Psychological stress and psoriasis: a systematic review and meta-analysis

I. Snast, O. Reiter, L. Atzmony, Y. A. Leshem, E. Hodak, D. Mimouni, L. Pavlovsky*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Background: Psychological stress has long been linked with the exacerbation/onset of psoriasis. Objectives: To determine if antecedent psychological stress is associated with the exacerbation/onset of psoriasis. Methods: A search of the PubMed, PsycINFO, Cochrane library and databases was performed. Surveys evaluating beliefs about stress reactivity were analysed separately. Suitable studies were meta-analysed. Results: Thirty-nine studies (32 537 patients) were included: 19 surveys, seven cross-sectional studies, 12 case–control studies and one cohort study. Forty-six per cent of patients believed their disease was stress reactive and 54% recalled preceding stressful events. Case–control studies evaluating stressful events rates prior to the exacerbation (n = 6) or onset (n = 6) of psoriasis varied in time lag to recollection (≤ 9 months to ≥ 5 years). Pooling five studies evaluating stressful events preceding onset of psoriasis gave an odds ratio (OR) of 3·4 [95% confidence interval (CI) 1·8–6·4; I 2 = 87%]; the only study evaluating a documented stress disorder diagnosis reported similar rates between patients and controls (OR 1·2, 95% CI 0·8–1·8). Four studies evaluating stressful events prior to psoriasis exacerbation reported comparable rates with controls, whereas two found more frequent/severe preceding events among patients with psoriasis. A small prospective cohort study reported a modest association between stress levels and exacerbation of psoriasis (r = 0·28, P < 0·05). Conclusions: The association between preceding stress and exacerbation/onset of psoriasis is based primarily on retrospective studies with many limitations. No convincing evidence exists that preceding stress is strongly associated with exacerbation/onset of psoriasis.

Original languageEnglish
Pages (from-to)1044-1055
Number of pages12
JournalBritish Journal of Dermatology
Issue number5
StatePublished - May 2018


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