Psoriasis is a chronic, inflammatory skin disease with a prevalence rate of 0.09–11.43%, which has been increasing over time, affecting approximately 2% of the global population (1). Its main characteristics are scaly plaques on the skin, accompanied by pain and itching, imposing significant physical, psychological, and social burdens on patients (2). The pathogenesis of psoriasis is associated with various genetic and environmental factors (3). Environmental factors such as stress, smoking, alcohol abuse, and obesity also contribute to the development of psoriasis. The immune system plays a crucial role in the pathogenesis of psoriasis, with T-cells considered major players, particularly T-cell-mediated immune inflammatory responses, such as the IL23/IL17 axis, which is thought to play an important role in psoriasis pathophysiology (4). This axis is also involved in the development of many systemic chronic diseases, such as cardiovascular diseases, diabetes, and mental disorders, which are well-recognized comorbidities. Among them, psoriasis is believed to be associated with negative mental health outcomes, including psychosis, suicidal ideation, anxiety, depression, psych (5–10). However, the relationship between them has not been fully established. The COVID-19 pandemic has led to widespread mental health issues, including depression, anxiety disorders, stress, panic, anger, impulsivity, somatic disorders, sleep disorders, mood disorders, post-traumatic stress disorder, and suicidal behavior (11). Studies have shown that the general population experienced psychosocial stress of varying degrees during the COVID-19 pandemic and subsequently developed mental health issues (12, 13). For psoriasis patients, who are more susceptible to negative psychological states, home quarantine appears to exert a greater impact on disease control, quality of life, and mental health; however, no studies have yet explored the impact of COVID-19 home quarantine on disease severity, quality of life, and mental health in psoriasis patients in southwestern of China. Our study aimed to clarify the impact of home quarantine on disease severity, quality of life, and mental health in psoriasis patients through a multidimensional analysis of home quarantine status, psoriasis severity, quality of life, and depression scores during the COVID-19 pandemic.

In this study, we aimed to investigate whether the COVID-19 lockdown affected clinical symptoms, psoriasis-related quality of life, and mental state in patients with psoriasis in southwest of China. We found a significant correlation between lockdown status and BSA levels of patients; The level of BSA was significantly higher in patients under lockdown compared with without lockdown, and psoriasis severity was positively correlated with DLQI scores. There was also a weak but positive correlation between psoriasis severity and QIDS-SR16 scores. The QIDS-SR16 score was significantly higher in the older adult group than in the younger group.

Psoriasis is a chronic inflammatory skin disease often accompanied by comorbidities such as diabetes, cardiovascular diseases, and depression; shared genetic factors, oxidative stress, overlapping inflammatory processes, and immune dysregulation may underlie their concurrent occurrence. Previous literature has demonstrated that excessive stress can trigger psoriasis and exacerbate the condition (16). Increased sympathetic activity, pro-inflammatory factor release, and hyperactivation of the hypothalamic–pituitary–adrenal (HPA) axis are thought to play significant roles (17, 18). On the other hand, psychosocial functioning in psoriasis patients is often severely impaired, potentially leading to depression, anxiety, and in extreme cases, suicidal ideation or attempts. Despite this, mental health remains under-recognized in routine psoriasis care. For patients particularly vulnerable to psychological issues, the impact of the COVID-19 lockdown cannot be ignored. Several studies have highlighted the negative impact of the COVID-19 lockdown on patients with psoriasis (19–21). Narang et al. (22) found that many patients experienced flares, with financial loss linked to anxiety and depression, while shorter disease duration and a relaxed mental state were protective. Burkauskas et al. (23) similarly reported that decreased income, treatment changes, and depressive symptoms contributed to worsening psoriasis and impaired quality of life, particularly in male patients. In parallel, Pendlebury et al. (23) emphasized the essential role of dermatologists in early recognition and treatment of COVID-related cutaneous manifestations to help reduce complications and improve outcomes. And our previous study found that SARS-CoV-2 infection was associated with COVID-19 vaccination, while booster dose vaccination assisted in lowering the incidence of COVID-19 sequelae. Other major SARS-CoV-2 infection risk factors were female gender, employed individuals, lack of routine protection, severe cases of psoriasis (24). In our study, due to concerns about infection during COVID-19, some patients opted for home lockdown; the BSA was significantly higher in the home lockdown group than in the non-lockdown group, which was associated with medication cessation or modification. In our study, DLQI scores did not differ significantly between short-term, long-term, or non-lockdown psoriasis patients, suggesting that disease burden itself outweighed the incremental effects of lockdown on quality of life. Similar findings were reported by Boch et al. (25), who observed paradoxical stability or improvement in DLQI during lockdown, likely due to reduced social and leisure relevance. By contrast, psychological scores were higher in the short-term lockdown group, reflecting acute stress from sudden restrictions and uncertainty. Over time, patients appeared to adapt, with distress levels attenuating in long-term lockdown—a pattern consistent with other studies linking psoriasis outcomes and psychological stress during the pandemic (23).

Furthermore, our study found that disease-related quality of life and depression symptom scores were significantly higher in mild and moderate-to-severe psoriasis groups compared to the no-lesion group, with positive correlations between BSA and DLQI scores. There was also a weak but positive correlation between psoriasis severity and QIDS-SR16. The results were consistent with previous reports from other regions. These findings suggest that the COVID-19 pandemic imposed an additional burden on psoriasis patients, with disease worsening associated with reduced quality of life and poor mental health. Notably, our study found that depression scores were higher in the older adult group than in the younger group, independent of skin involvement, suggesting that older adult patients may require greater psychological support and treatment.

However, our study has some limitations. First, patients’ self-assessment of mental state and disease flare-up may be inaccurate, as experts did not independently validate these responses. In addition, telephone-based collection may have limited participation for certain individuals. The impact of home isolation and restricted physical activity may also have influenced patients’ mental states, thereby affecting both disease activity and questionnaire responses.

Our research results revealed the impact of COVID-19 lockdown on disease severity, quality of life, and mental health in psoriasis patients. Many patients experienced varying degrees of psoriasis symptoms during the lockdown. The severity of psoriasis was negatively correlated with quality of life and positively correlated with depression symptoms. Older adult patients were more likely to feel depressed. Dermatologists should focus on patients’ mental health alongside disease management.