Background: The purpose of the study was to evaluate the possible role of stress before the onset/extension/recurrence of psoriasis.
Patients and method: One hundred and sixty-nine outpatients with psoriasis and 169 age and gender matched controls were enrolled. The design was a case-control study (controls had skin diseases with low psychosomatic component). Stressful life events were evaluated using Holmes and Rahe's Social Readjustment Rating Scale.
Results: In the psoriatic group, there was a female predominance (66%) and a median age 47.55 years (SD = 20.32). In all, 10.65% of patients had family history of psoriasis. More than 54% of cases experienced at least one stressful event (47.36% for onset, 63.51% for recurrence/extension), compared with 19.52% of controls (chi(2) = 42.71, P < 0.0001). The odds ratio was 4.92. There was a significant difference in the mean number of stressful events between patients and controls (P < 0.0001). Women with psoriasis vulgaris and men with guttate psoriasis seemed to be more sensitive to stressful events. We divided the events described by Holmes and Rahe into three categories: family, personal, and job/financial problems. Family matters were mentioned by 42.7% of psoriatic patients, statistically significant compared with controls (P < 0.0001). In 35% of psoriatic cases, "the stressful event" was represented by the illness/death of someone dear. Both "personal" (25.6%; P = 0.02) and "job/financial problems" (31.6%; P < 0.0001) were significantly different compared with controls.
Conclusions: Stressful events could be highly related to psoriasis (especially in recurrences/extensions). Problems related to family are the most often involved with counseling being suggested.