Effect of phototherapy on psychoemotional state in psoriasis: assessment of depression, anxiety and quality of life

BACKGROUND: Psoriasis is a widespread chronic genetically determined inflammatory dermatosis that affects approximately 125 million people worldwide. In the vast majority of cases, the first rashes appear in people younger than 35 years old who are just starting to build a career and start a family. Localization of psoriatic rashes on visible areas of the skin and stigmatization in society, regular exacerbations and multiple courses of expensive and insufficiently effective treatment negatively affect the quality of life and emotional state of patients up to the development of depressive and anxiety disorders, and even suicide attempts. An imbalance of mental status leads to the progression of psoriasis, which further aggravates the course of the skin process. This necessitates a personalized approach to the choice of a therapy method, taking into account high efficiency and maximum comfort for patients, which will improve their psychoemotional state.

AIM: to study the effect of phototherapy (PUVA and UVB-311 nm) on the mental status of psoriasis patients

MATERIALS AND METHODS: A prospective study was conducted on the basis of FGKU “Central Polyclinic” and V.A. Rakhmanov’s clinic of skin and venereal diseases of Sechenov University with the participation of 228 patients with moderate-to-severe psoriasis who received UVB-311 nm (n=116) and PUVA therapy (n=112), including psoriasis vulgaris (n=193), guttate psoriasis (n=14), exudative psoriasis (n=21). Before and after treatment, patients were assessed for the severity of psoriasis (PASI), quality of life (DQLI), as well as the presence of depression and anxiety disorders (panic disorder, social phobia) using PHQ-9 and GAD-7 questionnaire tests. The initial radiation dose was 1 J/cm² at PUVA and 0.1–0.2 J/cm² at UVB-311 nm with a gradual increase in the dose every 1–2 sessions by 0.5 J/cm² and 0.1 J/cm², respectively. As photosensitizers ammifurin and oxoralen were used. The treatment was carried out according to the method of four-time irradiation per week using the UV-7001K cabin (Waldmann, Germany).

RESULTS: Among 228 patients there were 108 women and 120 men aged 43±8.2 years. The UVB-311 nm group included 102 patients with moderate psoriasis vulgaris and 14 – guttate psoriasis, the second group (PUVA) included patients with severe recalcitrant psoriasis vulgaris (n=91) and exudative psoriasis (n=21). In the first group, the course of therapy consisted of 28±2 procedures of UVB-311 nm. Before treatment, minimal depression was observed in 19 (16%) patients, mild depression – in 87 (75%), moderate depression – in 10 (9%). A high level of anxiety was observed in 94 (81%), the average level – in 22 (19%) patients. At the end of the course of UVB, PASI 90 was achieved in 94% (n=109) of patients, PASI 100 – in 88% (n=102); at the same time, on average, anxiety decreased by 80%, depressive symptoms decreased by 73%, quality of life increased by 92%. In the second group, the PUVA course consisted of 25±3 irradiation sessions. Before starting therapy, minimal depression was observed in 12 (11%) cases, mild depression – in 73 (65%), moderate depression – in 27 (24%). A high level of anxiety was characteristic of 100% of patients. As a result of therapy, PASI 90 was achieved in 95.5% (n=107) of cases, PASI 100 – in 90% (n=101). The average severity of anxiety, depression, and quality of life improved by 88%, 83%, and 96% respectively.

CONCLUSION: PUVA and UVB-311 nm have demonstrated high efficacy and safety in moderate-to -severe psoriasis, contributing to the rapid cleansing of the skin from rashes and improving the psycho-emotional state, which not only significantly improves the quality, but also increases the life expectancy of patients.

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