Four Weeks of Biologic Treatment are Sufficient to Normalize Blunted HPA-Axis Activity and Significantly Improve Psychological Burden in Patients with Psoriasis.

PURPOSE: Psoriasis is associated with substantial psychological burden and dysregulation of endocrine pathways, including the hypothalamic-pituitary-adrenal (HPA) axis. Although biologic therapies improve skin disease, early changes in psychological burden and HPA-axis activity remain insufficiently characterized. This study addresses this scientific gap.

PATIENTS AND

METHODS

This prospective observational study analyzed data from n = 50 patients with moderate-to-severe psoriasis who were assessed at baseline and after 4 weeks of biologic therapy, and from n = 50 matched healthy controls evaluated at baseline. Primary psychological outcomes were depressive symptoms, anxiety, and perceived stress, measured using Beck's Depression Inventory (BDI), the State-Trait Anxiety-Depression Inventory (STADI), and the Perceived Stress Scale (PSS). Plasma cortisol levels were analyzed in a sampling-time-matched subgroup of n = 25 patients and n = 25 healthy controls.

RESULTS

At baseline, patients with psoriasis showed pronounced psychological distress compared with healthy controls, including higher depressive symptoms, state and trait anxiety, state and trait depression, and perceived stress. After 4 weeks of biologic treatment, patients with psoriasis showed significant improvements in BDI, STADI state anxiety, STADI trait anxiety, and PSS scores (all p ≤0.002). By week 4, BDI scores, trait anxiety, and perceived stress were no longer different between patients and controls according to Bonferroni-adjusted tests. Baseline plasma cortisol in patients with psoriasis was lower than in controls (p =0.015) and increased significantly after 4 weeks (p =0.008), no longer differing from healthy controls (p =0.839). Concurrently, PASI decreased from 16.9 to 7.2 after 4 weeks of biologic therapy (p <0.001).

CONCLUSION

After only 4 weeks of biologic therapy, patients with psoriasis showed marked improvement in psychological burden, and plasma cortisol shifted from a reduced baseline level toward the range observed in healthy controls, consistent with early normalization of HPA-axis activity.