Patients with plaque psoriasis manifest heightened sympathetic nervous system activity, indicating a distinct stress response.

The need to assess frontal hemispherical lateralization in plaque psoriasis (PSO) and other skin diseases is important due to their connection between brain hemispheres and cognitive, behavioral, and emotional processes, explains Szabolcs Bozsányi, MD, PhD. “Chronic skin diseases such as PSO often have psychological components, and understanding the degree of lateralization between frontal hemispheres could offer insights into the links between skin diseases and psychological factors,” he says.

For a study published in the Journal of Clinical Medicine, Dr. Bozsányi and colleagues address the need to comprehensively analyze the psychophysiological and psychometric characteristics of patients with PSO and other skin diseases, seeking to uncover potential shared and distinct psychodermatological mechanisms. “We aimed to investigate hemispherical lateralization, neurovegetative responses, and psychometric characteristics in patients with PSO and other skin diseases,” Dr. Bozsányi says.

Elevated Sympathetic Nervous System Activity Found in Patients With PSO

The study team conducted frontal electroencephalogram measurements, heart rate variability assessments, and psychological tests in patients with PSO, other skin diseases, and healthy patients (patients without skin disease). Statistical analyses, including ANOVA with Bonferroni correction, were used to compare the groups.

The researchers observed significant right-lateralized prefrontal activity in patients with PSO, compared with healthy patients, indicating a shared prevalence of right-hemispheric dominance. “However, the results also highlighted distinct psychodermatological mechanisms in PSO, Dr. Bozsányi says. “For patients with PSO, they found elevated sympathetic nervous system activity. These findings emphasize the importance of understanding the psychological factors in PSO and other skin diseases and tailoring treatments accordingly.”

The key takeaway, he adds, is that patients with PSO exhibit unique patterns of behavioral systems compared with healthy patients. “Patients with PSO manifest heightened sympathetic nervous system activity, indicating a distinct stress response,” he says.

“The Future Lies in Personalized Treatment Approaches”

“These distinctions underscore the intricate interplay between psychological and physiological factors inherent in Pso and other skin diseases (Figure),” says Dr. Bozsányi. He and colleagues envision a shift toward the integration of psychodermatology in clinical practice. “The future lies in personalized treatment approaches, and our research offers the potential for more precise and individualized interventions for patients with PSO and other skin diseases.”

The study team would like to see dermatologists incorporating these findings by considering the psychological dimension alongside the physical symptoms. “This approach can help identify specific psychological factors contributing to disease onset and progression,” Dr. Bozsányi notes. “By doing so, dermatologists may in the future be able to offer tailored psychotherapeutic interventions that address negative emotions, stress, and avoidance behaviors to  enhance treatment outcomes and improve QOL.”

Future research, he adds, could delve deeper into the molecular mechanisms linking psychophysiology, immunology, and skin diseases like PSO. “Investigating the connections between psychophysiological factors, immune pathways, and cellular-level information could provide more insights,” he says, adding that understanding the causal relationships between hemispherical dominance and inflammatory diseases would be valuable. “We could also explore more personalized therapeutic interventions, building on the current findings, to improve the psychodermatological care of patients. As we venture forth into this realm of investigation, we usher in a new era of medical understanding—one that promises to revolutionize healthcare paradigms by integrating the intricate interplay between psychological and physiological dimensions.”