Journal of Palliative Care & Medicine
Open Access

Abstract

Introduction: Psoriasis is a common chronic condition that affects 1â�?�?3% of the general population and estimates suggest that 0.4â�?�?2.3% of the adult population have psoriasis but remain undiagnosed. It is commonly associated with a variety of psychological difficulties, including poor self-esteem, sexual dysfunction, anxiety, depression, and suicidal ideation. Tumor necrosis factor (TNF), �?± pro inflammatory cytokine, has been implicated in the pathogenesis of both psoriasis and depression. Patients with psoriasis and depression have elevated levels of TNF. A direct correlation exists between TNF concentrations and psoriasis symptoms as measured by Psoriasis Area and Severity Index (PASI) scores. Aim: The aim of this study was to obtain data on the extent of depression among psoriatic patients, the effectiveness of Adalimumab treatment on the depression symptoms associated with psoriasis and to explore the association between improvement in depression symptoms and improvement in Psoriasis Area and Severity Index. Methods: The effects of Adalimumab (40 mg every other week) on ZDS score and PASI at week 24 were assessed. Relationships between ZDS and PASI were assessed. Changes in ZDS score were compared to patients with and without a 75% or greater reduction in baseline PASI score. An improvement of 6 points or more in the Zung depression scale was considered a clinically meaningful improvement. Forty five patients with moderate to severe psoriasis were assessed for depression symptoms at baseline and week 24 using the Zung Self-rating Depression Scale (ZDS). Results: At month 6 after starting Adalimumab, 80% of enrolled patients achieved 75% improvement in their PASI score (PASI75) at month 6 of Adalimumab therapy and 97.8% achieved a meaningful improvement of Zung depression score (more than 6 points decline in the Zung depression score). Age at time of assessment significantly predicted depression (p=0.030), with the younger age predicting a higher depression score (standard co-efficient-0.451). Achieving PASI 75 could significantly predict improvement in depression (p=0.002, standard coefficient-0.746). Conclusion: From this study, we can conclude that Adalimumab may be associated with relief symptoms of depression in patients with moderate to severe psoriasis. Reductions in depression symptoms were significantly correlated with reductions in psoriasis severity.

Biography

Email: hananrnada.dermato@gmail.com