Only limited support for a role of psychosomatic factors in psoriasis - Results from a case-control study
ABSTRACT To investigate the role of stressful events, social support, attachment security and alexithymia in triggering or exacerbating psoriasis.
Outpatients experiencing a recent onset or exacerbation of psoriasis (n=40) were compared with outpatients with skin conditions in which psychosomatic factors are regarded as negligible (n=116). Stressful events during the last year were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and perceived social support were assessed with the ECR questionnaire, the TAS-20 and the MSPSS, respectively.
The mean number of recently experienced life events, or of undesirable, uncontrollable or major events was not different between psoriatic patients and controls. The only stress measure that showed a slight trend towards an association with psoriasis was having experienced four or more stressful events in the preceding year. There was a statistical trend towards an association between alexithymia and psoriasis, whereas there were no significant differences between patients with psoriasis and controls with respect to perceived social support and attachment security. Subgroup analysis suggested that the role of all psychosomatic factors studied might be more important in certain clinical types, such as guttate and diffuse plaque psoriasis.
Our findings provide only limited support for a role of psychosomatic factors in psoriasis. Future studies should investigate chronic and daily stressors in addition to major life events, include measures of stress appraisal and include specifically patients with a recent onset of disease.
- SourceAvailable from: Suleyman Akarsu
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- "High sympathetic activity, high heart rate, high electrodermal activity, and low oxygen consumption were reported in alexithymic individuals (Guilbaud et al., 2003; Kauhanen et al., 1994). In a study by Picardi et al. (2003) in patients with alopecia areata, more alexithymic features, inadequate social support, and less close relationship have been reported. The majority of patients with alopecia areata who did not respond to treatment were shown to be alexithymic (Panconesi and Hautmann, 1996). "
ABSTRACT: The aim of this study was to evaluate the primary focal hyperhidrosis patients in terms of alexithymia. Participants (n = 50) diagnosed with primary focal hyperhidrosis by a dermatologist were referred to a psychiatrist and evaluated via Structured Clinical Interview for DSM-IV Axis I Disorders and Toronto Alexithymia Scale-20. The rate of alexithymia was 45.6 percent and 18.2 percent, respectively, for primary focal hyperhidrosis and control participants (n = 44). Multivariate analysis of variance results showed that the primary focal hyperhidrosis group scored significantly higher than the control group in Difficulty Identifying Feelings and Difficulty Describing Feelings subscales, and total score. Psychotherapeutic interventions can increase the chances of dermatological treatment success and can have a positive impact on the quality of life in chronic cases.Journal of Health Psychology 08/2012; 18(5). DOI:10.1177/1359105312454908 · 1.88 Impact Factor
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- "The association between onset and exacerbation of psoriasis with stress is much debated and previous studies point in different directions. A recent study comprising 40 patients with mixed psoriasis phenotypes showed no evidence for an influence of stressful life events on psoriasis symptoms (Picardi et al, 2003), whereas other studies suggest a link between psycho-social stress and both onset and exacerbation of psoriasis (Naldi et al, 2001; Fortune et al, 2003). Obviously, more epidemiological and experimental research is needed to understand this potentially key issue in expression of psoriasis phenotype. "
ABSTRACT: Psoriasis is clinically a heterogeneous disease. Detailed evaluation of phenotype at disease onset is lacking. This study is a baseline characterization of 400 adult individuals with first time incidence of psoriasis on non-hairy skin, describing clinical phenotypes and putative environmental triggers at disease onset. In total, 74 patients with guttate and 326 patients with non-guttate phenotype, the majority with plaque psoriasis, were included. Guttate phenotype was associated with younger age and recent infection in 84%, where acute streptococcal pharyngitis was verified in 63%. The predominating factor associated with onset of plaque psoriasis was a recent life crisis (46%). A positive family history for psoriasis was approximately the same in both groups. Psoriasis arthropathy was diagnosed in 5% of guttate and 15% of non-guttate patients, with enthesopathy being the dominant symptom among guttate patients. This study confirms the strong link between onset of guttate psoriasis phenotype and streptococcal throat infection, whereas onset of plaque psoriasis was highly associated with a preceding distinct stressful life event. Longitudinal follow-up of the patients will provide robust information about disease development and response to treatment.Journal of Investigative Dermatology 04/2005; 124(3):499-504. DOI:10.1111/j.0022-202X.2004.23611.x · 6.37 Impact Factor
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ABSTRACT: A link between the mind and the skin has long been hypothesized. Indeed, some studies suggested that psychosocial factors may play a role in the pathogenesis and course of several skin diseases. Conversely, other studies suggested that psychiatric disorders and psychosocial difficulties may result as a complication of a primary skin disease. Epidemiological studies indeed found a high prevalence of psychiatric disorders among dermatological patients. This is a source of concern, because psychiatric morbidity is associated with emotional suffering, disability, lower quality of life, poorer adherence to dermatological treatment, and increased risk of self-harm. Conditions such as demoralization, health anxiety, irritable mood, type A behavior, and alexithymia were also found to be frequent in dermatological patients, and to be independently associated with greater psychological distress, lower quality of life, and poorer psychosocial functioning. Several studies also raised concerns about underrecognition and undertreatment of psychiatric disorders. This large body of findings suggests that psychosocial issues deserve more attention in everyday dermatological practice, and highlights the need for a biopsychosocial approach to the management of patients with skin disease. To this purpose, the development of efficient consultation-liaison services enabling an effective collaboration between dermatologists and mental health professionals is mandatory.Advances in psychosomatic medicine 01/2007; 28:109-126. DOI:10.1159/000106800