Magazine article Clinical Psychiatry News

Psychological Factors Contribute to Dermatitis

Magazine article Clinical Psychiatry News

Psychological Factors Contribute to Dermatitis

Article excerpt

LAS VEGAS -- The psychoanalytic theory of atopic eczema characterized in 1940 by Dr. Franz Alexander as an outgrowth of a child's emotional angst at being unable to express anger and hostility arising from maternal rejection was dismissed long ago by most experts in psychodermatology.

However, increasing evidence points to a psychoneuroimmunologic "setup" for atopic dermatitis (AD), if not an eczema personality profile, asserts Dr. Torello M. Lotti, professor and chair of dermatology at the University of Florence, Italy.

Dr. Lotti and other researchers have hypothesized that an interconnection between genetic and environmental factors may predispose a patient to allergic inflammation, which may then cascade in a vulnerable individual into a long-lasting diminished capacity for appropriate protective reactivity within the hypo-thalamus-pituitary-adrenal (HPA) axis.

Certain responses to experimental conditions point to notable differences in the psycho-neuroendocrine-immune function of people with atopic dermatitis and other inflammatory allergic diseases, Dr. Lotti said during a seminar on dermatology sponsored by Skin Disease Education Foundation.

He cited numerous studies to make the point:

* Diurnal plasma Cortisol (stress marker) variations in AD patients were found to rise and fall in synch with atopy-relevant inflammatory parameters, with associated waxing and waning of severity of allergic symptoms (J. Clin. Invest. 1992;90:596-603).

* AD-like symptoms were actually precipitated in healthy volunteers after treatment with the glucocorticoid receptor antagonist RU 486 (J. Clin. Endocrinol. Metab 1990;71:1474-80).

* When exposed to experimental stressor conditions (asking volunteers to speak and do mental arithmetic tasks in front of an audience), eosinophil counts and IgE levels rose significantly in atopic eczema sufferers, but not in healthy volunteers (J. …

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