To the Editor: In their Commentary on the Archives of Dermatology article describing the association between obesity, smoking and psoriasis,1 Drs Lebwohl and Callen2 do not address the potential psychological effects of psoriasis. While they acknowledge the association between psoriasis and a sedentary lifestyle, they attribute this to higher rates of psoriatic arthritis, leading to physical limitations. However, psoriasis frequently leads to social isolation and clinical depression, with higher rates of social stigmatization and anxiety, irrespective of disease severity.3 These are independent risk factors for poor physical fitness and have negative correlations with diet, exercise, and substance use.4 Moreover, depression has been independently associated with higher cardiac mortality.5
Skolnick AH, Alexander ZJ. Psychiatric Implications of Psoriasis. JAMA. 2006;295(19):2249–2250. doi:10.1001/jama.295.19.2249-c
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