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Neurocognitive Responses in Psoriasis Patients

Imaging in patients with psoriasis shows brain changes that blunt responses to expressions of disgust in others.

Psoriasis can have profound emotional effects. Patients have a disproportionately high prevalence of depression and report a greater emotional impact of their disease on quality of life than patients with cancer, heart disease, or diabetes. In this study, investigators examined neurocognitive responses to facial expressions of disgust in patients with psoriasis.

Reactions of 13 men with mild-to-moderate chronic plaque-type psoriasis (mean PASI score, 5.3 ± 3.6) were compared with reactions of 13 age- and sex-matched controls. Rates of anxiety and depression did not differ between groups. The subjects were presented with neutral, disgusted, and fearful facial expressions during functional magnetic resonance imaging (fMRI). Compared with controls, the patients had blunted reactions in the insula cortex, the area of the brain that controls response to expressions of disgust. Moreover, patients were less able than controls to identify different intensities of disgust on the FERT facial expression recognition task. Patients, however, did not react significantly differently from controls on fMRI in response to fearful faces or to fear and sadness in the FERT. The authors speculate that psoriasis patients develop a subdued response to expressions of disgust as a means of coping with their disease.

Comment: These findings provide more evidence of the serious emotional impact of psoriasis. It is worth noting that the patients in this study did not have particularly extensive disease. Physicians need to be aware of these effects, even in patients with mild involvement, because emotional support may be just as important to them as the topical and systemic agents used to treat the skin disease.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology October 2, 2009

Citation(s):

Kleyn CE et al. Diminished neural and cognitive responses to facial expressions of disgust in patients with psoriasis: A functional magnetic resonance imaging study. J. Invest Dermatol 2009 Aug 27; [e-pub ahead of print]. (http://dx.doi.org/10.1038/jid.2009.152)

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• Neurocognitive Responses in Psoriasis Patients
  June M. Spooner, 2 Oct 2009 11:39 PM EST
  In reference to this article could it be possible that some cases of psoriasis could be caused by an underlying... [more]
• Psoriasis' Patients' fMRIs
  GP Gilmore, 4 Oct 2009 8:50 PM EST
  It will be interesting to apply this finding's premise to other similarly-challenged individuals