Christine E. Kleyn

The lasting effects of acne vulgaris can affect a patient into adulthood. For individuals with darker skin types, hyperpigmentation and keloid scarring are often considered too late in management. We present an argument for a more holistic approach to care.

Purpose: The present study explored whether people with psoriasis display an attentional bias towards disease‐related threat words and whether this bias occurs relatively early during the phase of stimulus disengagement, or during a later maintained attention phase dominated by controlled strategic processes. We also explored the degree to which attentional bias is dependent on the emotional valence of control words. Methods: Individuals with psoriasis and matched controls took part in 4 online experiments. Participants completed a spatial cueing paradigm using disease‐related threat words and control words as cues, in order to obtain reaction time estimates of attentional bias. Results: We did not observe evidence for attentional bias when control words were matched with threat words for emotional valence, regardless of whether processing time for the cues was limited (Experiment 1: SOA = 250 ms) or extended (Experiment 2: SOA = 1050 ms). We also did not observe evidence for attentional bias when control words of positive valence were used, but processing time was limited (Experiment 3). An attentional bias was only observed ( p = .012, Cohen's d = .37) when sufficient processing time was available and positively‐valanced control words were used (Experiment 4). Conclusion: Rather than showing large and generalized AB effects as predicted by previous accounts, our results tentatively suggest that AB in psoriasis is restricted to situations where participants have ample processing time and threat words are easily distinguishable from control words on the basis of emotional valence. The pattern of results suggests that attentional bias in psoriasis is best characterized as a relatively slow strategic process.

Background: Despite some evidence that psoriatic arthritis (PsA) may increase psychological burden in psoriasis, the mental health of this subpopulation is under-investigated. Objectives: To investigate whether PsA is associated with higher depression and anxiety in moderate-to-severe psoriasis; explore whether pain mediates these associations; and estimate the prevalence of undiagnosed and untreated depression. Methods: Baseline data from British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) participants completing the Hospital Anxiety and Depression Scale (HADS) were analysed. Results: 707 patients (n = 540 with psoriasis only; n = 167 with PsA) were included. Depression prevalence was higher in patients with than without PsA, when a HADS-depression subscale cut-off ≥8 was used (33% vs. 23%, adjusted Odds Ratio [OR] (95% Confidence Intervals [CI]) = 1.64 (1.09–2.45)), but did not differ using the HADS cut-off ≥ 11. Anxiety prevalence was higher among PsA patients, regardless of HADS cut-off (cut-off ≥11: adjusted OR (95% CI) = 1.62 (1.07–2.45)). Pain fully mediated the effect of PsA on depression and anxiety in psoriasis. 53.6% of participants identified as depressed did not have a known psychiatric disorder; two thirds of depressed participants were not treated. Conclusions: PsA comorbidity in psoriasis is associated with higher anxiety; its association with depression appears to be robust when milder depressive syndromes are included, but less consistent for higher-threshold depression definitions. Depression remains unrecognized and untreated in over half of moderately-to-severe psoriasis patients. Routine depression and anxiety screening is recommended in psoriasis and PsA. PsA comorbidity may increase depression and anxiety in psoriasis through pain experience.

Background: Illness perceptions in psoriasis have an impact on adherence and disability. Changes in dermatological healthcare provision during the Covid-19 pandemic and distress may have affected illness perceptions in psoriasis patients. Objectives: To test whether illness perceptions about psoriasis changed during the first year of the Covid-19 pandemic compared to pre-pandemic in a tertiary population with psoriasis and whether pandemic effects differed depending on depressive burden, given this population's high depression prevalence. Methods: In a cross-sectional survey of n = 188 tertiary patients with dermatologist-confirmed psoriasis recruited before and during the pandemic, eight illness perceptions domains were assessed using the Brief-Illness Perceptions Questionnaire (BIPQ). Presence of depression was assessed with the Hospital Anxiety and Depression Scale (HADS). Results: Beliefs about treatment control and patients' understanding of psoriasis were significantly worse in patients responding during the pandemic compared to before Covid-19. These differences were greater when depression was absent (treatment control: adjusted p < 0.001; coherence: adjusted p = 0.01). However, participants during the pandemic felt less emotionally affected (adjusted p = 0.02) and concerned (adjusted p = 0.007) about psoriasis, independently of depression. Conclusions: We found diverse pandemic effects on illness perception domains in psoriasis. Uncertainty and reduced healthcare access may drive poorer treatment and coherence beliefs during Covid-19. These beliefs can hinder patients' health-promoting behaviours and may explain the high pandemic non-adherence reported previously in psoriasis. Appropriate interventions are needed to establish positive long-term cognitions and improve psoriasis management, for example, using the PsoWell patient materials. Dermatology services should invest in engaging and educating patients regardless of concurrent psychological distress.

Dear Editor,At the beginning of the first wave of the COVID-19 pandemic, hospitals were advised to limit face-to-face patient contact, given the concerns over nosocomial-acquired infection [1]. Fac...

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A cohort study of patients with moderate‐severe psoriasis registered to the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) determined that there was no association between developing a first basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) following treatment with biologic therapy when compared to non‐biologic systemic therapies.