Researchers at Yale School of Medicine have identified a significant association between psoriasis and obsessive-compulsive disorder (OCD), a psychiatric disorder characterized by compulsive behaviours and intrusive thoughts. The study found that individuals with psoriasis had a 1.5-fold increased likelihood of being diagnosed with OCD.
Published in the Archives of Dermatological Research, the study utilized data from the All of Us Research Program, a U.S. National Institutes of Health initiative, which provided a diverse dataset from more than 250,000 U.S. participants. This research marks the first demonstration of this link in American adults, expanding on previous findings in Taiwanese and Swedish populations.
Psoriasis affects more than 8 million individuals in the U.S., while OCD impacts between 2 and 3 million people. Dr. Jeffrey Cohen, assistant professor of dermatology and principal investigator of the study, emphasized the potential for dermatologists to identify mental health disorders in patients with psoriasis, facilitating timely referrals to mental health professionals.
The study evaluated several potential mechanisms for the observed association. Symptoms of psoriasis, such as chronic itching and disfigurement, may heighten the risk of developing OCD. Conversely, OCD-related behaviours such as excessive washing or bathing could exacerbate psoriasis symptoms. “Excessive bathing can dry the skin and flare psoriasis. The itch of psoriasis can lead to a lot of scratching that can become a compulsion,” Dr. Cohen said in a news release.
Both conditions are linked to elevated levels of inflammatory cytokines, including IL-2, IL-6, and TNF-α, suggesting a shared inflammatory pathway. Genetic predispositions may also play a role, as families with a history of OCD show higher rates of immune-mediated diseases, including psoriasis.
The All of Us database's diverse participant pool was instrumental in this research, offering insights into underrepresented groups in biomedical studies. Dr. Cohen has leveraged this resource since 2021 to explore other psychodermatological associations, such as eczema with eating disorders and atopic dermatitis with OCD.
Despite these findings, mental health considerations remain underemphasized in dermatology practice, he said. Dr. Cohen advocates for increased awareness and integration of mental health assessments in dermatologic care, highlighting the pivotal role dermatologists can play in early identification and intervention for mental health concerns.
“We’re interested in the overlap between psychiatric disease and inflammatory skin disease,” Dr. Cohen said in the release, adding “In dermatology, we’re not that great at asking about certain mental health disorders that may be relevant . . . But if we identify it, if we see that someone might be at risk, we could put the wheels in motion to try to get them thoroughly evaluated and, if needed, treated for whatever it is that’s going on, in addition to what we’re doing for their skin.”
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