Recognition of facial emotions in patients with psoriasis, melasma and healthy controls

Abstract

Dermatological diseases impact on the health of patients in different aspects, including significant impairment of the psychosocial well-being.Studies have found losses in quality of life similar to that seen in patients with severe heart disease, advanced malignancy or diabetes mellitus for some dermatoses, such as acne, psoriasis and severe suppurative hidradenitis.Skin lesions may suggest contamination risk signs, raising aversive behaviors in observers, which can lead to psychological repercussions in patients with skin diseases, including behavioral changes and processing and facial emotion recognition.Moreover, clinical and laboratory studies suggest that some dermatoses such as alopecia, acne and psoriasis may suffer interference, in their severity, from psychological disturbances.Previous studies have indicated that psoriasis patients have a greater tendency to believe that they will be judged solely by the appearance of their skin. Also, possibly as a coping mechanism, present a deficit in facial recognition of the expression of disgust, which was confirmed in analysis of functional magnetic resonance imaging. The psoriasis patients evaluated showed reduced activation of the insula after viewing disgusted expressions. The insula is associated with the judgment process related to stigma and empathy.In the present study we intend to evaluate the ability to identify facial expressions, mainly disgust, in patients with dermatoses of variable tendency to trigger aversion and high impairment of life quality and healthy controls seeking to identify if there is a decrease in this cognitive function related to the presence, quality of life impairment, and aversiveness triggered by skin diseases, as well as verifying the correlation between this observation and losses in quality of life and the presence of signs of anxiety and depression in patients with skin diseases.This is a cross-sectional study. We will include 104 persons of both sexes over 17 years of age among employees of the Botucatu Medical School and clinical hospital of FMB-UNESP and patients receiving outpatient treatment at the Dermatology department, carrying either psoriasis or melasma.Data will be collected through personal interview. We will collect demographic and socioeconomic data, quality of life index in dermatology, hospital anxiety and depression scale, social phobia inventor and facial emotions recognition test including 56 facial images encompassing seven emotions.Continuous variables will be analyzed bivariately by parametric student's t test and non-parametric Mann-Whitney's test, depending on the normality of distributions assessed by the Shapiro-Wilk test. Categorical variables were compared using the chi-square or Fisher's exact tests, according to the lowest number of events obtained in each analysis. The correlations will be analyzed by Pearson or Spearman tests, according to the normality of distributions. The scores obtained will be evaluated between groups by ANOVA, Kruskal-Wallis and generalized linear mixed models. The internal consistency of the questionnaires will be evaluated by Cronbach's alpha index.We hope to identify changes in facial recognition capabilities of emotions in patients with skin diseases, mainly in the expression of disgust, as possible psychological mechanism related to the acceptance process of the skin disease.