The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials
Received 19 November 2018
Accepted for publication 14 January 2019
Published 7 February 2019 Volume 2019:12 Pages 97—106
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Mei-chun Cheung
Yi Xiao,1–3,* Xingyu Zhang,4,* Dan Luo,4 Yehong Kuang,1–3 Wu Zhu,1–3 Xiang Chen,1–3 Minxue Shen1–3
1Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; 2Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China; 3Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China; 4Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
*These authors contributed equally to this work
Background: Previous observational studies have shown comorbidity between psoriasis and psychological disorders. However, the evidence of the efficacy of psychological interventions, including cognitive behavioral therapy (CBT) and other treatments, on psoriasis is still debated.
Objectives: The aim of this study was to systematically review the psychological interventions used in the treatment of psoriasis and to meta-analyze the efficacy of psychological interventions on psoriasis with respect to area and severity reduction.
Materials and methods: A systematic review and meta-analysis were conducted. PubMed, Web of Science, EMbase, and major Chinese academic journal databases were searched for articles published before January 2018. Studies of randomized controlled trials (RCTs) that applied psychological interventions in the treatment of psoriasis and used area and severity as the outcome measures were meta-analyzed. The pooled mean difference between groups was estimated using either fixed-effects models or random-effects models in the presence of heterogeneity. Subgroup analysis was performed by method of intervention and severity of psoriasis.
Results: Out of the 4,152 potentially relevant studies, 8 RCTs were included. The pooled mean difference was –1.36 (95% CI: –2.52 to –0.19; P=0.02). The pooled estimate was –1.80 (95% CI: –2.57 to –1.03; P<0.001) for CBT intervention and was –0.70 (95% CI: –2.39 to 0.99; P=0.42) for non-CBT intervention. The pooled estimates for mild and moderate-to-severe psoriasis were –1.95 (95% CI: –3.91 to 0.00; P=0.05) and –0.61 (95% CI: –1.61 to 0.38; P=0.23), respectively.
Conclusion: CBT is effective in the treatment of psoriasis in terms of area and severity reduction. Systemic treatment does not further enhance the efficacy of CBT. The effect of the psychological intervention is stronger in patients with moderate-to-severe psoriasis.
Keywords: psoriasis, psychological intervention, cognitive behavioral therapy, randomized controlled trial, meta-analysis
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