Rev. Neurosci.

2018; aop

Man Amanat, Mona Salehi and Nima Rezaei*

Neurological and psychiatric disorders in psoriasis

https://doi.org/10.1515/revneuro-2017-0108
Received December 12, 2017; accepted January 26, 2018
Abstract: Psoriasis used to be known as a skin disorder;
however, it can now be considered as a systemic disease
with the involvement of multiple organs. Neurologi-
cal and psychiatric disorders are some of the associated
problems that can be observed in patients with psoriasis.
Stroke, multiple sclerosis, seizure, migraine, restless leg
syndrome, Parkinson’s disease, Guillain-Barré syndrome,
and myasthenia gravis are the reported neurological dis-
eases, while depression, bipolar mood disorder, anxiety,
psychosis, cognitive impairment, personality disorders,
sexual disorders, sleep disturbance, and eating disorders
are the recognized psychiatric presentations in patients
with psoriasis. Herein, the neurological and psychiatric
disorders of psoriasis are described.
Keywords: anxiety; depression; migraine; multiple scle-
rosis; myasthenia gravis; Parkinson’s disease; psoriasis;
psychosis; seizure; stroke.
disease (Oka et al., 2012). On the other hand, the role of
innate and adaptive immune systems has been described
in the pathophysiology of psoriasis too (Harden et  al.,
2015; Sun et al., 2017).
Emerging evidence indicates that psoriasis not only
involves the skin but also has different systemic impacts.
In other words, about 75% of psoriasis patients have at
least one comorbidity. Hypertension, diabetes, cardio-
vascular diseases, uveitis, inflammatory bowel disease,
osteoporosis, and chronic obstructive pulmonary disease
are some of the examples (Machado-Pinto et  al., 2016).
Increased risk of different malignancies is also reported is
psoriasis cases (Jensen et al., 2017). Therefore, psoriasis is
currently considered as a multisystem disease rather than
exclusive skin disorder.
Various neurological and psychiatric manifestations
have also been reported in psoriasis (Table 1). Considering
psychiatric implications, they can both result from or con-
tribute to psoriasis, which can lead to a cycle of worsening
disease and mental health dysfunctions (Ferreira et  al.,
2016; Koo et al., 2017). The overall physical and psycho-
social disabilities of psoriasis can affect all the aspects of

Introduction patients’ lives. Studies reported lower quality of life and

higher costs of treatments in subjects with psoriasis and
psychiatric presentations compared to patients with pso-
Psoriasis is a chronic immune mediated disease, which is
riasis alone (Feldman et al., 2017). Focusing on neurologi-
mostly characterized by thick red scaly patches of skin. It
cal comorbidities will indicate that our knowledge about
affects 7.4 million adults in the US, and its overall preva-
the different aspects of neurological disorders associated
lence in the industrialized world population is estimated
with psoriasis is limited.
to be 2–3% (Rachakonda et al., 2014). It appears that the
In this review, we discuss about the association of
interaction of genetic and immunologic factors plays
psoriasis with all these neuropsychiatric comorbidities.
a crucial role in the development of psoriasis. In fact,
numerous genes have been recognized that increase pso-
riasis susceptibility. Moreover, a positive family history
of psoriasis was reported in 60–90% of patients with the Neurological disorders

*Corresponding author: Nima Rezaei, Research Center for Stroke

Immunodeficiencies, Children’s Medical Center, Tehran University of
Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran 14194, Iran;
Department of Immunology and Biology, School of Medicine, Tehran
University of Medical Sciences, Tehran 14155-6447, Iran; and Network
of Immunity in Infection, Malignancy and Autoimmunity (NIIMA),
Universal Scientific Education and Research Network (USERN),
Boston, MA 1419733151, USA, e-mail: rezaei_nima@tums.ac.ir
Man Amanat and Mona Salehi: NeuroImmunology Research
Association (NIRA), Universal Scientific Education and Research
Network (USERN), Tehran 14194, Iran; and Students’ Scientific
Research Center, Tehran University of Medical Sciences,
Tehran 1417755331, Iran
Various risk factors have been described for the occur-
rence of stroke, including diabetes, hypertension,
smoking, alcohol consumption, psychosocial factors,
cardiac causes, and transient ischemic attacks (O’Donnell
et al., 2016). Many of these factors have been reported as
psoriasis comorbidities. Therefore, a high prevalence of
stroke in psoriasis due to the presence of these factors
is expectable. However, a large-scale study on mild pso-
riasis patients, cases with severe psoriasis, and matched

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2      M. Amanat et al.: Neurological and psychiatric disorders in psoriasis
Table 1: Neurological and psychiatric disorders in psoriasis.
Neurological disorders   Psychiatric disorders
Multiple sclerosis   Depression
Epilepsy Bipolar mood disorder
Migraine Anxiety
Restless leg syndrome Psychosis
Guillain-Barré syndrome Cognitive impairment
Myasthenia gravis Personality change
Sexual disorders
Sleep disturbance
Eating disorders
controls indicated that the unadjusted risk of stroke in mild
psoriasis subjects was less than in the control group and
significantly higher in severe cases. The interesting part of
the article was that by stratification of major risk factors
of stroke, both mild psoriasis and severe psoriasis were
shown to be independent risk factors for stroke (Gelfand
et al., 2009). Overall, the risk of stroke occurrence in mild
and severe psoriasis is 1.10 [95% confidence interval (CI):
1.10–1.19] and 1.38 (95% CI: 1.20–1.60), respectively (Raaby
et al., 2017). It appears that acute and chronic depression
in psoriasis patients are both related to increased risk of
stroke (Egeberg et al., 2015a).
Multiple sclerosis
The effectiveness of fumarates in treatment of both mul-
tiple sclerosis (MS) and psoriasis suggested that these
diseases may have common pathogenesis (Metz et  al.,
2015). In fact, both of these inflammatory disorders have
similarities in genetic risk variants and inflammatory
pathways. Nearly 5% of MS patients were reported to have
psoriasis, and the incidence of psoriasis was 54% greater
in the MS population than in matched subjects (Marrie
et al., 2017). On the opposite side, increased incidence of
MS was reported in psoriasis patients too (Egeberg et al.,
2016c; Guido et al., 2017). A recent Danish study demon-
strated that among cases with psoriasis, severity was sig-
nificantly associated with increased risk of MS (Egeberg
et  al., 2016c). In other words, the incidence rates of MS
per 10  000 person-years were 3.22 (95% CI: 2.57–4.04),
4.55 (95% CI: 2.52–8.22), and 1.78 (95% CI: 1.74–1.82)
for mild psoriasis, severe psoriasis, and control group,
respectively. After stratification for possible confound-
ers, this rate was still higher in severe and mild psoriasis
population compared to the reference group. The inter-
action of MS and psoriasis on each other and on overall
prognosis of patients is not fully understood. However,
it seems that the presence of psoriasis is associated with
slower progression of MS, longer time to relapses, and
longer time to significant neurological disability scores
(Miron et al., 2017).
Epilepsy
Seizure as a manifestation in psoriasis was reported in
case-report studies (Gadzia and Turner, 2010). However,
in those individuals, progressive multifocal leukoenceph-
alopathy as the result of using efalizumab was the etiology
of seizures. The association between psoriasis and occur-
rence of unprovoked seizures (epilepsy) was first reported
by Lindegård (1986). The study demonstrated increased
risk of epilepsy among psoriasis females who were born
from 1911 to 1922. Investigating the intake of comedica-
tions related to comorbidities of psoriasis indicated that
the use of anticonvulsant agents among psoriasis patients
was 4.37-fold greater than in the control group [odds ratio
(95% CI): 4.37 (2.81–6.79); adjusted odds ratio (95% CI):
4.20 (2.68–6.60); p < 0.001] (Gerdes et  al., 2008). The
study of 23 542 cases with psoriasis proved that the risk
of epilepsy was considerably higher than in the general
population [odds ratio (95% CI): 1.9 (1.6–2.3)] (Ong et al.,
2014). Moreover, increased risk of epilepsy was reported in
pediatric psoriasis too (Ong et al., 2014; Kelati et al., 2017).
To date, many aspects of epilepsy occurrence in psoriasis
subjects such as common types, prevalence, and factors
associated to seizures remain under question.
Migraine
Migraine is mostly characterized by moderate to severe
recurrent unilateral and pulsatile headache with or
without aura (MA and MO, respectively). MA and MO are
related to 23 and 12 comorbid conditions, respectively
(Le et  al., 2011). The association between psoriasis and
migraine has been described in four studies (Le et al., 2011;
Egeberg et al., 2015b; Capo et al., 2018; Galili et al., 2017).
The risk of migraine occurrence in patients with psoriasis
was detected to be greater in females than males. More-
over, the prevalence and number of crises of MA were sig-
nificantly higher than in the general population and
individuals with MA and without psoriasis, respectively.
However, no difference was reported in the number of MO
crises. Of note, the score of psoriasis severity (psoriasis
area and severity index, or PASI) was shown to be signifi-
cantly higher among psoriasis cases with migraine (Capo
et al., 2018). In contrast, the result of a population-based
study was inconsistent with the other above-mentioned
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 M. Amanat et al.: Neurological and psychiatric disorders in psoriasis      3
ones and no evidence was found to show correlation
between psoriasis and high risk of migraine (Yang et al.,
2011). Another study indicated that migraine was only
associated with moderate to severe psoriasis (Galili et al.,
2017). Overall, according to limited number of studies,
more investigations in this area need to be performed.
Restless leg syndrome
Restless leg syndrome (RLS) or Willis-Ekbom disease is a
chronic progressive movement disorder of the limbs that
is characterized by an urge to move the legs accompanied
by unpleasant sensations starting at rest. About 2–3%
of people in the US suffer from this neurological disease
(Muth, 2017). The higher prevalence of RLS in psoria-
sis was reported in five studies (Table 2). However, their
results were not completely consistent with each other.
One study (Schell et al., 2015) indicated that the onset age
of RLS in patients with psoriasis was lower than in cases
with RLS alone (without psoriasis). Although RLS is more
frequent in women, no gender preference was reported
in cases with both psoriasis and RLS. Considering the
interaction of these two disorders with each other, the
presence of psoriasis was associated with more severity
of RLS. On the other hand, no difference in PASI scores
of cases with and without RLS was observed. Consider-
ing quality of life, it seems that the co-occurrence of pso-
riasis and RLS may lead to greater impairment in quality
of life compared to cases with psoriasis alone. Another
study (Temel et al., 2016) reported that no significant dif-
ferences among psoriasis and psoriasis with RLS groups
were found considering age, sex, body mass index, and
Table 2: Characteristics of studies that reported the link between
psoriasis and RLS.
Study   Samples   Number   Rate of RLS
Duffin et al.   Psoriasis   188  
(2009)   Psoriatic arthritis   86  
  Control   169  
Cicek et al.   Active atopic dermatitis   65  
(2012)   Inactive atopic dermatitis   55  
  Psoriasis   50  
  Control   83  
Bilgic et al.   Psoriasis   44  
(2013)
Schell et al.   Psoriasis   300  
(2015)   Control   300  
Temel et al.   Psoriasis   114  
(2016)   Control   67  
PASI. Regarding comorbid conditions, depression was
more frequent in cases with psoriasis and RLS, while the
prevalence of hypertension was higher among patients
with psoriasis alone.
Parkinson’s disease
Only four studies investigated the correlation between
psoriasis and risk of the development of Parkinson’s
disease (PD) (Rugbjerg et  al., 2009; Li et  al., 2012; Sheu
et  al., 2013; Chung et  al., 2015). Although increased risk
was reported in all studies, statistical significance was not
achieved in two of them (Rugbjerg et  al., 2009; Li et  al.,
2012). Overall, the risk of PD occurrence in psoriasis was
1.38-fold greater than in healthy individuals (Ungprasert
et  al., 2016). Of note, a population-based study revealed
no association between PD and increased risk of psoriasis
(Pupillo et  al., 2016). Overall, further large-scale studies
should be performed to resolve these conflicting results.
Other neurological disorders
Only two and four case-report studies specifically dis-
cussed that psoriasis is associated with Guillain-Barré
syndrome (GBS) and myasthenia gravis, respectively
(Table 3). However, the coexistence of psoriasis and GBS
was also mentioned in other few studies (Fagius et  al.,
1985; Shin et  al., 2006). Overall, more attention on dif-
ferent neurological comorbidities in psoriasis is essential
because it can be so helpful to increase our understanding
about the pathophysiology of not only psoriasis but also
its various neurological manifestations.
Psychiatric disorders
(%)
6.4
Depression
15.1
4.1 The presence of depression in psoriasis was investi-
55.3 gated in many old and recent studies. Three large-scale
23.6 studies in the US and Europe demonstrated increased
18
risk of depression in both pediatric and adolescent
10.8
15.9
patients (Kurd et al., 2010; Kimball et al., 2012; Todberg
et al., 2017). Ninety percent was the highest prevalence
17 rate of depression reported by Kumar et al. (2011). Other
4 studies also reported a high prevalence of depressive
11.4 mood in psoriasis ranging from 6% to 78% (Dowlat-
6.0
shahi et  al., 2014; Lakshmy et  al., 2015) depending on
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4      M. Amanat et al.: Neurological and psychiatric disorders in psoriasis

Table 3: Case-report studies indicating the association between psoriasis and Guillain-Barre and myasthenia gravis.

Study   Explanation

Nakao et al.   A 42-year-old Japanese man with juvenile onset of psoriasis vulgaris. Seven months after administration of
(2016) adalimumab with initiation dose of 80 mg, followed by 40 mg twice a week, the symptoms of Guillain-Barre presented
Sargin and   A 66-year-old male with a history of chronic plaque psoriasis affected lower limbs, presented with numbness,
Gürer (2017) tingling, and weakness in his legs and was diagnosed with Guillain-Barre. No specific etiology such as drug
complication was considered for this coexistence
Brand and   A woman with positive HLAB27 and history of myasthenia gravis and thymectomy presented with psoriatic arthritis
Littlejohn (1984)
Kwan et al.   A 36-year-old male with complex partial seizures since the age of 12 years and myasthenia gravis since he was
(2000) 27 years old was diagnosed with psoriasis vulgaris since the age of 29 years
Koc and   A 53-year-old woman with a history of myasthenia gravis since the age of 35 years and thymectomy presented with
Yerdelen (2009) psoriasis at 49 years old
Takahashi et al.   A 56-year-old female with plaque-type psoriasis who presented with waddling gait, fluctuating fatigue, and ptosis
(2014) was diagnosed with myasthenia gravis with antiacetylcholine receptor antibody
A 37-year-old woman with a history of myasthenia gravis and thymectomy had psoriatic lesions that started from the
scalp, followed by the trunk and four extremities, respectively
A 47-year-old male with a history of myasthenia gravis and thymectomy presented with psoriatic lesions on his trunk,
scalp, and upper extremities

sample size, outcome definition of depression, and Anxiety

scales used for depression. Overall, a systematic review
study demonstrated that the prevalence of depressive
Considering anxiety in psoriasis, the overall preva-
symptoms was 28% using questionnaires, while the
lence rate was reported as 7–48%, which was signifi-
prevalence of clinical depression was 9%, 12%, and 28%
cantly higher than its global prevalence (Baxter et al.,
based on using antidepressant medications, Interna-
2013; Fleming et al., 2017). Moreover, The risk in severe
tional Classification of Diseases codes, and Diagnostic
psoriasis was slightly higher than in mild one (Fleming
and Statistical Manual of Mental Disorders IV, respec-
et al., 2017). The presence of psoriatic arthritis is related
tively (Dowlatshahi et al., 2014). Moreover, according to
to a higher prevalence of anxiety compared to psoriasis
a Danish nationwide cohort study, the incidence rate of
patients without arthritis (McDonough et al., 2014).
depression in severe psoriasis cases was significantly
greater than in patients with mild psoriasis (Jensen
et  al., 2016). Acute depression was shown to be asso-
Psychosis
ciated with cardiovascular diseases and stroke, while
chronic depression was only correlated with stroke
Psychosis as a comorbid disease in psoriasis was reported
(Egeberg et al., 2016b). Noted, depression not only was
in case-report studies (Shivakumar et  al., 2016; Marin
reported as a comorbid condition but also may trigger or
et al., 2017). Furthermore, seven population-based studies
worsen psoriasis (Ferreira et al., 2016).
demonstrated the association of schizophrenia and other
Various studies have discussed about the underlying
psychosis with psoriasis (Table 4). Interestingly, psoriasis
mechanism of this co-occurrence. It is now well recognized
was also shown to be in correlation with family history of
that cytokines have a great impact on the presentation of
schizophrenia and nonaffective psychosis (Eaton et  al.,
depression. In fact, increased levels of proinflammatory
2010; Benros et al., 2014a).
agents such as tumor necrosis factor-α, interferon γ, and
interleukin (IL) 6 and IL17 were reported in patients with
depression. This incline was also identified in psoriasis Cognitive impairment
(Aleem and Tohid, 2017). Therefore, we can conclude that
this common immune pathway may lead to the bidirec- Cognitive functions are crucial for perceiving and judging.
tional correlation between psoriasis and depression. Of They include information processing, attention, learning,
note, manic episodes were also reported in few cases of memory, production of language, and executive functions.
psoriasis (Demirhan et  al., 2012; Bouguéon and Misery, Different aspects of cognition are impaired in psoriasis.
2013). A study of 97 psoriasis cases presented that this disease

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 M. Amanat et al.: Neurological and psychiatric disorders in psoriasis      5

Table 4: Population-based studies mentioning the association between psoriasis and psychosis.

Study   Purpose   Reported association between psoriasis and psychosis

Eaton et al.   To investigate the prevalence of autoimmune   Psoriasis prevalence was 0.03% among schizophrenia cases vs.
(2006) disorders in schizophrenia patients and their 0.02% in a control matched group [crude IR (95% CI): 1.7 (0.4–7),
parents adjusted IR (95% CI): 1.6 (0.4–6.8)]
Psoriasis had a significantly higher prevalence among parents
of patients compared to parents of comparison individuals
[IRR (95% CI): 2.0 (1.2–3.2)]
Eaton et al.   To determine the risk of schizophrenia,   Risk of psoriasis was 1.2-fold greater among the parents or
(2010) nonaffective psychosis, and bipolar disorder sibling of both schizophrenia and nonaffective psychosis patients
in 30 autoimmune diseases compared to the control group
Psoriasis was significantly associated with an increased risk of
schizophrenia during the concurrent perioda (adjusted RR: 2.0) but
was not correlated with delayed periodb
Benros et al.  To investigate whether autoimmune diseases   The IRs of schizophrenia spectrum disorders were 2.77- and 1.37-
(2011) accompanied by exposures to severe fold greater in patients with and without infections, respectively,
infections increase the risk of schizophrenia compared to healthy individuals
Chen et al.   To determine the association between   The prevalence rate of psoriasis among the schizophrenia group
(2012) autoimmune diseases and schizophrenia was 5.180% compared to 3.504% in the control group
Psoriasis was more prevalent in males than females
Kumar et al.   To examine the prevalence of psychiatric   Paranoid schizophrenia and delusional disorder plus severe
(2013) comorbidities in patients with pemphigus and depressive episode with psychotic symptoms were each detected
psoriasis in 3.3% of psoriasis subjects
Benros et al.  To determine the risk of autoimmune diseases   The IR of psoriasis was 2.13-fold higher among patients with
(2014b) in patients with previous diagnosis of schizophrenia compared to individuals without it
schizophrenia and other related psychosis The increased risk of occurrence of psoriasis was higher in both
concurrent and delayed period in comparison to the control group
Matusiewicz  To explore the epidemiology, treatment, and   Delirium, psychosis, and psychotic and dissociative disorders
et al. (2014) comorbidities of juvenile psoriasis were found in 1.1% of patients with juvenile psoriasis
a
The first 5 years following date of onset of the condition. bFive and more years after the onset of condition.
IR, Incidence rate; IRR, incidence rate ratio.

is associated with lower psychomotor speed, diminished
efficiency of visuospatial working memory, and set shift-
ing ability as well as poorer verbal working memory and
attention compared to the control group (Marek-Józefowicz
et  al., 2017). Impairments in executive functions, visuos-
patial domain, long-term verbal memory, and attention
were also mentioned in other studies (Gisondi et al., 2014;
Sarkar et  al., 2014; Colgecen et  al., 2016). According to
these findings, it is obvious that different parts of the brain
are involved in psoriasis, such as prefrontal cortex. Neuro-
imaging of individuals with psoriasis described a signifi-
cant decline in the cortical thickness (Gisondi et al., 2014).
Cognitive impairment was correlated with neither the
severity nor the duration of the last exacerbation of the
disease. However, it was significantly associated with a
longer duration of psoriasis (Marek-Józefowicz et al., 2017).
In other words, the longer the disease lasts, the larger
brain damages occur. Of note, cognitive dysfunction is
related to a high possibility of dementia occurrence in the
future. In fact, increased risk of mortality due to demen-
tia was reported in the United Kingdom (UK) psoriasis
population (Abuabara et al., 2010). In contrast, decreased
risk was also reported in studies (Svedbom et  al., 2015;
Lee et al., 2017). Overall, the correlation between psoria-
sis and dementia has been controversial, and large-scale
studies should be performed to resolve this issue.
Personality traits
Some personality traits were shown to be more prevalent
in psoriasis. Schizoid, avoidant, dependent, and compul-
sive were more frequent personality disorders in one study
(Rubino and Zanna, 1996), whereas the most common
personality trait in another study (Mazzetti et  al., 1994)
was moody, followed by anxious and schizophrenic trait.
Alexithmia is a term that describes deficiency in
understanding, processing, and describing emotions
(Sifneos, 1973). The main dimensions of alexithmia are dif-
ficulties in identifying and describing feelings and impair-
ment of externally oriented thinking. A high prevalence
of alexithmia was reported in psoriasis as well as differ-
ent psychiatric disorders (Crosta et al., 2014; ­Korkoliakou
et al., 2014).

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6      M. Amanat et al.: Neurological and psychiatric disorders in psoriasis
Not all the studies revealed the association between
the presence of specific personality traits and psoriasis.
A study of 101 psoriasis cases did not identify any spe-
cific personality trait that was correlated with psoriasis
(Remröd et al., 2013). However, early onset of the disease
and younger age at onset of psoriasis were two variables
that were associated with seven types of personality traits:
somatic trait, anxious, psychiatric trait, stress susceptibil-
ity, embitterment, mistrust, trait irritability, and verbal
trait aggression. These conflicting results in studies can
be due to methodological differences, such as using dif-
ferent scales for personality traits.
Sexual dysfunction
Impaired sexual function has been described in pso-
riasis recently. The estimated prevalence of this psycho-
social disorder in psoriasis was reported as 22.6–71.3%
(Molina-Leyva et al., 2015). Decreased sexual desire, erec-
tile dysfunction and orgasmic disorder were all reported
in psoriasis.7 Furthermore, involvement of joints, female
gender, increasing age, genital psoriasis, and the presence
of other psychiatric morbidities, including depression as
well as hypertension and hyperlipidemia, were correlated
with a higher risk of sexual dysfunction occurrence in pso-
riasis (Gupta and Gupta, 1997; Sampogna et al., 2007; Chen
et  al., 2013; Ji et  al., 2016). Considering sexual behavior,
higher rate of unprotected sex and lower age of the first
intercourse were reported in psoriasis cases, possibly due
to their lowered self-esteem (Molina-Leyva et al., 2015).
Sleep disorders
Different studies indicated a high prevalence of sleep dis-
turbance in cases with psoriasis. Initial insomnia, noctur-
nal or early morning awakenings, and daytime sleepiness
were reported in a study (Gowda et  al., 2010). A single
study also recognized the high prevalence of narcolepsy in
psoriasis (Martínez-Orozco et al., 2014). Obstructive sleep
apnea syndrome (OSAS) is another identified comorbid
condition in psoriasis, with an approximate prevalence
of 36–81.8% (Gupta et  al., 2016). Higher mean age and
PASI score were reported in OSAS patients compared to
non-OSAS cases (Karaca et  al., 2013). Furthermore, pso-
riatic arthritis was associated with a higher risk of OSAS
in comparison to psoriasis alone (Egeberg et  al., 2016a).
An increased risk of sleep movement disorders, including
RLS and periodic limb movement disorder, was also iden-
tified in cases with psoriasis (Gupta et al., 2016). RLS has
been described in previous parts of this review.
Eating disorders
Few studies have investigated the correlation between
psoriasis and eating disorders. It is well recognized that
obesity is more prevalent in psoriasis patients than in
the general population, and eating disorder may be the
underlying cause of obesity (Villarejo et al., 2012; Fleming
et al., 2015).
Binge eating disorder (BED) is a psychiatric term that
describes recurrent episodes of eating large amounts of
food that is accompanied by loss of control. One trial con-
sidered BED as a psychological factor in the presentation
of metabolic syndrome and obesity in psoriasis cases. Fur-
thermore, more subjects with psoriasis had dissatisfac-
tion from their body shape than healthy individuals did
(Crosta et al., 2014).
Conclusion
Overall, a high prevalence of different neurological and
psychiatric disorders was reported in psoriasis cases.
Interestingly, recent studies indicated the possible role of
proinflammatory mediators in the presentation of all the
above-mentioned neuropsychiatric diseases. Therefore,
pathological changes in immune system due to the occur-
rence of psoriasis may justify this co-occurrence.
Future direction
Various aspects of psoriasis remain unknown. Different
triggers have been mentioned for psoriasis, which are also
known as its comorbid conditions. However, our knowl-
edge about this circle is so limited. Immune system dys-
function is a new hypothesis that may not only resolve our
aforementioned issue but also increase our understand-
ing about pathophysiology of psoriasis. Therefore, further
studies should investigate the role of immune system in
psoriasis and its comorbidities.
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