To the Editor: In their Commentary on the Archives of Dermatology article describing the association between obesity, smoking and psoriasis,1 Drs Lebwohl and Callen2 do not address the potential psychological effects of psoriasis. While they acknowledge the association between psoriasis and a sedentary lifestyle, they attribute this to higher rates of psoriatic arthritis, leading to physical limitations. However, psoriasis frequently leads to social isolation and clinical depression, with higher rates of social stigmatization and anxiety, irrespective of disease severity.3 These are independent risk factors for poor physical fitness and have negative correlations with diet, exercise, and substance use.4 Moreover, depression has been independently associated with higher cardiac mortality.5
We believe that the authors' conclusion that “clinicians should emphasize the importance of diet, exercise, and smoking cessation to patients affected by psoriasis” is insufficient. More attention must be paid to addressing the underlying psychological consequences of this skin condition that might lead some patients to unhealthy habits, including smoking, poor dietary choices, and a sedentary lifestyle. In addition, clinicians should be aware that many patients with psoriasis may be reluctant to participate in the available public exercise opportunities due to their self-consciousness about wearing athletic gear, which might reveal their condition to others. In addition to recommending diet and exercise for patients with psoriasis who are at risk for coronary artery disease, physicians should consider the need to treat psychological factors that may contribute to their obesity and smoking.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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