Psoriasis and Psychiatric Disorders: Current Evidence on Depression, Anxiety, Psychosocial Burden, and the Skin-Brain Axis - A Narrative Review

Background: Psoriasis is a chronic immune-mediated inflammatory disease associated with substantial physical, psychological, and social burden. Beyond cutaneous manifestations, increasing evidence suggests a close relationship between psoriasis and psychiatric disorders, particularly depression and anxiety. Although psychosocial consequences such as stigmatization, social withdrawal, impaired body image, and reduced quality of life contribute significantly to mental distress, contemporary research also indicates that shared biological mechanisms may underlie this association. Objective: This narrative review aims to summarize current evidence regarding the relationship between psoriasis and psychiatric disorders, with particular emphasis on depression, anxiety, psychosocial burden, stigma, and biological mechanisms involved in the skin-brain axis. Methods: A narrative review was conducted based exclusively on twenty-nine peer-reviewed publications provided for this manuscript. The included literature comprised systematic reviews, meta-analyses, cross-sectional studies, observational investigations, neuroimaging studies, psychophysiological research, and psychodermatology reviews published between 2013 and 2026. Findings were synthesized qualitatively and organized into thematic domains. Results: The reviewed literature consistently demonstrates increased prevalence of depression, anxiety symptoms, social anxiety, emotional dysregulation, self-stigmatization, and psychological distress among individuals with psoriasis. Psychosocial mechanisms include visible lesions, shame, perceived rejection, social avoidance, impaired sexual and occupational functioning, and reduced quality of life. At the same time, shared biological pathways involving TNF-alpha, IL-6, IL-17, IL-23, HPA-axis dysregulation, neuropeptides, neurotransmitter alterations, neurotrophins, and neuroimmune signaling provide a plausible mechanistic link between psoriasis and psychiatric symptoms. Conclusions: The relationship between psoriasis and psychiatric disorders extends beyond psychosocial burden alone. Current evidence supports a bidirectional interaction involving inflammatory, neuroendocrine, neuroimmune, psychological, and social mechanisms. Routine screening for psychiatric symptoms and integration of psychodermatological care into psoriasis management may improve both dermatological and mental health outcomes.