–69.CrossRefGoogle Scholar
  43. 43.
    Paradisi A, Abeni D, Finore E, Di Pietro C, Sampogna F, Mazzanti C, et al. Effect of written emotional disclosure interventions in persons with psoriasis undergoing narrow band ultraviolet B phototherapy. Eur J Dermatol. 2010;20:599–605.Google Scholar
  44. 44.
    Tabolli S, Naldi L, Pagliarello C, Sampogna F, Di Pietro C, Spagnoli A, et al. Evaluation of the impact of writing exercises interventions on quality of life in patients with psoriasis undergoing systemic treatments. Br J Dermatol. 2012;167:1254–64.CrossRefGoogle Scholar
  45. 45.
    Vedhara K, Morris RM, Booth R, Horgan M, Lawrence M, Birchall N. Changes in mood predict disease activity and quality of life in patients with psoriasis following emotional disclosure. J Psychosom Res. 2007;62:611–9.CrossRefGoogle Scholar
  46. 46.
    Singh SM, Narang T, Vinay K, Sharma A, Satapathy A, Handa S, et al. Clinic-based group multi-professional education causes significant decline in psoriasis severity: a randomized open label pilot study. Indian Dermatol Online J. 2017;8:454–9.CrossRefGoogle Scholar
  47. 47.
    Van Geel MJ, Spillekom-Van Koulil S, Oostveen AM, Van De Kerkhof PCM, Klompmaker-Van Den Hoek W, Teunissen M, et al. An outpatient multidisciplinary training programme for children and adolescents with psoriasis and their parents: a pilot study. Eur J Dermatol. 2016;26:393–5.Google Scholar
  48. 48.
    Schmitt J, Wozel G, Garzarolli M, Viehweg A, Bauer M, Leopold K. Effectiveness of interdisciplinary vs. dermatological care of moderate-to-severe psoriasis: a pragmatic randomised controlled trial. Acta Derm Venereol. 2014;94:192–7.CrossRefGoogle Scholar
  49. 49.
    Balato N, Megna M, Di Costanzo L, Balato A, Ayala F. Educational and motivational support service: a pilot study for mobile-phone-based interventions in patients with psoriasis. Br J Dermatol. 2013;168:201–5.CrossRefGoogle Scholar
  50. 50.
    Bostoen J, Bracke S, De Keyser S, Lambert J. An educational programme for patients with psoriasis and atopic dermatitis: a prospective randomized controlled trial. Br J Dermatol. 2012;167:1025–31.CrossRefGoogle Scholar
  51. 51.
    Ersser SJ, Cowdell FC, Nicholls PG, Latter SM, Healy E. A pilot randomized controlled trial to examine the feasibility and efficacy of an educational nursing intervention to improve self-management practices in patients with mild-moderate psoriasis. J Eur Acad Dermatol Venereol. 2012;26:738–45.CrossRefGoogle Scholar
  52. 52.
    Lora V, Gisondi P, Calza A, Zanoni M, Girolomoni G. Efficacy of a single educative intervention in patients with chronic plaque psoriasis. Dermatology. 2009;219:316–21.CrossRefGoogle Scholar
  53. 53.
    Svendsen MT, Andersen F, Hansen J, Johannessen H, Andersen KE. Medical adherence to topical corticosteroid preparations prescribed for psoriasis: a systematic review. J Dermatol Treat. 2017;28:32–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University of Maryland School of MedicineBaltimoreUSA
  2. 2.Department of DermatologyHenry Ford Medical CenterDetroitUSA
  3. 3.George Washington University School of Medicine and Health SciencesWashingtonUSA
  4. 4.Department of DermatologyGeorge Washington Medical Faculty AssociatesWashingtonUSA

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