The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials

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.