[Influence of anxiety in diverse cutaneous diseases]

Factors Influencing Adherence to Phototherapy in Patients With Psoriasis: A Cross-Sectional Study

AIMS

Assess the level of adherence to phototherapy and determine what factors influence it.

DESIGN

Cross-sectional.

METHODS

This study included a convenience sampling of 72 patients with psoriasis undergoing phototherapy. Data were collected through a self-reported questionnaire with sociodemographic variables, the Goldberg Anxiety and Depression Scale, the Short Form Health Survey and the Dermatology Life Quality Index. Adherence to the treatment and its ending was measured through a session record.

RESULTS

A small percentage of the participants demonstrated adequate adherence, and nearly half of them had low adherence. The factors statistically significant and with a negative impact on adherence were as follows: having a partner, experiencing anxiety or depression or using public transportation to get to the hospital. The probability of not adhering to the treatment increased when: patients found it difficult to attend therapy; perceiving their mental and physical health as being worse; experiencing anxiety or depression; having a diagnosed mental illness; being a man; or having had the sickness for an extended period of time.

CONCLUSION

This study determined the level of adherence to phototherapy and advanced our understanding of this variable. Women exhibited higher levels of adherence compared to men, although they reported worse perceived mental and physical health, and the disease had a higher impact on their life.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Informing phototherapy nurses on the factors that impact treatment adherence may help to increase the treatment compliance, which may improve psoriasis patients' clinical symptoms.

IMPACT

Increase the body of knowledge about the treatment that phototherapy nurses administer.

REPORTING METHOD

STORBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

RNA sequencing and metabolic analysis of imiquimod-induced psoriasis-like mice with chronic restrain stress

AIM

Psoriasis is one of the most common dermatological disorders, characterized by increased epidermal hyperplasia and immune cell infiltration. Psychological stress has been reported to contribute to the severity, aggravation, and relapse of psoriasis. However, the exact mechanism involved in psychological stress's impact on psoriasis is still unclear. We aim to investigate the role of psychological stress in psoriasis from a transcriptomic and metabolomic perspective.

MAIN METHOD

We developed a chronic restrain stress (CRS)-imiquimod (IMQ)-induced psoriasis-like mouse model and performed a comprehensive comparative transcriptomic and metabolic analysis with control mice, CRS-treated mice, and IMQ-treated mice to investigate how psychological stress affects psoriasis.

KEY FINDING

We found that CRS-IMQ-induced psoriasis-like mice showed significant exacerbation of psoriasis-like skin inflammation compared with mice treated with IMQ only. Mice of the CRS + IMQ group showed increased expression of keratinocyte proliferation and differentiation genes, differential regulation of cytokines, and promotion of linoleic acid metabolism. Correlation analysis of differentially expressed genes in the CRS-IMQ-induced psoriasis-like mice and human psoriasis datasets compared with respective controls revealed 96 overlapping genes of which 30 genes showed consistent induced or repressed expression in all human and mouse datasets.

SIGNIFICANCE

Our study provides new insights into the effects of psychological stress on psoriasis pathogenesis and the mechanisms involved, which provides clues for development of therapeutics or biomarkers.

Psychiatric morbidity in children and adolescents with dermatological disorders

Background:

Understanding the existence of a cycle, where psychological disturbances cause skin diseases and in turn, skin diseases cause psychological disorders, provides the basis for good dermatological practice.

Objective:

The aim of this case-control study is to examine the psychiatric morbidity of dermatological disorders in children and adolescents with no history of psychiatric disorders.

Method:

In this study, 502 participants (251 patients and 251 healthy individuals) were evaluated according to DSM-IV criteria. All participants were interviewed and evaluated using the Turkish version of the Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime Version (K-SADS-PL) and the State-Trait Anxiety Inventory for Children (STAI-1 and STAI-2), the Childhood Depression Inventory (CDI), adolescent and parent forms of the Strengths and Difficulties Questionnaire (SDQ-A and SDQ-P) and a questionnaire evaluating child’s level of school success.

Results:

Our results indicated that the rates of general psychiatric comorbidity, mood disorders, anxiety disorders, and adjustment disorders were significantly higher in the study group compared to the control group. The CDI, STAI-1, STAI-2, and SDQ (and subscales) scores were significantly higher in the study group. Moreover, psychiatric comorbidity was higher in inflammatory and allergic dermatoses compared to other dermatological subgroups. Having a dermatological disease restricts physical activity thus increasing the risk of psychiatric comorbidity.

Conclusions:

Investigating the education, attitudes, and awareness of dermatologists about psychocutaneous disorders might contribute to the development of new educational strategies and elicit appropriate biopsychosocial approaches.

[Definition and psychopathology of chronic hand dermatitis]

Psychopathology in patients with DCM is as complex as its clinical forms where the factors are numerous and often intricate. It combines psychophysiological, psychopathological factors, behavioral disorders which can be the cause or the consequence of DCM but also the negative impact on quality of life and the simplest daily activities. DCM affects the quality of life of every patient, regardless of the severity. Women are more affected by the DCM that man older age, male sex, atopy and the existence of a contact sensitization are independent risk factors of severity. Depression may affect up to 10 % of patients, should involve greater attention from dermatologists and general practitioners. Health authorities and all health actors should be aware of interactions between secondary cognitive troubles or inherent to DCM and efforts required in terms of preventive measures. Thus, the presence of psychiatric comorbidity is more common in patients with chronic dermatoses. Today it is considered that the emotional environment, built by the mother - child relationship must be optimal, otherwise the mental stability of body image may be compromised. Diminished self-esteem, affects less well managed and somatic expression of emotional content. Recently, a surprising study showed that most patients with refractory occupational dermatitis were not able to recognize the warning sign of flare or the role of psychological factors in the formation and maintenance of the dermatose. In fact, they rejected their personal responsibility in the occurrence of the new flare. To address this public health problem, health authorities, trainers and caregivers should be aware of the cognitive impact of DCM in these patients and interactions with current means of prevention. The role of obsessive-compulsive washing as part of an anxiety disorder or personality disorder is most likely a contributing or maintaining factor systematically underestimated in the pathogenesis of DCM and in the therapeutic management.

Stress involvement as trigger factor in different skin conditions

Dermatological conditions are intimately related to stress. There was a great interest in this field in the last years. Stress could be involved as a trigger factor for a lot of cutaneous diseases: alopecia areata, psoriasis, vitiligo, lichen planus, acne, atopic dermatitis, urticaria. For other conditions: seborrheic dermatitis, hyperhydrosis, herpes, pemphigus, a.s.o, there are anecdotal notices. On the other hand, the skin disease itself could induce a secondary stress for the patient, influencing his quality of life. The stress per se is less important than the “perceived stress”, the patient’s perception of the stressful situation. This perception could be influenced by the psychological state of the patient. Anxiety, depression could change the perception of the event. It is important to take care of these aspects during the consultation. A good cooperation with psychiatrist or/and psychologist could improve the results, besides the specific therapy.

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study

BACKGROUND

It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease.

METHODS

Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed.

RESULTS

The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus.

CONCLUSION

Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.

Are skin disorders related to work strain in hospital workers? A cross-sectional study

Background

To evaluate whether occupational stress factors (high demands, low control, low social support, strain, and iso-strain) are associated with skin disorders in hospital workers and whether psychological problems, such as anxiety and depression, act as potential mechanisms through which occupational stress factors are associated with skin disorders.

Methods

1,744 hospital workers were invited to answer a questionnaire concerning the occurrence of skin disorders and psychosocial factors at work. The abbreviated Italian version of the Demand/Control model (Karasek) was used to assess perceived work strain, while the Goldberg scales were used to assess anxiety and depression. Analyses were adjusted for age, gender, occupation, latex glove use and history of atopy.

Results

Of the participants, 25% reported hand dermatitis in the previous 12 months and 35% had been affected by skin disorders in other parts of the body. High job demands (OR = 1.09 CI95% 1.05-1.14), low social support (OR = 0.90, CI95% 0.87-0.93), high strain (OR = 1.54 CI95% 1.20-1.98) and high iso-strain (1.66 CI95% 1.27-2.19) were all associated with a higher prevalence of reported hand skin disorders. Both depression (OR = 2.50 CI95% 1.99-3.14) and anxiety (OR = 2.29 CI95% 1.81-2.89) were associated with higher risk of hand skin disorders. The same pattern was observed for dermatological complaints in other parts of the body. Only a slight reduction in the association between occupational stress variables and skin disorders was observed after including depression and anxiety in the model.

Conclusions

Job stress plays a significant role in triggering skin disorders among hospital workers and psychological problems do not appear to be the mechanism behind this association. Occupational health education and training should focus on reducing job demands and occupational stress in order to prevent skin problems among hospital workers.

Life events involvement in psoriasis onset/recurrence

BACKGROUND

The purpose of the study was to evaluate the possible role of stress before the onset/extension/recurrence of psoriasis.

PATIENTS AND METHOD

One hundred and sixty-nine outpatients with psoriasis and 169 age and gender matched controls were enrolled. The design was a case-control study (controls had skin diseases with low psychosomatic component). Stressful life events were evaluated using Holmes and Rahe's Social Readjustment Rating Scale.

RESULTS

In the psoriatic group, there was a female predominance (66%) and a median age 47.55 years (SD = 20.32). In all, 10.65% of patients had family history of psoriasis. More than 54% of cases experienced at least one stressful event (47.36% for onset, 63.51% for recurrence/extension), compared with 19.52% of controls (chi(2) = 42.71, P < 0.0001). The odds ratio was 4.92. There was a significant difference in the mean number of stressful events between patients and controls (P < 0.0001). Women with psoriasis vulgaris and men with guttate psoriasis seemed to be more sensitive to stressful events. We divided the events described by Holmes and Rahe into three categories: family, personal, and job/financial problems. Family matters were mentioned by 42.7% of psoriatic patients, statistically significant compared with controls (P < 0.0001). In 35% of psoriatic cases, "the stressful event" was represented by the illness/death of someone dear. Both "personal" (25.6%; P = 0.02) and "job/financial problems" (31.6%; P < 0.0001) were significantly different compared with controls.

CONCLUSIONS

Stressful events could be highly related to psoriasis (especially in recurrences/extensions). Problems related to family are the most often involved with counseling being suggested.