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.