Psoriasis is a chronic immune-mediated inflammatory disease associated not only with cutaneous manifestations but also with substantial psychosocial burden, including impaired quality of life, depression, anxiety, stigmatization, fatigue, and sexual dysfunction. While cyclosporine A (CsA) is an established systemic therapy for moderate-to-severe psoriasis, its broader psychosocial effects remain insufficiently characterized. This prospective study enrolled 37 patients (20 men, 17 women; mean age 47.8 ± 4.9 years) with moderate-to-severe plaque psoriasis treated with oral CsA for 12 weeks. Therapy was initiated at 5 mg/kg/day for the first 42 days and subsequently reduced to 2.5 mg/kg/day until Day 84. Clinical severity was assessed using the Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA). Patient-reported outcomes included assessments of quality of life, illness acceptance, life satisfaction, depression, anxiety, fatigue, sexual satisfaction, stigmatization, disability, stress, and pruritus using validated psychometric instruments. Sociodemographic and metabolic determinants were additionally analyzed. CsA therapy resulted in rapid and marked clinical improvement, with PASI scores decreasing from 20.3 ± 4.2 at baseline to 0.9 ± 0.9 at week 12 (p < 0.001) and BSA involvement declining from 41.9% to 1.9% (p < 0.001). Significant improvements were additionally observed across multiple psychosocial domains, including dermatology-related quality of life, depressive and anxiety symptoms, fatigue, sexual satisfaction, illness acceptance, stigmatization, disability, stress, and pruritus (all p < 0.05). Younger age, single marital status, urban residence, longer disease duration, and metabolic comorbidity burden were associated with greater baseline psychosocial impairment. CsA therapy provides multidimensional benefits in patients with moderate-to-severe plaque psoriasis, improving not only clinical disease severity but also psychological well-being, social functioning, fatigue, illness acceptance, and overall quality of life. These findings support the integration of psychosocial assessment into routine therapeutic evaluation and reinforce the continued role of CsA as a multidimensional therapeutic approach in contemporary psoriasis management.
