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Biazus Soares G, Mahmoud O, Yosipovitch G, Mochizuki H. The mind-skin connection: A narrative review exploring the link between inflammatory skin diseases and psychological stress. J Eur Acad Dermatol Venereol 2024; 38:821-834. [PMID: 38311707 DOI: 10.1111/jdv.19813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/16/2023] [Indexed: 02/06/2024]
Abstract
Inflammatory skin diseases are known to negatively impact patient psychology, with individuals experiencing higher rates of stress and subsequent diminished quality of life, as well as mental health issues including anxiety and depression. Moreover, increased psychological stress has been found to exacerbate existing inflammatory skin diseases. The association between inflammatory skin diseases and psychological stress is a timely topic, and a framework to better understand the relationship between the two that integrates available literature is needed. In this narrative review article, we discuss potential neurobiological mechanisms behind psychological stress due to inflammatory skin diseases, focusing mainly on proinflammatory cytokines in the circulating system (the brain-gut-skin communications) and the default mode network in the brain. We also discuss potential descending pathways from the brain that lead to aggravation of inflammatory skin diseases due to psychological stress, including the central and peripheral hypothalamic-pituitary-adrenal axes, peripheral nerves and the skin barrier function.
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Affiliation(s)
- G Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - O Mahmoud
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - G Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - H Mochizuki
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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Christensen RE, Jafferany M. Unmet Needs in Psychodermatology: A Narrative Review. CNS Drugs 2024; 38:193-204. [PMID: 38386200 DOI: 10.1007/s40263-024-01068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
Psychodermatology, the multidisciplinary field that explores the intricate interplay between the mind and the skin, has gained increasing recognition over the past decade. However, several knowledge gaps and unmet needs persist in the field. The objective of this narrative review was to investigate the unmet needs in the field of psychodermatology as they pertain to medical training, treatment, research, and care access. PubMed was searched from inception through December 2023 to identify articles related to psychodermatology. Findings revealed several unmet needs within the field of psychodermatology. First, there is a need for further investigation into the pathophysiology that links psychological stress to cutaneous disease including the development of novel therapies targeting key neuropeptides. Second, the existing literature focuses primarily on the pharmacologic treatment of body dysmorphic disorder and body-focused repetitive behaviors, as well as delusional parasitosis, for which the first-line agents are selective serotonin reuptake inhibitors and atypical antipsychotics, respectively. However, additional research into the efficacy and safety of the remaining psychotropic medications and the treatment of other common psychocutaneous diseases is required. Finally, there exists a significant gap in knowledge amongst clinicians tasked with treating psychocutaneous diseases. Dermatologists report low rates of training in psychodermatology and discomfort with prescribing psychotropic medications. In conclusion, increasing resources for dermatologist education on psychotropic agent use, development of new drugs targeting stress-induced skin conditions, and research on the psychocutaneous applications of current medications may greatly improve the quality and access of psychodermatology care.
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Affiliation(s)
- Rachel E Christensen
- Department of Psychiatry and Behavioral Sciences, Central Michigan University College of Medicine/CMU Medical Education Partners, Saginaw, MI, 48603, USA
- Department of Dermatology, Northwestern Feinberg School of Medicine, Chicago, IL, 60611, United States
| | - Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Central Michigan University College of Medicine/CMU Medical Education Partners, Saginaw, MI, 48603, USA.
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Zhang H, Wang M, Zhao X, Wang Y, Chen X, Su J. Role of stress in skin diseases: A neuroendocrine-immune interaction view. Brain Behav Immun 2024; 116:286-302. [PMID: 38128623 DOI: 10.1016/j.bbi.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Psychological stress is a crucial factor in the development of many skin diseases, and the stigma caused by skin disorders may further increase the psychological burden, forming a vicious cycle of psychological stress leading to skin diseases. Therefore, understanding the relationship between stress and skin diseases is necessary. The skin, as the vital interface with the external environment, possesses its own complex immune system, and the neuroendocrine system plays a central role in the stress response of the body. Stress-induced alterations in the immune system can also disrupt the delicate balance of immune cells and inflammatory mediators in the skin, leading to immune dysregulation and increased susceptibility to various skin diseases. Stress can also affect the skin barrier function, impair wound healing, and promote the release of pro-inflammatory cytokines, thereby exacerbating existing skin diseases such as psoriasis, atopic dermatitis, acne, and urticaria. In the present review, we explored the intricate relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective. We explored the occurrence and development of skin diseases in the context of stress, the stress models for skin diseases, the impact of stress on skin function and diseases, and relevant epidemiological studies and clinical trials. Understanding the relationship between stress and skin diseases from a neuroendocrine-immune interaction perspective provides a comprehensive framework for targeted interventions and new insights into the diagnosis and treatment of skin diseases.
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Affiliation(s)
- Hanyi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Mi Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China; Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xue Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Yujie Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
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Duran S, Yürekli A. Quality of life and satisfaction with life in patients with skin diseases. PSYCHOL HEALTH MED 2023; 28:2848-2859. [PMID: 36813771 DOI: 10.1080/13548506.2023.2182893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
Individuals with skin disease may experience negative symptoms such as itching and pain, social stigma, and isolation. This cross-sectional study included 378 patients with skin diseases. The Dermatology Quality of Life Index (DLQI) score was found to be higher in individuals with skin disease. A high score indicates an impaired quality of life. Married people than single people, those who are 31 years old and older than those who are 30 years old and younger have higher DLQI scores. And also those who work than those who are unemployed, those who have diseases than those who do not have any other diseases, and those who smoke than those who are non-smokers have higher DLQI scores. In order to increase the quality of life of individuals with skin diseases, it is necessary to detect risky situations as well as symptom control and add psychosocial and psychotherapeutic interventions to the treatment plan.
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Affiliation(s)
- Songül Duran
- Health Services Vocational College, Care of Elderly Program, İzmir Demokrasi University, İZMİR, Turkey
| | - Aslan Yürekli
- Department in Muğla, Hospital at Dermatology, Muğla, Turkey
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Senulytė A, Vasiliauskaitė G, Rudzikaitė-Fergizė G, Grigaitienė J. Psychodermatology in Lithuania. A survey on knowledge, awareness, and practice patterns in Lithuanian dermatovenereologists. Arch Dermatol Res 2023; 315:2351-2357. [PMID: 37162577 DOI: 10.1007/s00403-023-02631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
The aim of this study was to evaluate the knowledge, awareness, and practice patterns of Lithuanian dermatovenereologists regarding psychocutaneous medicine. An online survey questionnaire was distributed to the members of the Lithuanian Association of Dermatovenereologists and to dermatovenereologists through public and private healthcare institutions in Lithuania. The questionnaire consisted of questions related to dermatovenereologists' awareness, knowledge, experience, and training needs regarding psychocutaneous disorders. 50% of respondents reported having a good or excellent understanding and knowledge of psychodermatology, and 42% feel prepared to consult psychodermatology patients. 54% of doctors rated their preparedness to prescribe psychopharmacological treatment as poor. The most frequent diagnoses referred to mental health professionals were dermatitis artefacta, acne excoriée, other self-inflicted dermatoses, trichotillomania, and pruritus. The most common course of action with patients at high risk of suicide or other acute psychiatric condition was trying to provide psychological support during dermatovenereology consultation. The most frequent management tactic for patients with chronic psychological problems was a referral to a psychiatrist. 85% of all respondents would participate in educational events about psychodermatology. 70% expressed interest in events about psychopharmacological treatment in dermatology. Lithuanian dermatovenereologists have a good understanding and knowledge of psychodermatology and are willing to further their education in this field. However, some gaps remain. Many doctors reported feeling poorly prepared to administer psychopharmacological treatment to their patients and there seems to be a lack of formal training in psychodermatology in Lithuania.
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Affiliation(s)
- Augustė Senulytė
- Clinic of Infectious Diseases and Dermatovenerology, Vilnius University Faculty of Medicine, Vilnius, Lithuania.
| | - Gabrielė Vasiliauskaitė
- Clinic of Infectious Diseases and Dermatovenerology, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | | | - Jūratė Grigaitienė
- Vilnius University Hospital Santaros Klinikos Centre of Dermatovenereology, Vilnius, Lithuania
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Ait Oussous S, Jafferany M, Chakiri R. Psychodermatology knowledge, awareness and patterns of practice among Moroccan dermatologists: a national survey study. Clin Exp Dermatol 2023; 48:1152-1154. [PMID: 37309904 DOI: 10.1093/ced/llad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
We aimed to assess the knowledge, attitudes and patterns of practice of Moroccan dermatologists and their awareness of psychodermatology (PD). A survey questionnaire was distributed to dermatologists and dermatology trainees from May to July 2022. A total of 112 completed surveys were received. Of these, 63.4% were dermatologists and 36.6% were dermatology residents. Of the participants, 72.3% summarized PD as the psychological impact of dermatological conditions and 50.9% reported frequent involvement with PD. Patients with a psychocutaneous condition represented a significant proportion of dermatological consultations (41.1% of dermatologists stated that 10-25% of their consultations were for psychocutaneous conditions). Only 17% felt 'very comfortable' in the management of PD conditions and 56.3% were not confident prescribing psychotropics. A total of 88.4% had never participated in PD training. Moroccan dermatologists lack a full understanding and proper training in PD. We recommend the incorporation of PD curriculum in training programmes and advocate dermatology and psychiatry liaison.
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Affiliation(s)
- Sara Ait Oussous
- Department of Dermatology, Souss-Massa Hospital, Ibn Zohr University, Agadir, Morocco
| | - Mohammad Jafferany
- Psychodermatology, Psychiatry and Behavioral Sciences Department, College of Medicine, Central Michigan University, Saginaw, MI, USA
| | - Radia Chakiri
- Department of Dermatology, Souss-Massa Hospital, Ibn Zohr University, Agadir, Morocco
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Alonso-Naranjo L, Berna-Rico E, Blanco Abbad-Jaime de Aragón C, Castañeda-Vozmediano R, Prieto-López L, Sánchez-Moya AI, Pérez-Hortet C, González-Cantero Á. Spanish Version of Teenagers’ Quality of Life (T-QoL) for Adolescents with Skin Diseases: Translation, Cultural Adaptation and Validation. Actas Dermosifiliogr 2023; 114:T299-T307. [PMID: 36868511 DOI: 10.1016/j.ad.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/15/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Teenagers' Quality of Life (T-QoL) is an age-specific measure to assess QoL of teenagers suffering from different skin diseases. A validated Spanish language version is lacking. We present the translation, cultural adaptation and validation of the T-QoL into Spanish. METHODS A prospective study with 133 patients (between 12-19 years old), attended at the dermatology department of Toledo University Hospital, Spain, (September 2019-May 2020), was carried out for the validation study. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were used for the translation and cultural adaptation. We evaluated the convergent validity with the Dermatology Life Quality Index (DLQI), the Children's Dermatology Life Quality Index (CDLQI) and with a Global Question (GQ) on self-assessed disease severity. We also analysed internal consistency and reliability of the T-QoL tool and confirmed its structure with a factor analysis. RESULTS Global T-QoL scores significantly correlated with the DLQI and the CDLQI (r=0.75) and with the GQ (r=0.63). The Confirmatory Factor Analysis showed optimal fit for the bi-factor model and an adequate fit for the correlated three-factor model. Reliability indicators were high (Cronbach's α=0.89; Guttman's Lambda 6 index=0.91; Omega ω=0.91) and test-retest showed a high stability (ICC=0.85). The results were consistent with those found by the authors of the original test. CONCLUSION Our Spanish version of the T-QoL tool is valid and reliable to assess QoL of Spanish-speaking adolescents with skin diseases.
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Affiliation(s)
- L Alonso-Naranjo
- Departamento de Dermatología, Hospital Universitario de Toledo, Toledo, España
| | - E Berna-Rico
- Departamento de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | | | - L Prieto-López
- Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, España
| | - A I Sánchez-Moya
- Departamento de Dermatología, Hospital Universitario de Toledo, Toledo, España
| | - C Pérez-Hortet
- Departamento de Dermatología, Hospital Universitario de Toledo, Toledo, España
| | - Á González-Cantero
- Departamento de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, España; Facultad de Medicina, Universidad Francisco de Vitoria, Madrid, España.
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Boullion GQ, Witcraft SM, Schadegg MJ, Perry MM, Dixon LJ. Emotion Regulation Difficulties and Depression Among Individuals With Dermatological and Body Dysmorphic Concerns. J Nerv Ment Dis 2021; 209:650-655. [PMID: 34009860 DOI: 10.1097/nmd.0000000000001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Existing literature demonstrates strong links between emotion regulation (ER) difficulties and depression. Although high rates of depression are observed among individuals with body dysmorphic disorder and skin disease, little is known about these co-occurring syndromes. To advance our understanding of a vulnerable population, this study examined facets of ER difficulties in relation to depression among adults with skin disease symptoms and body dysmorphic concerns (N = 97). Participants were recruited online and completed self-report measures. The overall hierarchical regression model accounted for 61.6% of the variance in depression. After controlling for anxiety and stress, ER difficulties added 9.9% unique variance. In particular, limited access to ER strategies was the only ER dimension significantly associated with depression. This study integrates divergent literatures and suggests the important role of ER difficulties in depression in this unique sample, thereby highlighting directions for future investigation.
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Affiliation(s)
- Gina Q Boullion
- Department of Psychology, University of Mississippi, University, Mississippi
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Meneguin S, de Souza Matos TD, Pollo CF, Garuzi M, Miot HA, de Oliveira C. Psychometric characteristics of DLQI-BRA and Skindex-16 to measure the impact of dermatological diseases on quality of life in Brazilian patients. PLoS One 2021; 16:e0254882. [PMID: 34388159 PMCID: PMC8362944 DOI: 10.1371/journal.pone.0254882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare the psychometric performance of the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16 to assess quality of life (QoL) in Brazilian patients with dermatological diseases. METHODS This was a cross-sectional study carried out in a dermatology outpatient clinic of the São Paulo State University, with 188 patients with dermatological diseases. QoL was evaluated using the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16. Cronbach's alpha and Intraclass Correlation for Perfect Concordance (ICC) were used to analyse the reliability and temporal stability, respectively. RESULTS A positive correlation was found between the total Skindex-16 score and DLQI-BRA (0.75). Both instruments showed a significant (p< 0.01) reduction in their scores at the second assessment, demonstrating that they were sensitive in detecting changes in responsiveness in cases where there was a clinical change. Cronbach alpha coefficients for the instruments showed satisfactory performance (>0,7), but Skindex-16 displayed the highest Cronbach alpha (0.94; CI = 0.93-0.95). CONCLUSION Both instruments tested showed a good psychometric performance assessing QoL in patients with skin dermatoses. The instruments displayed reliability and temporal stability as well as responsiveness.
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Affiliation(s)
- Silmara Meneguin
- Nursing Department, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | | | - Camila Fernandes Pollo
- Nursing Department, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | - Miriane Garuzi
- Program in Pathophysiology in Medical Practice, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, São Paulo State University, Botucatu Medical School, São Paulo, Brazil
| | - César de Oliveira
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
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Abstract
Background While it is well established that skin disease places significant psychosocial burden on a patient’s wellbeing, its effects have rarely been examined in Asian populations. Objective Evaluate the psychosocial burden of skin disease among community-dwelling adults in Singapore. Methods This cross-sectional study included 1510 participants interviewed on their history of thirteen skin diseases. The Patient Health Questionnaire (PHQ-9), Lubben Social Network Scale-6 (LSNS-6), University of California Los Angeles (UCLA) Loneliness Scale, and European Quality of Life-5 Dimensions- 5 Level (EQ-5D-5L) were used as measures for depressive symptoms, social isolation, loneliness and quality of life respectively. Multiple linear regression analysis was used to examine the association of skin diseases with each of the four measured outcomes. Results Participants with skin diseases reported significantly higher PHQ-9 and UCLA Loneliness scale scores, and lower LSNS-6 and EQ-5D-5L scores when compared to their healthy counterparts. The presence of skin disease was positively associated with depressive symptoms (B = 0.40, SE = 0.11), and negatively associated with quality of life (B = -0.03, SE = 0.01). As disease severity was not evaluated in this study, we were unable to ascertain the associations between disease severity and measured outcomes. Conclusion Participants with skin diseases were more likely to have depressive symptoms, social isolation, loneliness and lower quality of life. Unemployed, single and elderly patients were at higher risk of developing depressive symptoms. More emphasis should be placed on the psychosocial aspect of care to reduce the burden of skin disease. Some considerations include monitoring patients for mood-related changes and implementing early psychosocial interventions.
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Affiliation(s)
- Yik Weng Yew
- Department of Dermatology, National Skin Centre, Singapore, Singapore
- * E-mail:
| | | | - Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, Singapore, Singapore
| | - Chun Wei Yap
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, Singapore, Singapore
| | - Bee Hoon Heng
- Health Services and Outcomes Research, National Healthcare Group Pte Ltd, Singapore, Singapore
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Guo F, Yu Q, Liu Z, Zhang C, Li P, Xu Y, Zuo Y, Zhang G, Li Y, Liu H. Evaluation of life quality, anxiety, and depression in patients with skin diseases. Medicine (Baltimore) 2020; 99:e22983. [PMID: 33126372 PMCID: PMC7598870 DOI: 10.1097/md.0000000000022983] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To investigate the incidence of skin diseases, the factors affecting the life quality, anxiety, and depression of patients with skin diseases and the correlation among the 3.A total of 1127 patients with skin diseases were selected online from March 2018 to June 2018. Logistic regression was used to analyze the factors influencing life quality, anxiety, and depression. Spearman rank correlation was used to analyze the correction among the life quality, anxiety, and depression.There was no significant difference in ethnicity, education, and time of question among patients (P > .05). Sex ratio, age, marital status, and occupation were statistically significant difference among patients with different skin diseases (P < .05). The life quality index of patients with psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia were 11.96 ± 6.74, 9.84 ± 6.99, 11.57 ± 6.85, 13.86 ± 6.31, 7.86 ± 6.82, respectively. The differences were statistically significant (P < .05). The main factors affecting quality of life included age, family history, and types of skin diseases. The age, ethnicity, education, and family history of skin diseases were the main factors affecting anxiety of patients with different skin diseases. Additionally, sex, marital status, education, and family history of skin diseases were the main factors influencing depression. Spearman rank correlation analysis showed that the life quality, anxiety, and depression were positively correlated.Psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia have a certain impact on the life quality of most patients, and may cause different degrees of anxiety and depression.
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Affiliation(s)
| | - Qin Yu
- Dermatology Department, People Hospital of Changji Hui Autonomous Prefecture, Changji city
| | | | | | | | | | | | | | - Yuanyuan Li
- Medical Research Design and Data Analysis Center, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, P. R. China
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Dalgard FJ, Sjöström K, Fhager J, Svensson Å, Wallin E, Hauksson I. Subjective and Objective Characteristics of Patients Seen at a Psychodermatology Unit: One-year Experience in Malmö, Sweden. Acta Derm Venereol 2020; 100:adv00126. [PMID: 32179934 PMCID: PMC9128943 DOI: 10.2340/00015555-3460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/16/2022] Open
Abstract
Clinical epidemiological knowledge concerning psychodermatology patients is scarce. The objective of this study was to assess morbidity in a new psychodermatology service. Information was gathered from patient records at the psychodermatology unit in Skåne University Hospital, Malmö, Sweden, from 1 February 2017 to 31 January 2018. All patients were screened with the Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI) at baseline and after 12 months. Additional information was collated from the patient records. A total of 50 patients were treated during the 12 months, 86% were women, mean age 44 years (standard deviation (SD) 16 years). Itch was present in 72% of patients. Forty-two percent of patients were diagnosed with mood disorders, 30% with personality disorders, and 16% with delusional disorders. At baseline 40% of patients had a DLQI score >11, clinical depression was present in 14%, and clinical anxiety in 28%. These data emphasize the need for access to a multidisciplinary unit for dermatology patients.
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Affiliation(s)
- Florence J Dalgard
- Department of Dermatology and Venereology, Skåne University Hospital, SE-214 21 Malmö, Sweden.
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van der Bent SAS, Kemperman PM, Vulink NC, Hoekzema R. [Morgellons, a 'socially transmitted' disease]. Ned Tijdschr Geneeskd 2019; 163:D4109. [PMID: 31750635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Morgellons disease is a controversial condition characterised by a great variety of skin-related symptoms such as wounds, itch and pain and whereby the patient strongly believes these are caused by threads or fibres penetrating the skin. The subject is often discussed in social media, which leads to increasing numbers of patients who think they have the condition. CASE DESCRIPTION A 56-year-old woman had been suffering for three years of compulsive behaviour involving her hair and scratching her skin. She was convinced there were threads running under her skin. She had self-diagnosed 'Morgellons disease'. Psychodermatological treatment led to reduced symptoms. CONCLUSION The majority of medical practitioners believe that Morgellons disease is a type of delusional infestation. Even though there are some medical and non-medical practitioners who take the position that there is an infectious cause, such a cause has never been found.
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Affiliation(s)
| | | | | | - Rick Hoekzema
- Amsterdam UMC (locatie AMC), Afd. Dermatologie, Amsterdam
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Akinboro AO, Adelufosi AO, Onayemi O, Asaolu SO. Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: sociodemographic and clinical correlates. An Bras Dermatol 2019; 94:422-428. [PMID: 31644614 PMCID: PMC7007018 DOI: 10.1590/abd1806-4841.20197919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/21/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder is a relatively common psychiatric disorder in the context of dermatology and cosmetic and plastic surgery but is underdiagnosed and underreported in Africa. OBJECTIVE To evaluate the prevalence of body dysmorphic disorder and symptoms of anxiety/depression and determine their sociodemographic and clinical correlates. METHODS A systematic random sampling design was made to recruit 114 patients with skin diseases. Sociodemographic and clinical data were obtained. The Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Scale, Hospital Anxiety and Depression Scale was administered, and data were analyzed using SPSS 20. RESULTS Mean age of participants was 37.70±17.47 years, and 67/114 (58.8%) were females. Prevalence of body dysmorphic disorder was 41/114 (36.0%), and prevalence of anxiety/depression symptoms was 35/114 (30.7%). Prevalence of body dysmorphic disorder in patients with anxiety/depression symptoms was 15/41 (36.6%), and patients with facial disorders expressed the highest burden of anxiety/depression symptoms, in 15/35 (42.9%). Factors associated with significantly higher mean body dysmorphic disorder include age<50years (p=0.039), and anxiety/depression (p<0.001), education below high school was associated with higher mean anxiety/depression score (P= 0.031). In a binary logistic regression model, presence of anxiety/depression symptoms was predictive of body dysmorphic disorder (OR=10.0, CI: 4.1-28.2, p<0.001). STUDY LIMITATIONS the study is uncontrolled, conducted in a single source of care, thus limiting generalization to nonrelated settings. CONCLUSION Prevalence of body dysmorphic disorder is high among dermatology patients and most prevalent in facial disorders. Facial diseases are associated with the highest burden of anxiety/depression symptoms. This is a clarion call for dermatologists to routinely assess for body dysmorphic disorder and appropriately refer affected patients to mental health care.
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Affiliation(s)
- Adeolu Oladayo Akinboro
- Dermatology Unit, Department of Internal Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
| | | | - Olaniyi Onayemi
- Department of Dermatology and Venereology, Obafemi Awolowo University Teaching Hospital Complex, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Stephen O Asaolu
- Department of Internal Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria
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15
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De Souza B, McMichael A. A new somatic-type delusional disorder subtype: delusion inversus. Dermatol Online J 2019; 25:13030/qt20s9f78r. [PMID: 31735003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023] Open
Abstract
The interplay between psychiatric and dermatologic conditions has been recognized for decades as evidenced by the widely accepted classification system of psychocutaneous disorders: (1) primary dermatologic disorder with psychiatric sequelae, (2) primary dermatologic disorder exacerbated by stress, (3) primary psychiatric disorder with dermatologic sequelae, and (4) miscellaneous. However, there is minimal literature regarding dermatologic patients who demonstrate a preoccupation with a more severe cutaneous disorder despite evidence confirming a diagnosis of a minor, treatable skin condition. These patients are a hybrid of the first and fourth categories and should be classified under a new entity known as delusion inversus. These patients have a primary dermatologic condition; however, they believe their condition to be more severe and malignant than it is, despite evidence to the contrary. Their beliefs are pathological and analogous to delusion disorder somatic type. Given the scarcity of data concerning delusion inversus, the epidemiology, diagnosis, and management of the disorder as described in this review is extrapolated from reported cases of delusion disorder and delusion disorder somatic-type. Often these patients will present to a non-psychiatric, outpatient clinic for medical care. Thus, it is imperative that dermatologists are able to identify the condition and manage the patient appropriately.
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Affiliation(s)
| | - Amy McMichael
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC.
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Chang AY, Ochoa MT. What Neglected Tropical Diseases Teach Us About Stigma. Cutis 2019; 104:202-203. [PMID: 31774887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Aileen Y Chang
- Department of Dermatology, School of Medicine, University of California, San Francisco, USA
| | - Maria T Ochoa
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, USA
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17
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Kansal NK. Dermatitis Artefacta: An Update. Skinmed 2019; 17:311-316. [PMID: 31782704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Dermatitis artefacta is a specific psychocutaneous illness, in which the patient creates skin lesions to satisfy the unconscious need to presume a sick role. It is more common in women and in patients with a diagnosis of psychiatric illness/personality disorder (usually borderline) or external stressor. The clinical signs are characteristic and usually present with typical psychiatric manifestations. This diagnosis is by exclusion, and possible organic causes of cutaneous lesions must be ruled out. Treatment of dermatitis artefacta is taxing, both on the physician as well as on relatives, and it needs to involve a multidisciplinary approach consisting of dermatologists and mental health professionals.
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Affiliation(s)
- Naveen Kumar Kansal
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, India;
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18
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Tracey EH. Challenges of treating primary psychiatric disease in dermatology. Cutis 2019; 104:E12-E14. [PMID: 31603969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Psychiatric disorders are common among dermatology patients. They may be secondary to skin disease but also can be the primary cause of cutaneous concerns. Because patients with primary psychiatric disorders who present to dermatology often refuse referral to mental health providers, dermatologists are challenged with management of various psychiatric conditions, such as delusional infestation and trichotillomania. Effective, evidence-based treatments are available for psychodermatologic disorders, and dermatologists should be comfortable with their implementation.
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Dimitrov D, Matusiak Ł, Evers A, Jafferany M, Szepietowski J. Arabic language skin-related stigmatization instruments: Translation and validation process. ADV CLIN EXP MED 2019; 28:825-832. [PMID: 30740941 DOI: 10.17219/acem/102617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Skin diseases are frequently the reason for social rejection. Therefore, the assessment of stigmatization level in patients suffering from dermatoses plays a crucial role in providing proper health service. OBJECTIVES The aim of this study was to create and validate Arabic language versions of stigmatization instruments - the 6-item Stigmatization Scale and the Feelings of Stigmatization Questionnaire. MATERIAL AND METHODS Development of the Arabic language versions was done with international standards of forward-back translations. The validation was performed on 39 psoriatic individuals. The group included 11 females and 28 males. The subjects were asked to fill out both questionnaires: the 6-item Stigmatization Scale and the Feelings of Stigmatization Questionnaire (Arabic language versions) at the time of examination and 7 days after enrollment for reassessment to evaluate test-retest reliability. During the first visit the patients additionally filled out an already existing Arabic version of Dermatology Life Quality Index (DLQI), which was used as a reference questionnaire. RESULTS The results concerning the integrity of instruments were very good, and the Cronbach's α coefficient for both scales was 0.89. The reproducibility level assessed with interclass correlation coefficient (ICC) stood at 0.91 for the 6-item Stigmatization Scale and 0.92 for the Feelings of Stigmatization Questionnaire. There was a strong correlation between total score of the 6-item Stigmatization Scale and DLQI. Significant negative moderate correlation was documented between the Feelings of Stigmatization Questionnaire and DLQI. Moreover, both stigmatization instruments correlated significantly with each other. CONCLUSIONS The developed Arabic language versions of the abovementioned stigmatization instruments can be successfully used in daily clinical practice as well as in clinical research.
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Affiliation(s)
- Dimitre Dimitrov
- Presidential Medical Wing, Al Mafraq and Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Andrea Evers
- Department of Health, Medical and Neuropsychology, Leiden University, the Netherlands
| | - Mohammad Jafferany
- Department of Psychiatry and Behavioral Science, Central Michigan University, Saginaw, USA
| | - Jacek Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
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20
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Topp J, Augustin M, von Usslar K, Gosau R, Reich K, Reusch M, Blome C. Measuring Patient Needs and Benefits in Dermatology using the Patient Benefit Index 2.0: A Validation Study. Acta Derm Venereol 2019; 99:211-217. [PMID: 30307024 DOI: 10.2340/00015555-3063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated the validity and feasibility of the Patient Benefit Index 2.0 (PBI 2.0), a short instrument to assess patient-relevant treatment benefit. In a cross-sectional study, patients with skin diseases completed the PBI 2.0 alongside instruments on quality of life and disease-specific PBI long versions to assess convergent validity. Feasibility questions appraise comprehensibility, completeness, length, and readability. Data from a longitudinal study were used to explore responsiveness and test-retest reliability. Most patients rated the PBI 2.0 easy to understand, complete, legible, and not too long. The amount of missing values was overall low. In all groups, except for vitiligo, correlation analyses indicated good convergent validity of PBI 2.0. Responsiveness of the PBI 2.0 could not be clearly confirmed. Retest-reliability achieved satisfactory results. Thus, the PBI 2.0 may be a suitable instrument for its use in different skin diseases. Its broad applicability allows for comparisons across diagnosis groups.
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Affiliation(s)
- Janine Topp
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), DE-20246 Hamburg, Germany.
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21
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Dalgard FJ, Bewley A, Evers AW, Gieler U, Lien L, Sampogna F, Ständer S, Tomas-Aragones L, Vulink N, Kupfer J. Stigmatisation and body image impairment in dermatological patients: protocol for an observational multicentre study in 16 European countries. BMJ Open 2018; 8:e024877. [PMID: 30580274 PMCID: PMC6307615 DOI: 10.1136/bmjopen-2018-024877] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Patients with common skin diseases may have substantial psychosocial comorbidity and reduced quality of life. This study aims at exploring further the psychosocial burden of skin diseases by assessing stigmatisation and body image problems in a large sample of patients with skin disease across Europe. METHODS AND ANALYSIS The study is an observational cross-sectional multicentre study across 16 European countries comparing stigmatisation and body image in patients with skin disease compared with controls. Consecutive patients will be recruited in outpatient clinics and will complete validated questionnaires prior to clinical examination by a dermatologist at each recruitment site. In addition to sociodemographic background information, the outcomes will be: mood disorders assessed by short versions of the Patient Health Questionnaire and the General Anxiety Disorder Assessment; general health assessed by the EuroQol-Visual Analogue Scale; stigmatisation experience assessed by the Perceived Stigmatisation Questionnaire; stress assessed by the Perceived Stress Scale and body image assessed by the Dysmorphic Concern Questionnaire. The main criteria for eligibility are to be 18 years old or more. The analysis will include comparison between patients and controls for the main outcomes using t-tests, analyses of covariance and multivariate logistic regression models adjusting for potential confounding factors. ETHICS AND DISSEMINATION The study protocol is approved by the University of Giessen and by the local Ethical Committee in each recruitment centre. Informed consent will be given by each participant. The results of the study will be disseminated by publications in international peer-reviewed journals and presented at international conferences and general public conferences. Results will influence support intervention and management of patients with skin disease across Europe. TRIAL REGISTRATION NUMBER DRKS00012745; Pre-results.
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Affiliation(s)
- Florence J Dalgard
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Anthony Bewley
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - Andrea W Evers
- Department of Health, Medical and Neuropsychology, Faculty of Social and Behavioral Science, Leiden, The Netherlands
| | - Uwe Gieler
- Department of Dermatology, Justus Liebig University, Giessen, Germany
| | - Lars Lien
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - Francesca Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Sonja Ständer
- Center for Chronic Pruritus and Department of Dermatology, University Hospital Münster, Münster, Germany
| | | | - Ninke Vulink
- Department of Psychiatry, Academic Medical Hospital, Amsterdam, The Netherlands
| | - Jörg Kupfer
- Institute of Medical Psychology, Justus Liebig University, Giessen, Germany
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22
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Ahmed HO, Arif SH, Abdulhakim SA, Kakarash A, Ali Omer MA, Nuri AM, Omer HH, Jalal HK, Omer SH, Muhammad NA. Gender difference in requesting abdominoplasty, after bariatric surgery: Based on five years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq. Int J Surg 2018; 56:155-160. [PMID: 29929023 DOI: 10.1016/j.ijsu.2018.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year, many patients who have experienced massive weight loss are left with the dissatisfying consequences of loose and redundant skin, resulting in contour irregularities, an aesthetic and functional problem, and profound dissatisfaction with appearance, residual body image dissatisfaction, There is a subsequent increase in the number of patients seeking additional corrective procedures including abdominoplasty which considered as one of the most popular body-contouring procedures. Correcting skin excess, could improve all the corollaries, including body, and functional problems and gives profound satisfaction with appearance, it has shown to improve both psychological and social aspects of the patients' lives. OBJECTIVES Is there a gender difference in seeking body countering after bariatric surgery for weight loss? PATIENTS AND METHODS A longitudinal observational study includes 209 obese patients with mean age of 31 ± 8.6 years; (31 ± 9, 31 ± 7 years for female and male patients respectively). Gender ratio M/F = 1.94/1, mean BMI 40 ± 9 kg/m2sin (n = 138 female) and 45±8m2s in (n = 71 male) patients, and Waist circumference 109 ± 7 cm in female and 118 ± 4 cm in males. RESULTS Some female (n = 10, 7.25%) patients were seeking abdominoplasty from the third month after the operations were they have lost (21 ± 2 kg) of their excess weight, fourteen patients (10.14%), at 6 months and 27 patients (19.56%) at 12 months, but most of male patients were requesting abdominoplasty (n = 7, 09.86%) at 12 months after the operations. Male patients have shifted their ideal from weight loss to abdominoplasty after losing (50-70) of their excess weight 12 months after the operations. The main motivation of requesting abdominoplasty in female and male patients was physical difficulty because of redundant skin, and a smaller number in both genders were motivated by a friend or by a doctor. CONCLUSION The motivation for abdominoplasty in females is parallel to the amount of EWL or waist circumference. Female patients are looking for body countering three months after surgery, while male patients more often than not request body shaping following one year after surgery, the age groups are invert in genders; female patients asking for body contouring in younger age group while male patients in older age group.
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Affiliation(s)
- Hiwa O Ahmed
- Senior Lecture in College of Medicine -University of Sulaimani, Iraq.
| | - Sarmad H Arif
- Senior Lecture in College of Medicine -University of Sulaimani, Iraq.
| | | | - Aram Kakarash
- General Surgeon in Sulaimani Teaching Hospital, Iraq.
| | | | | | - Hallo H Omer
- Clinical Pharmacist- Sulaimani Teaching Hospital, Iraq.
| | - Hardi Kareem Jalal
- Trainee of Kurdistan Board of Surgery in Sulaimani Teaching Hospital, Iraq.
| | - Shahen H Omer
- SHO in Faciomaxillary Surgery in Sulaimani Teaching Hospital, Iraq.
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Balieva FN, Finlay AY, Kupfer J, Aragones LT, Lien L, Gieler U, Poot F, Jemec GBE, Misery L, Kemeny L, Sampogna F, van Middendorp H, Halvorsen JA, Ternowitz T, Szepietowski JC, Potekaev N, Marron SE, Altunay IK, Salek SS, Dalgard FJ. The Role of Therapy in Impairing Quality of Life in Dermatological Patients: A Multinational Study. Acta Derm Venereol 2018; 98:563-569. [PMID: 29507999 DOI: 10.2340/00015555-2918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%). The largest reduction in HRQoL attributable to therapy, as a percentage of total DLQI, adjusted for confounders, was seen in blistering conditions (10.7%), allergic/drug reactions (10.2%), psoriasis (9.9%), vasculitis/immunological ulcers (8.8%), atopic dermatitis (8.7%), and venous leg ulcers (8.5%). In skin cancer, although it had less impact on HRQoL, the reduction due to therapy was 6.8%. Treatment for skin disease contributes considerably to reducing HRQoL: the burden of dermatological treatment should be considered when planning therapy and designing new dermatological therapies.
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Affiliation(s)
- Flora N Balieva
- Department of Dermatology, Stavanger University Hospital, Pb. 8100, NO-4068 Stavanger, Norway.
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Cárcano CBM, de Oliveira CZ, Paiva BSR, Paiva CE. The Brazilian version of Skindex-16 is a valid and reliable instrument to assess the health-related quality of life of patients with skin diseases. PLoS One 2018; 13:e0194492. [PMID: 29566036 PMCID: PMC5864026 DOI: 10.1371/journal.pone.0194492] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/05/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess the psychometric properties of the Brazilian version of Skindex-16 in patients with various skin diseases. METHODS Dermatologic assessments were performed for the diagnosis and classification of the severity of skin conditions. The clinical feasibility of Skindex-16 was assessed based on the time required to complete the questionnaire and the number of unanswered items. The participants (n = 110) answered the Hospital Anxiety and Depression Scale (HADS), the Dermatology Life Quality Index (DLQI) and the Skindex-16 (Portuguese/Brazil version) questionnaires. Convergent validity was assessed based on the correlation of the Skindex-16 with the DLQI and HADS subscales. Known-groups validity was assessed based on the comparison of the mild, moderate and severe disease groups using the Kruskal-Wallis test. Internal consistency was assessed using Cronbach's alpha and test-retest reproducibility using the intraclass correlation coefficient (ICC) obtained with 29 participants who answered the Skindex-16 a second time 3 to 10 days after the first assessment. RESULTS The mean time to answer the questionnaire was 2 min 41 sec. Cronbach's alpha scores were 0.867, 0.930 and 0.888 for the Skindex-16 domains symptoms, emotions and functioning, respectively. The ICCs were 0.947, 0.860 and 0.843 for the Skindex-16 domains symptoms, emotions and functioning, respectively. All three Skindex-16 scales exhibited strong correlations with DLQI. Moderate correlations were found between HADS subscales and the Skindex-16 emotions domain. Known-groups validity showed differences in all three Skindex-16 domains between the mild and moderate skin disease groups (emotions: p < 0.001; symptoms: p = 0.049; functioning: p < 0.001) and between the mild and severe skin disease groups (emotions: p = 0.002; symptoms: p = 0.001; functioning: p = 0.002). CONCLUSION The Portuguese/Brazil version of Skindex-16 is a valid and reliable instrument to assess the quality of life of patients with skin diseases.
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Affiliation(s)
- Cristiane Botelho Miranda Cárcano
- Department of Prevention, Barretos Cancer Hospital, Barretos, Brazil
- Dr. Paulo Prata School of Health Sciences (Faculdade de Ciências da Saúde Dr. Paulo Prata – FACISB), Barretos, Brazil
| | | | - Bianca Sakamoto Ribeiro Paiva
- Researcher Support Center, Barretos Cancer Hospital, Barretos, Brazil
- Palliative Care and Health-Related Quality of Life Research Group, Barretos, Brazil
| | - Carlos Eduardo Paiva
- Palliative Care and Health-Related Quality of Life Research Group, Barretos, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil
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He Z, Lo Martire R, Lu C, Liu H, Ma L, Huang Y, Li Y, Sun L, Bai Y, Liu W, Zha X. Rasch Analysis of the Dermatology Life Quality Index Reveals Limited Application to Chinese Patients with Skin Disease. Acta Derm Venereol 2018; 98:59-64. [PMID: 28676885 DOI: 10.2340/00015555-2742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to examine the psychometric properties of the Chinese version of the Dermatology Life Quality Index (DLQI) and to assess the invariance of its items with respect to several patient parameters via Rasch analysis. Data were aggregated from 9,845 patients with various skin diseases across 9 hospitals in different regions of China. The response structure, local independence, and reliability of the DLQI scale were analysed in a partial credit model, and differential item functioning (DIF) across region, disease, sex, and age were assessed with a Mantel-Haenszel procedure. Although acceptable scale reliability (Person Separation Index=2.3) was obtained, several problems were revealed, including disordered response thresholds, misfitting items, DIF by geogra-phical region and disease, and mis-targeting patients with mild impairment regarding health-related quality of life (HRQL). In conclusion, the DLQI provides inadequate information on patients' impairments in HRQL, and the application of the DLQI in Chinese patients with skin disease is limited.
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Affiliation(s)
- Zehui He
- Department of Dermatology, Guangzhou University of Chinese Medicine Second Affiliated Hospital, 111 Da De Road, Guangzhou 510120, China
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Shenefelt PD. Noxious nocebos in dermatology. Cutis 2017; 100:190-191. [PMID: 29121131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Philip D Shenefelt
- Department of Dermatology and Cutaneous Surgery, College of Medicine, University of South Florida, Tampa, USA
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Prabhakar D, Peterson EL, Hu Y, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Williams LK, Beck A, Simon GE, Ahmedani BK. Dermatologic Conditions and Risk of Suicide: A Case-Control Study. Psychosomatics 2017; 59:58-61. [PMID: 28890116 DOI: 10.1016/j.psym.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients diagnosed with skin conditions have a higher risk of comorbid psychiatric conditions and suicide-related outcomes such as suicidal ideations and behaviors. There is paucity of evidence in the US general population about the risk of suicide death in patients with dermatologic conditions. METHODS We conducted a retrospective case-control study to investigate the risk of suicide death in patients receiving care for dermatologic conditions. This study involved 8 US health systems. A total of 2674 individuals who died by suicide (cases) were matched with 267,400 general population control individuals. RESULTS After adjusting for age, sex, and any mental health or substance use condition, we did not find an association between death by suicide and any skin condition including conditions where clinicians are generally concerned about the risk such as acne (adjusted odds ratio [aOR] = 1.04, p = 0.814), atopic dermatitis (aOR = 0.77, p = 0.28), and psoriasis (aOR = 0.91, p = 0.64). CONCLUSION This case-control study provides no evidence of increased risk of death by suicide in individuals with major skin disorders in the US general population.
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Affiliation(s)
- Deepak Prabhakar
- Behavioral Health Services, Henry Ford Health System, Detroit, MI.
| | - Edward L Peterson
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI
| | - Yong Hu
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI
| | | | - Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Christine Y Lu
- Harvard Pilgrim Health Care, Wellesley, MA; Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - L Keoki Williams
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI
| | | | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI
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Milutinović JD, Krstić N, Janković SM. Translation and Validation of the Serbian Version of the Skindex-29 Instrument for Measuring Impact of Skin Disease on Quality of Life. Acta Dermatovenerol Croat 2017; 25:120-127. [PMID: 28871926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Skindex-29 instrument, which is intended for measuring the influence of skin diseases on quality of life, was developed and validated in several languages. However, a Serbian translation of the instrument is not available. The aim of this study was to translate the Skindex-29 from English to Serbian, to make necessary cultural adaptations, and to test its psychometric properties in a sample of outpatients with various skin diseases. The Skindex-29 was translated and adapted according to internationally accepted guidelines and then tested on a sample of Serbian outpatients with various skin diseases. Internal consistency was checked through calculation of Cronbach's alpha and Interclass Correlation Coefficient for the instrument's domains. The criterion validity of the translation was tested by correlating scores of domains with scores on the Serbian version of Dermatological Life Quality Index (DLQI).Validity of the construct was tested through comparison of the domains scores in groups of patients with different skin diseases. Fifty-three patients (18.6%) suffered from acne vulgaris, 48 (16.8%) from verrucae vulgares, 40 (14.0%) from psoriasis, 34 (11.9%) from an undetermined type of mild dermatitis, 20 (7.0%) from venous ulcers, 19 (6.7%) from eczema, and 71 (24.9%) from other skin diseases. The Serbian translation of Skindex-29 showed good internal consistency: Cronbach's alpha for Emotional, Symptoms, and Functioning domains was 0.885, 0.752, and 0.901, respectively. Validity of the instrument in all aspects (criterion, content, and construct validity) was satisfactory, yet the Symptoms domain could not discriminate well between more and less severe skin diseases. The Serbian translation of Skindex-29 appears to be a reliable and valid specific instrument for measuring the adverse influence of skin diseases on quality of life.
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Affiliation(s)
| | | | - Slobodan M Janković
- Prof. Slobodan M. Jankovic, MD, DSc, MSc, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica Street 69, 34000 Kragujevac, Serbia;
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Braunberger T, Mounessa J, Rudningen K, Dunnick CA, Dellavalle RP. Global skin diseases on Instagram hashtags. Dermatol Online J 2017; 23:13030/qt7sk410j3. [PMID: 28537860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 06/07/2023] Open
Abstract
Recently named one of the most influential phone applications, Instagram continues to grow in popularity [1]. Instagram consists of images and video posts, making it ideal for education and communication within the visual field of dermatology. In this study, we seek to determine the presence of dermatology-related content with regard to the most common cutaneous diseases of the world. We searched the account types and hashtags associated with the eight most common skin diseases globally as identified by the Global Burden of Disease (GBD) study by Hollenstein et al.: eczema, psoriasis, acne,pruritus, alopecia, decubitus ulcer, urticaria, andscabies [9]. The majority of Instagram accounts included patient experiences (n=73), private accounts(n=52), and disease advocacy and awareness groups(n=20), (total n=221). We further investigated over 2 million skin disease hashtags. The greatest numbersof hashtags were the following: #acne (n = 1,622,626),#alopecia (n = 317,566), and #eczema (n = 196,115). Our results demonstrate that patients interact withone another through Instagram. As social networking platforms become more frequently used as a source of information for patients and patient support, medical professionals must gain awareness of content available through Instagram and consider it as a means to educate the public.
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Affiliation(s)
| | | | | | | | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, Dermatology Service, Eastern Colorado Health Care System, US Department of Veteran Affairs, Denver, Colorado.
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Affiliation(s)
- Jonathan M R Goulding
- Department of Dermatology, Heart of England NHS Foundation Trust, Solihull Hospital, Lode Lane, Solihull, B91 2JL, United Kingdom
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Kuhn H, Mennella C, Magid M, Stamu-O'Brien C, Kroumpouzos G. Psychocutaneous disease: Clinical perspectives. J Am Acad Dermatol 2017; 76:779-791. [PMID: 28411771 DOI: 10.1016/j.jaad.2016.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/26/2016] [Accepted: 11/03/2016] [Indexed: 01/03/2023]
Abstract
Psychocutaneous disease, defined in this review as primary psychiatric disease with skin manifestations, is commonly encountered in dermatology. Dermatologists can play an important role in the management of psychocutaneous disease because patients visit dermatology for treatment of their skin problems but often refuse psychiatric intervention. This review describes common psychocutaneous syndromes, including delusional, factitious, obsessive-compulsive and related, and eating disorders, as well as psychogenic pruritus, cutaneous sensory (pain) syndromes, posttraumatic stress disorder, and sleep-wake disorders. The updated classification of these disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition is included. Strategies for management are reviewed.
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Affiliation(s)
- Helena Kuhn
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Constance Mennella
- Division of Child/Adolescent Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michelle Magid
- Department of Psychiatry at Dell Medical School, University of Texas at Austin, Austin, Texas; Department of Psychiatry, University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Psychiatry, Texas A&M Health Science Center, Round Rock, Texas
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts.
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Maydick-Youngberg D. A Descriptive Study to Explore the Effect of Peristomal Skin Complications on Quality of Life of Adults With a Permanent Ostomy. Ostomy Wound Manage 2017; 63:10-23. [PMID: 28570245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Approximately 1 million people are living with an ostomy, and 100 000 to 130 000 new ostomies are created each year. The exact incidence and prevalence of complications are unknown but have been reported to be as high as 70% and to affect quality of life (QoL). Using convenience sampling methods, a descriptive study was conducted to explore QoL scores and peristomal complications reported by adults with a permanent ostomy attending the 2009 United Ostomy Associations of America conference. Attendees who had a permanent ileostomy, colostomy, or urostomy; were at least 18 years of age; and able to read and speak English were invited to participate. Participants completed a paper/pen survey containing questions about demographics (age, gender, marital status), ostomy (time since and reason for surgery, ostomy type), and peristomal complication variables (number and type, who provided help, and satisfaction with treatment rated on a Likert-type scale from 0 [not satisfied] to 100 [completely satisfied]). QoL data were collected using the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ), which consists of 2 sections - Lifestyle Impact and Quality of Life Impact - and measures 4 QoL domains on a scale of 1 (lower) to 10 (higher) QoL. Descriptive statistics (means, standard deviation, frequencies, percentages) were used to describe the demographic, ostomy, and peristomal complication variables. Univariate analyses of covariance were used to investigate the relationships among QoL scores and peristomal complications, and the number of different complications was correlated with the QoL total score using hierarchical multiple regression analysis. Of the 230 eligible participants invited, 140 (the majority women [83, 59.3%], with an ileostomy [86, 61.4%], and a diagnosis of ulcerative colitis [55, 39.3%]) met inclusion criteria and completed the survey. The majority of participants were married both before (97, 69.3%) and after (88, 62.9%) surgery; the mean QoL score was 7.56 (SD 1.59). The mean number of complications was 0.83 (SD 1.03); approximately one third of participants experienced allergic contact dermatitis (43, 32.3%), and persons with irritant contact dermatitis reported significantly lower QoL total scores (mean 6.64 [SD 1.64], P = .02) than those without this complication (mean 7.77 [1.56]). Of those with complications, most saw an ostomy nurse (33, 47.8%), but many did not see anyone for help with their complications (24, 16.3%). Persons who sought help were generally satisfied with the help received (mean satisfaction score 77.94 ± 24.71). In this study, allergic contact dermatitis was the most common peristomal complication reported. Irritant contact dermatitis negatively affected QoL, and almost half of the participants sought the help of an ostomy care nurse. The results of this study suggest patients may benefit from more education about peristomal complications and the reporting of appliance-related contact dermatitis. Studies examining the presence of peristomal skin complications and their influence on QoL, as well as availability of and access to follow-up care with qualified ostomy nurses, are needed.
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Affiliation(s)
- Andrew Y Finlay
- Department of Dermatology and Wound Healing, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom. ,
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Sampogna F, Abeni D, Gieler U, Tomas-Aragones L, Lien L, Titeca G, Jemec GBE, Misery L, Szabó C, Linder MD, Evers AWM, Halvorsen JA, Balieva F, Szepietowski JC, Romanov DV, Marron SE, Altunay IK, Finlay AY, Salek SS, Kupfer J, Dalgard F. Impairment of Sexual Life in 3,485 Dermatological Outpatients From a Multicentre Study in 13 European Countries. Acta Derm Venereol 2017; 97:478-482. [PMID: 27819713 DOI: 10.2340/00015555-2561] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin conditions may have a strong impact on patients' sexual life, and thus influence personal relationships. Sexual issues are difficult to discuss directly in clinical practice, and a mediated instrument may be useful to capture such information. In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation.
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Affiliation(s)
- Francesca Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Via dei Monti di Creta 104, IT-00167 Rome, Italy. ,
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Abstract
The mind-skin connection has been studied since the nineteenth century. The last 40 years have set the development of new research areas which allowed the clarifying of how these two dimensions interact. The diseases that involve skin and mind constitute the field of psychodermatology and require that specialists in dermatology, psychiatry and psychology together and integrated take part in it, since skin, nervous system and mind are simultaneously affected. This paper aims to expose how psychodermatoses are currently conceptualized and the need of integration of these three specialties for conveniently treating the patients.
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Affiliation(s)
- Roberto Doglia Azambuja
- Service of Dermatology of the Hospital
Universitário de Brasília - Universidade de Brasília (UnB)
- Brasília (DF), Brazil
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Shiue I. People with dyslexia and heart, chest, skin, digestive, musculoskeletal, vision, learning, speech and mental disorders were more dissatisfied with neighbourhoods: Scottish Household Survey, 2007-2008. Environ Sci Pollut Res Int 2016; 23:23840-23853. [PMID: 27628699 PMCID: PMC5110607 DOI: 10.1007/s11356-016-7585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Rarely do we know the perception toward neighbourhoods in people specifically with health conditions. Therefore, the aim of the present study was to understand the perception toward neighbourhoods among adults with a series of the existing health conditions in a country-wide and population-based setting. Data were retrieved from and analysed in Scottish Household Survey, 2007-2008. Information on demographics, self-reported health conditions and perception toward neighbourhoods and the surrounding facilities was obtained by household interview. Analysis including chi-square test, t test and logistic regression modelling were performed. Of 19,150 Scottish adults (aged 16-80) included in the study cohort, 1079 (7.7 %) people were dissatisfied with their living areas; particularly for those who experienced harassment (15.4 %), did not recycle or with dyslexia, chest, digestive, mental and musculoskeletal problems. Twenty to forty per cent reported common neighbourhood problems including noise, rubbish, disputes, graffiti, harassment and drug misuse. People with heart or digestive problems were more dissatisfied with the existing parks and open space. People with arthritis, chest or hearing problems were more dissatisfied with the waste management condition. People with dyslexia were more dissatisfied with the existing public transportation. People with heart problems were more dissatisfied with the current street cleaning condition. People with hearing, vision, speech, learning problems or dyslexia were also more dissatisfied with sports and recreational facilities. People with heart, chest, skin, digestive, musculoskeletal, vision, learning, speech and mental disorders and dyslexia were more dissatisfied with their current neighbourhood environments. Upgrading neighbourhood planning to tackle social environment injustice and put pleasant life experience as priorty would be suggested. Graphical abstract interrelations of individual health and neighbourhood health.
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Affiliation(s)
- Ivy Shiue
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England, NE1 8ST, UK.
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.
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Montgomery K, Norman P, Messenger AG, Thompson AR. The importance of mindfulness in psychosocial distress and quality of life in dermatology patients. Br J Dermatol 2016; 175:930-936. [PMID: 27169607 PMCID: PMC5091630 DOI: 10.1111/bjd.14719] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mindfulness, defined as purposively and nonjudgementally paying attention in the present moment, could be used within psychosocial interventions to reduce the distress associated with social anxiety and avoidance found in many skin conditions. However, little is known about the relationship between naturally occurring levels of mindfulness and distress in dermatology patients. OBJECTIVES To examine the relationship between mindfulness and psychosocial distress in a dermatological population. It was hypothesized that higher levels of mindfulness would be associated with lower levels of social anxiety, anxiety, depression and skin shame, and with better quality of life. METHODS Adult dermatology outpatients (n = 120) from one hospital completed items assessing subjective severity, skin shame, fear of negative evaluation, anxiety and depression, quality of life, and levels of mindfulness. RESULTS Considering depression, 14% reported mild, 5% moderate and 2·5% severe symptoms. For anxiety, 22% reported mild, 23% moderate and 6% severe symptoms. In addition, 33·4% reported clinically significant social anxiety. After controlling for subjective severity, mindfulness explained an additional 19% of the variance in depression, 39% in anxiety, 41% in social anxiety, 13% in skin shame and 6% in dermatological quality of life. One specific facet of mindfulness (acting with awareness) was found to be the most consistent predictor of distress. CONCLUSIONS The findings indicate that higher levels of mindfulness are associated with lower distress. This suggests that facilitating mindfulness may be helpful in reducing distress in dermatology patients, and the use of mindfulness techniques warrants further investigation.
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Affiliation(s)
- K Montgomery
- Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 2TP, U.K..
| | - P Norman
- Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 2TP, U.K
| | - A G Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, U.K
| | - A R Thompson
- Department of Psychology, University of Sheffield, Western Bank, Sheffield, S10 2TP, U.K
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Abstract
The aim of this study was to evaluate perception of body image and anxiety of 221 university students presenting to the dermatology outpatient clinic with a skin disease and 205 students without skin disease. Analysis of anxiety and body image scores yielded differences by sex and age in both groups. The group with skin disease had lower scores on body image. Acne vulgaris seems to be the most disturbing among the skin diseases, and this was more prominent in younger patients.
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40
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Becatti M, Barygina V, Emmi G, Silvestri E, Taddei N, Lotti T, Fiorillo C. SIRT1 activity is decreased in lesional psoriatic skin. Intern Emerg Med 2016; 11:891-3. [PMID: 27286867 DOI: 10.1007/s11739-016-1482-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Matteo Becatti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Victoria Barygina
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Giacomo Emmi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Elena Silvestri
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Niccolò Taddei
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Torello Lotti
- Dermatology and Venereology Division, Guglielmo Marconi University, Rome, Italy
| | - Claudia Fiorillo
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Abstract
The nervous, immune, endocrine and integumentary systems are closely related and interact in a number of normal and pathological conditions. Nervous system mediators may bring about direct changes to the skin or may induce the release of immunological or hormonal mediators that cause pathological changes to the skin. This article reviews the psychological mechanisms involved in the development of skin diseases.
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Affiliation(s)
- Juan F Honeyman
- Department of Dermatology, University of Chile, Catholic University of Chile, 8320000 Santiago, Chile.
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Abstract
Psychodermatology is a relatively new field of medicine. It encompasses the interaction of mind and skin. The role of psychoneuroimmunology in the causation of psychocutaneous disorders and psychosocial aspects of skin disease have gained momentum lately. The treatment of psychodermatological disorders focus on improving function, reducing physical distress, diagnosing and treating depression and anxiety associated with skin disease, managing social isolation and improving self esteem of the patient. Both pharmacological and psychological interventions are used in treating psychocutaneous disorders. The interest in Psychodermatology around the world is increasing and there are several organizations holding their regular meetings.
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Affiliation(s)
- Mohammad Jafferany
- Department of Psychiatry and Behavioural Sciences, Central Michigan University, MI 48603 Saginaw, USA.
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Abstract
Most people would like to change something about their bodies and the way that they look, but for some it becomes an obsession. A healthy skin plays an important role in a person's physical and mental wellbeing, whereas a disfiguring appearance is associated with body image concerns. Skin diseases such as acne, psoriasis and vitiligo produce cosmetic disfigurement and patients suffering these and other visible skin conditions have an increased risk of depression, anxiety, feelings of stigmatization and self-harm ideation. Body image affects our emotions, thoughts, and behaviours in everyday life, but, above all, it influences our relationships. Furthermore, it has the potential to influence our quality of life. Promotion of positive body image is highly recommended, as it is important in improving people's quality of life, physical health, and health-related behaviors. Dermatologists have a key role in identifying body image concerns and offering patients possible treatment options.
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Affiliation(s)
- Lucia Tomas-Aragones
- Department of Psychology and Sociology, University of Zaragoza, C/ San Juan Bosco, 7, ES-50009 Zaragoza, Spain.
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Smulevich AB, Lvov AN, Romanov DV. Hypochondriasis Circumscripta: A Neglected Concept with Important Implications in Psychodermatology. Acta Derm Venereol 2016; 96:64-8. [PMID: 27283953 DOI: 10.2340/00015555-2371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The article is devoted to a psychodermatological disorder with self-destructive behavior - hypochondriasis circumscripta. Presented data are based on a clinical analysis of 22 consecutive cases (15 female; mean age - 56.1 ± 12.6 years) observed in the dermatologic department of First Moscow State Medical University and managed in a multidisciplinary approach by dermatologists and a consultation-liaison psychiatrist. Psychopathology, clinical presentations, historical aspects and treatment options are discussed. The self-inflicted skin lesions result from a severe repetitive autodestruction of focal skin loci primarily affected with heterogeneous sensations associated with a hypochondrical over-valued idea. Hypochondriasis сircumscripta is a serious diagnostic and treatment challenge and should be distinguished from dermatitis artefacta, skin picking disorder and delusional infestation.
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Affiliation(s)
- Anatoly B Smulevich
- Department of Psychiatry and Psychosomatics, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
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Abstract
Human-based medicine (HbM), a form of psychiatry that focuses not only on fragments and constructs but on the whole person, no longer finds its theoretical basis in the positivism of the modern era, but rather owes its central maxims to the post-modernist ideal that ultimate truths or objectivity in identifying the final cause of illness remain hidden from us for theoretical reasons alone. Evidence-based medicine (EbM) and HbM are thus not mutually exclusive opposites; rather, despite superficial differences in methods of diagnosis and treatment, EbM must be integrated into HbM as an indispensable component of the latter. Probably the most important difference between EbM and HbM lies in the aims and methods of treatment. In HbM the goal is no longer simply to make illnesses disappear but rather to allow the patient to return to a life that is as autonomous and happy as possible. The human being with all his or her potential and limitations once again becomes the measure of all things. This also implies, however, that the multidimensional diagnostics of HbM are oriented not only towards symptoms, pathogenesis, process and understanding but also to a greater degree towards the patient's resources. Treatment options and forms of therapy do not put the disease construct at the centre of the diagnostic and therapeutic interest, but have as their primary aim the reopening of the possibility of a largely autonomous and joyful life for the patient.
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Affiliation(s)
- Michael Musalek
- Department of Psychiatry, Anton Proksch Institute, 1230 Wien, Austria.
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46
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Abstract
Psychodermatology is a newer and emerging subspecialty of dermatology, which bridges psychiatry, psychology, paediatrics and dermatology. It has become increasingly recognised that the best outcomes for patients with psychodermatological disease is via a multidisciplinary psychodermatology team. The exact configuration of the multidisciplinary team is, to some extent, determined by local expertise. In addition there is a growing body of evidence that it is much more cost effective to manage patients with psychodermatological disease in dedicated psychodermatology clinics. Even so, despite this evidence, and the demand from patients (and patient advocacy groups), the delivery and establishment of psychodermatology services is very sporadic globally. Clinical and academic expertise in psychodermatology is emerging in dermatology and other (often peer-reviewed) literature. Organisations such as the European Society for Dermatology and Psychiatry champion clinical and academic advances in psychodermatology, whist also enabling training of health care professionals in psychodermatology. Emiliano Panconesi, to whom this supplement is dedicated, was at the forefront of psychodermatology research and was a founding member of ESDaP.
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Affiliation(s)
- Claire Marshall
- Department of Dermatology, Barts NHS Trust, Whipps Cross University Hospital, E11 1NR London, United Kingdom
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47
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Abstract
There is increasing awareness of the limitations of the disease oriented approach in medical care. The primary goal of psychosomatic medicine is to correct this inadequacy by incorporation of innovative operational strategies into clinical practice. Psychosomatic practice can be recognized by 2 distinctive features: the holistic approach to patient management (encompassing psychosocial factors) and the clinical model of reasoning (which reflects a multifactorial frame of reference). A basic psychosomatic assumption is the consideration of patients as partners in managing disease. The partnership paradigm includes collaborative care (a patient-physician relationship in which physicians and patients make health decisions together) and implementation of self-management (a plan that provides patients with problem-solving skills to enhance their self-efficacy). Pointing to strategies that focus on individual needs may improve patient quality of life and final outcomes.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna,, IT-40121 Bologna, Italy. ,
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48
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Abstract
The doctor-patient relationship in dermatology, as in all the fields of medicine, is not a neutral relationship, removed from affects. These affects take root in the sociocultural, professional, family and personal history of both persons in the relationship. They underpin the psychic reality of the patients, along with a variety of representations, preconceived ideas, and fantasies concerning dermatology, the dermatologists or the psychiatrists. Practitioners call these "countertransference feelings", with reference to the psychoanalytical concept of "countertransference". These feelings come forward in a more or less conscious way and are active during the follow-up of any patient: in fact they can facilitate or hinder such a follow-up. Our purpose in focusing on this issue is to sensitize the dermatologists to recognizing these countertransference feelings in themselves (and the attitudes generated by them), in order to allow the patients and doctors to build a dynamic, creative, trustful and effective relationship.
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Affiliation(s)
- Sylvie G Consoli
- Private practice, 7 Rue Mouton-Duvernet, FR-75014 Paris, France.
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Ulnik JC, Linder MD. The Psychoanalytic Interpretation of Symptoms - Evidence and Benefits. Acta Derm Venereol 2016; 96:22-4. [PMID: 27283247 DOI: 10.2340/00015555-2427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dermatological symptoms are explained in medicine in biological terms. Nevertheless, exploring the life history of dermatological patients can lead to seductive, but non-rigorously scientific interpretations which are of associative, or even symbolic nature. Moreover, associations of physical signs and life events, suggest us to consider our patients as subjects pervaded by the will to communicate not only through language, but also through their body and all its functions and malfunctions. Interpreting symptoms and eventually finding a meaning to the disease must not imply a causative attribution, because the very signification of cause and effect is probably beyond our grasp. Hence, aware of our limits, we should know whether we wish to treat the disease as a whole, considering that the observer (the doctor, the patient or the medicine as a theoretical corpus) is not only an observer from outside, but part of the disease that will be treated or described.
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Affiliation(s)
- Jorge C Ulnik
- Department of Psychiatry and Mental Health, Buenos Aires University, (C1425) Buenos Aires, Argentina
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Giovannelli L, Barbasio C, Burroni AG, Fassino M, Parodi A, Granieri A. Alexithymia, dissociation, and trauma in patients with chronic skin conditions. GIORN ITAL DERMAT V 2016; 151:347-352. [PMID: 26159657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND There is considerable literature concerning psychological distress and dermatological diseases. Recent studies highlight the role of emotion dysregulation in several skin diseases. Our study sought to explore emotion regulation in patients with chronic skin conditions and the frequency of traumatic experiences they had encountered. METHODS Forty-nine sequential dermatological patients were compared with 49 healthy adults. Both groups were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale [TAS-20]) and dissociation (Dissociation Experiences Scale [DES-II] and they completed a checklist for traumatic events (Traumatic Experiences Checklist [TEC]). RESULTS Our results indicated that subjects suffering from chronic dermatological diseases presented more severe alexithymic and dissociative traits. Furthermore, they had suffered a greater number of stressful experiences than had individuals in the control group. CONCLUSIONS Our findings appear to be consistent with literature linking skin diseases and emotion regulation, highlighting a psychosomatic specificity in these conditions.
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