Depression and anxiety could be related to the impact of psoriasis, arthritis, or inflammation.59 It is estimated to affect more than 30% of psoriasis patients.60 The rate of depression and anxiety was reported to be significantly higher in patients with PsA than in those with psoriasis and was associated with disease-related factors such as actively inflamed joint count as well as disability, pain, and fatigue.61 Treatment with TNFα blockers was associated with reduced rates of depression and insomnia, as well as a reduced rate of regular antidepressant use.62 This evidence concerns the gene TNF and psoriasis.