Table_6_Childhood Trauma and Psychosocial Stress Affect Treatment Outcome in Patients With Psoriasis Starting a New Treatment Episode.docx

ObjectiveTraumatic childhood experiences and psychosocial stress may predispose the evolvement of somatic diseases. Psoriasis is a multifactorial chronic inflammatory skin disease that often associates with current and past stress. Both may entail pathological alterations in major stress axes and a balance shift in the level of T helper type 1 (Th1) and 2 (Th2) cytokines, affecting the development and course of psoriasis. Until now, it is unclear whether traumatic stress experiences during the childhood or current stress are more frequent in psoriatic compared to skin-healthy individuals, and if they interact with treatment outcome.
MethodIn a prospective cohort study, the impact of acute and early childhood stress on the course of dermatological treatment were studied in patients with moderate to severe psoriasis (PSO). Patients were examined before (T1) and about 3 months after (T2) the beginning of a new treatment episode. Assessments included clinical outcomes (Psoriasis Area and Severity Index—PASI, Structured Clinical Interview SCID-I) and patient-reported outcomes (PRO) (Childhood Trauma Questionnaire-CTQ, Perceived Stress Scale-PSS, itching/scratching, Dermatology Life Quality Index-DLQI, Hospital Anxiety and Depression Scale, Body Surface Area, Self-Administered PASI).
ResultsN = 83 PSO patients (median age 53.7, IQR 37.8, 62.5) and n = 66 skin-healthy control subjects (HC) (median age 51.5, IQR 33.3, 59.2) participated. PSO had higher CTQ physical neglect than HC, as well as higher PRO levels. The positive impact of improved skin on the skin-related quality of life was moderated by the perceived stress. Acute stress at T1 had a positive effect both on the skin severity and the skin-related quality of life. CTQ total closely interacted with baseline psoriasis severity, and was associated with higher improvement from T1 to T2.
ConclusionOne might tentatively conclude, that chronic psychosocial stressors like childhood maltreatment may predispose the manifestation of psoriasis. The latter may be amplified by acute psychological stressors. In addition, the present evidence suggests that systemic therapies work well in PSO, with childhood trauma and acute psychosocial stress. Both should therefore be routinely assessed and addressed in PSO.

研究目的：童年创伤性经历与社会心理应激可能诱发躯体疾病的发生发展。银屑病（Psoriasis）是一种多因素慢性炎症性皮肤病，常与当前及既往应激事件相关。二者均可引发主要应激轴的病理改变，并导致1型辅助性T淋巴细胞（Th1）与2型辅助性T淋巴细胞（Th2）细胞因子水平失衡，进而影响银屑病的发生与病程进展。迄今为止，相较于皮肤健康人群，银屑病患者的童年创伤性应激经历或当前应激水平是否更高，以及二者是否会与治疗结局产生交互作用，仍尚不明确。

研究方法：本前瞻性队列研究针对中重度银屑病（PSO）患者，探讨急性应激与童年早期应激对皮肤病治疗进程的影响。所有患者均于新治疗疗程开始前（T1）及治疗开始后约3个月（T2）接受评估。评估内容涵盖临床结局指标：银屑病面积与严重性指数（Psoriasis Area and Severity Index, PASI）、结构化临床访谈SCID-I；以及患者报告结局指标（PRO）：童年创伤问卷（CTQ）、感知压力量表（PSS）、瘙痒/搔抓情况、皮肤病患者生活质量指数（Dermatology Life Quality Index, DLQI）、医院焦虑与抑郁量表、体表面积、自评PASI。

研究结果：本研究共纳入83例银屑病患者（中位年龄53.7岁，四分位间距37.8~62.5）与66名皮肤健康对照者（HC，中位年龄51.5岁，四分位间距33.3~59.2）。银屑病患者的童年创伤问卷躯体忽视维度得分及总体患者报告结局指标水平均高于健康对照。皮肤状况改善对皮肤相关生活质量的积极影响，会受到感知应激水平的调节。T1时点的急性应激水平，同时对皮肤严重性评分及皮肤相关生活质量产生正向影响。童年创伤问卷总分与银屑病基线严重程度存在显著交互作用，且与T1至T2期间更高程度的病情改善相关。

研究结论：本研究可初步得出结论：童年虐待等慢性社会心理应激因素可能诱发银屑病的发生，而急性心理应激因素可进一步加重病情。此外，本研究结果显示，无论患者是否合并童年创伤与急性社会心理应激，系统性治疗对银屑病均具有良好疗效。因此，临床诊疗中应常规评估银屑病患者的创伤与应激情况，并予以针对性干预。