[Psychosomatic medicine in dermatologic education]

Ten years' experience in handling psychosomatic aspects as part of dermatology courses in Göttingen have revealed an unexpected need for such courses among students. Our program includes lectures as well as work in small groups.

[Short-term discharge as a diagnostic and therapeutic possibility in psychosomatically oriented treatment of the atopic eczema patient]

70 patients suffering from atopic dermatitis and receiving in-patient care were discharged for one or two days upon achieving an improved and stable dermatological state. Back in hospital after their short-term demission, two thirds of these patients showed a deterioration of their cutaneous condition. The majority of them were able to perceive a connection between their worsened skin condition and the acute psychosocial constellation during their brief stay at home. A second short-term demission brought about more acceptable and steady skin conditions, especially in patients treated psychosomatically. Some of the patients declared definite changes in their own modes of behavior to be responsible for this stabilized improvement.

[The disease course and psychosocial events in inpatient treatment of atopic eczema patients--a pilot study]

Our pilot study deals with the systematic investigation of the clinical experience that, in correlation with psychosocial events, atopic dermatitis may take an unexpected course (deterioration or improvement) during hospitalization. We describe our procedures regarding the proposal of hypotheses, the operationalization of the variables "deterioration of eczema" and "psychosocial factor", and our methods in gaining the data required. In the evaluation of 19 courses of treatment, we first checked the possible correlations between individual deterioration of eczema and various psychosocial events. We had to rule out, however, that a positive reaction like this was purely coincidental. In this respect, the event "confrontation with every day life" has significantly been confirmed. We discuss possible further studies which may ensue from our psychosomatic research concept.

[Change in therapy as a model for interaction problems between dermatologists, nurses and patients]

We studied both the frequency of changes in the therapeutic management regarding in-patients with skin diseases and the estimation of these changes by dermatologists, nurses, and the patients concerned. Changing the procedures of topical treatment have been found a special source of conflict between doctors, nurses, and patients.

[Confronting the artefact patient with manipulative behavior]

Patients with self-inflicted skin disorders form a rather heterogeneous group. Our paper is intended to provide the practitioner with some orientation concerning interaction and therapeutic procedure in patients with artefactual skin diseases. Basically, these patients should be differentiated according to what extent they are aware of their manipulations. This degree of awareness should then be the guideline for a well-dosed and sensitive confrontation with their manipulative behavior. In any case, a positive result of the confrontation largely depends on the confidential relationship between physician and patient.

[Psychosomatic criteria in the treatment of atopic neurodermatitis]

We report on psychosomatic aspects regarding out-patient and hospital treatment of atopic dermatitis, including information concerning the disease, motivation for psychotherapeutic forms of treatment (relaxation, diagnostic and therapeutic conversation), as well as psychosomatic indicators for the discharge from hospital.

[Amiodarone therapy--behavior of serum and fatty tissue concentrations]

Thirty-eight patients with refractory supraventricular and ventricular tachyarrhythmias were administered a mean oral dosage of 400 mg amiodarone daily (200-600 mg). A high-pressure liquid chromatography method was used to measure serum concentrations of amiodarone and its metabolite desethylamiodarone after one week, one month, three months, and then at 6-month intervals. In 24 patients subcutaneous fatty tissue concentrations were also measured. The mean follow-up was 9 months (4 days to 29 months). A linear correlation was found between amiodarone and its metabolite in serum (r = 0.56, p less than 0.001) as well as in subcutaneous fatty tissue (r = 0.67, p less than 0.001). While serum concentrations were dose dependent, tissue concentrations accumulated during chronic therapy (p less than 0.01, both). Clinical efficacy was achieved in 84% of the patients. No statistically significant difference was found between responders and non-responders as regards serum and subcutaneous fatty tissue concentrations. Side effects of amiodarone occurred in 63%. The incidence of adverse effects was related to significantly higher serum and subcutaneous fatty tissue concentrations of amiodarone and its metabolite (p less than 0.001, both). Thus, although the determination of serum and subcutaneous fatty tissue concentrations does not seem to be helpful for assessing clinical efficacy of this antiarrhythmic drug, these values may predict the occurrence of adverse effects.

[Dysmorphophobia as casus pro diagnosi]

Our psychodiagnostic studies were concerned with two female patients considering themselves disfigured although their residual somatic findings were only minimal. Two main factors could be derived from analysis: "feelings of anxiety and insecurity" and "obsessive-compulsiveness". The compulsive and sometimes paranoid ideas of the patients suffering from dysmorphophobia require differentiated conclusions by the doctor.

[The pruritus of endogenous eczema patients (author's transl)]

The psychosomatic aspects of the pruritus symptom of endogenous eczema patients are presented. The phenomenon of "scratching" is analysed descriptively from observations of the behavior of the patient and his family. Psychotherapeutic approaches as a supplement to the dermatological therapy of endogenous eczema are described.

[Oxygen consumption of the spontaneous and artificially induced skincycle at different times of day (author's transl)]

In the "clean" rat skin purified from the panniculus carnosus the oxygen consumption of the spontaneous and artificially induced skincycle was measured at different times of day. The level of oxygen consumption correlated to diurnal and nocturnal periods. During the skincycle the oxygen consumption showed fluctuations. There were indications that the value of oxygen consumption of the early anagen is influenced by that phase of the cycle at which the new cycle is artificially induced. Furthermore, it was found that a certain decrease of oxygen consumption stimulates the quiescent hair follicles to spontaneous proliferation. During the katagen the peak value of the oxygen consumption seemed to be correlated with specially morphofunctional perifollicular changes. The application of these findings to the pathophysiology of human hair growth disturbances is discussed.

[Skincycle of a new spontaneous mutant (Nackig) with abnormal hair keratinization in the mouse (author's transl)]

The pathomorphological and pathophysiological reactions of the first skincycle of the mutant (Ng) were histologically investigated. 1. During the hair growth disturbances as the result of imperfect keratinisation changes of the morphology and function of different skin areas could be observed. 2. The developments of abnormal thinner hair growth were correlated to hyperorthokeratotic, inter-respectively intrafollicular hyperplasia of the epidermis and to infraseboglandular hypoplasia of the follicles. 3. The hyper- and hypoplasia of the epidermis corresponded with a functional pseudohypo- and pseudohypertrophy of the cutis. 4. During the skincycle the perifollicular epithelium ranged from the inter- to intrafollicular skin areas. The inter- and intrafollicular epidermal sections varied simultaneously. 5. These results are important for the understanding of some pathomorphological and pathophysiological reactions of skin compartments of man.

[Biographical information from patients with endogenous eczema]

Based on psychoanalytical biographies of 25 patients with atopic dermatitis, striking anamnestic facts concerning especially social contact of the patients are described and discussed.

[Social situation of persons with dermatoses as a phenomena of interpersonal perception (author's transl)]

Discussing the medical importance of the topic, the necessity of cooperation with social-scientific disciplines is demonstrated. Reflecting some relevant psychological theories, an experimental concept for analysing the interpersonal communication with persons suffering from skin-diseases is developed. It is a purpose of this investigation, not only to get the estimations of persons with and without skin-diseases but also the opinion which the other group is supposed to have. It was assumed that the state of health in persons with dermatoses is depending on these supposed estimations by the social environment. After describing the experimental setting, the results which were received from the answers of 465 persons (mean and women with and without dermatoses) are referred. Finally the findings are discussed from different points of view (methodical, cognition-theoretical, learning-psychological, psychoanalytical and last not least medical).

[Effect of pregnancy and lactation on hair growth in mice (author's transl)]

The influence of pregnancy and suckling in mice on spontaneous, induced hair growth and on body weight was examined. 1. An inhibition of spontaneous and induced growth of hair some days before delivery was found. 2. The initiation of hair growth was found not to be wave-like as usually, but nearly simulatneously. 3. Inhibition and initiation of hair growth seem to be related to body weight. 4. The influences on hair growth in mice are compared with known effects of pregnancy on hair growth in women.

[Possibility of thermography to differentiate pigmental skin tumors (author's transl)]

Problems and criteria to evaluate thermographic profiles and the differentiation of pigmental skin tumors are discussed.