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Abstract

This article explores the way stress affects the skin, both at the molecular level, where the skin has an intricate connection to the neurocutaneous and immune systems, and at the clinical level. The concept of psychodermatology is reviewed with regard to the way skin reacts to stress, how stress is a trigger for several common skin diseases, and how neuropsychiatric disorders may have skin manifestations. The article is directed at making the dermatologist, the psychiatrist, the psychologist, and the primary physician familiar with the brain-skin mechanisms involved in stress and the resultant clinical expressions on the skin. Copyright © 2014 Elsevier Inc. All rights reserved.

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... Emotional response can also cause changes in electrodermal activities. It has been demonstrated that the psychological stress can elicit significant changes in electrodermal activities in humans [31,32]. Whereas, it has also been shown that the electrodermal activities vary among subgroups of depressive patients [33,34], with a tendency of decrease in electrodermal activity during acute suicidal period [35]. ...
... Aging [25,26] and depression with suicidal tendency [35] both manifest reduction in electrodermal activities, indicating decrease in physiological responses of emotion [31,32]. In this regard, emotional memories would also be reduced in accordance. ...
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Many observations have demonstrated that the hypothalamic neuroendocrine change determines the chronological sequence of aging in mammals. However, it remains uncertain on the mechanism to account for the hypothalamic aging manifestations. In this article, it is pointed out that, as constantly exposed to sunshine and oxygen, the skin would undergo both telomere-shortening and oxidative senescent processes. The senescent alterations of skin, such as attenuation in electrodermal activities, would in turn reduce the emotional responses and memories. Whereas previously I demonstrated that the slow wave sleep just functioned to adjust the emotional balance disrupted by accumulated emotional memories, especially capable of ameliorating the symptoms of depressed patients. Therefore, the reduction in emotional responses and memories from skin senescence would reduce the requirement for slow wave sleep in many senescent observations. The decrement in slow wave sleep would in further cause functional but not chronological degeneration of suprachiasmatic nucleus rather than paraventricular nucleus in hypothalamus. In these respects, from skin senescence to slow wave sleep, there forms a new degenerative aging pathway able to account for the hypothalamic chronological sequence of aging, specifically addressed to the suprachiasmatic nucleus.
... 6 Besides, genetic and hormonal factors, nutritional habits, Propionibacterium acnes (P Acnes), emotional stress, and smoking have been reported to increase acne formation. [14][15][16][17][18][19] The possible interaction between gastrointestinal factors and depression, emotional stress, and acne was first proposed by Stokes and Pillsburry. 8 The authors suggested that emotional conditions such as depression and anxiety can lead to secretion of neurotransmitters such as serotonin, norepinephrine, and acetylcholine from the intestinal enteroendocrine cells. ...
... Brain-gut-skin axis, inflammation, diets with high glycemic index, and emotional stress are the common factors playing roles in the pathogenesis of both acne vulgaris and IBS. [15][16][17][18][19]34 Both diseases have been shown to have increased serum levels of proinflammatory cytokines such as IL-1, IL-6, and tumor necrosis factor alpha. 5,31,41,42 These data also support the likely relationship between IBS and acne. ...
Article
Background Irritable bowel syndrome (IBS) is a functional gastrointestinal disease characterized by chronic abdominal pain and changes in bowel movements without underlying organic pathology. Many skin diseases have been reported to be more common in individuals with functional bowel diseases. Aims In this study, we aimed to investigate a possible relationship between acne vulgaris (AV) and IBS. Patients/Methods This prospective controlled study included patients with AV and healthy volunteers. All the subjects were evaluated in terms of the presence of IBS. The diagnosis of IBS was made based on the ROME IV diagnostic criteria. The clinical severity of AV was calculated using the global acne grading system (GAGS). Results A total of 300 patients with acne vulgaris and 300 age and gender‐matched healthy controls were included in the study. The majority of the patients were female (n = 175, 58.3%). The mean ages of the patients and controls were 20.22 ± 5.24 years and 20.49 ± 5.36 years, respectively. A total of 183 patients (61.0%) and 84 (28.0%) controls were diagnosed with IBS based on the Rome IV diagnostic criteria. The frequency of IBS was statistically significantly higher in the patient group than in the control group. (P = .001). There was also statistically significant relationship between the GAGS scores and IBS diagnosis (P = .001), abnormal stool form (P = .001), abdominal distention (P = .001), and feeling of incomplete evacuation (P = .001). Conclusion Our study showed that IBS is significantly more common in patients with AV than in healthy controls. Additionally, GAGS scores were higher in patients diagnosed with IBS. To the best of our knowledge, this is the first study focusing on the subject.
... College can be a cause of increased psychological stress, especially given the complex social, academic, and financial pressures faced by today's students (1,2). The association between psychological stress and the manifestation or exacerbation of different skin diseases is well established (3)(4)(5)(6)(7)(8). Previous studies that demonstrated an association between stress and skin symptoms focused their analyses on a single skin disease. ...
... The studies available show that the skin lesions that occur in the course of the disease, such as skin rash with wheals and itch, are connected with psychological problems and last at least 6 weeks. [21][22][23] The psychological factors may involve unelaborated and suppressed emotions. They may manifest as difficulty describing emotions, for example, expressing anger. ...
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Aim: Alexithymia is associated with limited cognitive processing of emotions by an individual suffering from recurrent urticaria and alexithymia and makes them focus on somatic manifestations of emotional arousal and on poorly controlled compulsive reactions to negative stimulation. Alexithymia is considered to be a personality trait, which, along with other factors, predisposes individuals toward developing somatic diseases. The aim of the study was to assess the measurement of alexithymic features in patients with recurrent urticaria and to assess the types of concurrent anxiety disorders and overall anxiety level. Methods: In order to diagnose clinical anxiety symptoms in patients, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the Hamilton Anxiety Rating Scale were applied. Alexithymic features were measured by means of a shortened version of the Toronto Alexithymia Scale, characterized by high discrimination power, internal coherence, and reliability. Results: According to the Toronto Alexithymia Scale results, the greatest contributing factor was "inability to differentiate between feelings and bodily sensations". This was observed in both males and females. Most frequently, the patients were found to suffer from generalized anxiety disorder and social phobia. Conclusion: Alexithymia may result from the difficulty associated with expressing emotions caused by anxiety disorders. Undergoing treatment for anxiety disorders may contribute to reduced exacerbation of urticaria.
... As the majority of facial skin photoaging endpoints do not become visible until the chronological age of at least 25-30 years [59], these are, once again, visual cues that the owner is probably past reproductive prime. In addition, it is now known that solar UVR, and associated damage mechanisms transduced via the skin, can induce systemic immune suppression [68], increasing the risk of disease in the host and, consequently, lowering mate quality; (iii) many systemic disease states have direct dermatological manifestations [69]; (iv) we are now beginning to understand the importance of so-called psychodermatological disease, where host stress triggers a variety of skin disease and where neuropsychiatric disorders may manifest themselves in the skin condition [70]. ...
... (7) Other studies have proved that high severity of acne occurs due to increased stress rates as in premenstrual syndrome because of hormonal changes. (8) 4. Menstruation: The clinical route of acne often waxes and wanes during menstrual period in females. (9) 5. Diet: There is no clear association between diet and acne, as any definitive relationship between them has not been proved by high quality confirmation. ...
... We know that patient's subjective experience of illness is strongly influenced by personality traits, cognitive frames and individual emotional reactivity, and that stress and emotions may exacerbate inflammatory skin disorders (de Zoysa, 2013;Shenefelt, 2010;Rodriquez-Vallecio & Woodbury-Farina, 2014;Connor, 2017). In HS, patient anger can affect the severity of the clinical picture, and impair compliance to treatment. ...
Article
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Hidradenitis suppurativa/acne inversa (HS) is one of the most debilitating inflammatory chronic skin diseases and it heavily impairs the emotional and relational life of the patients. Despite its clinical and epidemiological relevance, its psychological correlates are still largely unexplored. The aim of the present study was to investigate the psychological and emotional impact of HS, with a specific focus on psychiatric symptoms, particularly depression, suicidal ideation, self-esteem, anger, and some personality traits. Thirty eight patients diagnosed with HS (HS Group) were compared with a control group of 28 outpatients diagnosed with nevi (N Group) and assessed with psychometric questionnaires (GHQ-28, STAXI-2, BDI-II, BHS, RSES, EF Questionnaire, and I–R Questionnaire). Results showed significant differences between the two groups, with more psychiatric symptoms, lower self-esteem, and higher levels of state anger and of emotional fragility in HS patients. These findings suggest the evidence of a significant psychiatric comorbidity in HS and of a strong emotional impact of the disease.
... The pathogenesis of acne vulgaris is multifactorial, and hormones, sebum production and bacterial colonization playing major roles. [5][6] Psychological stress has also been identified amongst the causative factors that exacerbate acne. 7 It has been thought that psychological stress can alter the immune functions of the skin 6 and cutaneous barrier function. ...
Article
BACKGROUND Although there is widespread acceptance of a relationship between stress and acne, not many studies have been performed to assess this relationship in Indian population particularly in unmarried females. The objective of this study was to determine the relationship between stress and acne severity. MATERIALS AND METHODS A case control study was planned to study the association. All the subjects were assessed on Perceived Stress Scale to assess the level of stress they may have felt over past one month. All the diagnosed cases of acne vulgaris were assessed by Global Acne Grading Scale (GAGS) to assess the severity of acne. Then the findings were analysed statistically. RESULTS The results indicate that there is positive correlation between stress & acne. The cases showed high stress levels as compared to the controls which were statistically significant (p
... The 'skin-brain axis' communication network has been recognized as a mechanism by which the central nervous system (CNS) response to psychological stress results in an afferent relay and physiological outcome in the skin (Paus et al., 2006;Pavlovic et al., 2008;Martins et al., 2020;Rodriguez-Vallecillo and Woodbury-Farina, 2014;Chapman and Moynihan, 2009). Stress, through a CNS-mediated mechanism, has been shown to exacerbate peripheral cutaneous manifestations of atopic dermatitis, psoriasis, and even hair growth (Martins et al., 2020;Alexopoulos and Chrousos, 2016;Ayasse et al., 2020;Paus, 2016;Pondeljak and Lugovi c-Mihi c, 2020;Theoharides, 2020;Torales et al., 2020;Yang and Zheng, 2020;Zeiser et al., 2021). ...
Article
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Patients with chronic wounds often have associated cognitive dysfunction and depression with an as yet unknown mechanism for this association. To address the possible causality of skin wounding inducing these changes, behavior and cognitive functions of female C57BL/6 mice with an excisional skin wound were compared to unwounded animals. At six days post wounding, animals exhibited anxiety-like behaviors, impaired recognition memory, and impaired coping behavior. Wounded animals also had concomitant increased hippocampal expression of Tnfa, the pattern recognition receptor (PRR) Nod2, the glucocorticoid receptors GR/Nr3c1 and Nr3c2. Prefrontal cortex serotonin and dopamine turnover were increased on day six post-wounding. In contrast to the central nervous system (CNS) findings, day six post -wounding serum catecholamines did not differ between wounded and unwounded animals, nor did levels of the stress hormone corticosterone, TNFα, or TGFβ. Serum IL6 levels were, however elevated in the wounded animals. These findings provide evidence of skin-to-brain signaling, mediated either by elevated serum IL6 or a direct neuronal signaling from the periphery to the CNS, independent of systemic mediators. Wounding in the periphery is associated with an altered expression of inflammatory mediators and PRR genes in the hippocampus, which may be responsible for the observed behavioral deficits.
... Recent studies have analyzed the neuroendocrinology of the skin (9,10), but the intricate crosstalk between skin conditions and stress was initially proposed during the time of the ancient Greeks and Romans. Cutaneous pruritus, dermatitis, vitiligo, and other skin inflammatory diseases are triggered or exacerbated by stress (11,12). Psychocutaneous morbidity is the cause of .1 in every 3 visits to dermatologists (13,14). ...
Article
Substance P (SP) is a candidate mediator along the brain-skin axis and can mimic the effects of stress to regulatemelanogenesis.Previously,we andothershave foundthat the regulationofSPforpigmentary functionwas mediated by neurokinin 1 receptor (NK1R). Emerging evidence has accumulated that psychologic stress can induce dysfunction in the cutaneous serotonin 5-hydroxytryptamine (5-HT)-5-HT1A/1B receptor system, thereby resulting in skinhypopigmentation.Moreover,NK1Rand5-HTR(except 5-HT3)belong toGPCR.Thepresent study aimedat assessing the possible existence ofNK1R-5-HTR interactions and relatedmelanogenic functions.Western blot and PCR detection revealed that SP reduced expression of 5-HT1Areceptor via theNK1 receptor. Biochemical analyses showed that NK1R and 5-HT1AR could colocalize and interact in a cell and in the skin.When theNterminus of the NK1R protein was removed NK1R surface targeting was prevented, the interaction between NK1R-5-HT1AR decreased, and the depigmentation caused by SP and WAY100635 could be rescued. Importantly, pharmaceutical coadministration of NK1R agonist (SP) and 5-HT1A antagonist (WAY100635) enhanced the NK1-5-HT1A receptor coimmunoprecipitation along with the depigmentary response. SP andWAY100635 cooperation elicited activation of a signaling cascade (the extracellular, regulated protein kinase p-JNK signaling pathway) and inhibition of p70S6K1 phosphorylation and greatly reduced melanin production in vitro and in vivo in mice and zebrafish. Moreover, the SP-induced depigmentation response did not be occur in 5-htr1aa+/2 zebrafish embryos. Taken together, the results of our systemic study increases our knowledge of the roles of NK1R and 5-HT1AR in melanogenesis and provides possible, novel therapeutic strategies for treatment of skin hypo/hyperpigmentation.
... One of these factors is stress, which influences several dermatological disorders. 3,4 Seventy four percent of 178 patients and relatives in a questionnaire survey reported that they believed that anxiety is an exacerbating factor of acne. 5 An interventional study found that patients had an improvement in their acne compared to controls when receiving biofeedback training, relaxation training, and stress reduction techniques. ...
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Introduction Although there is widespread acceptance of a relationship between stress and acne, not many studies have been performed to assess this relationship. The objective of this study was to determine the relationship between stress and acne severity. Methods A cross-sectional study was conducted among 144 6th year female medical students 22 to 24 years in age attending the medical faculty at King Abdulaziz University. This study used the global acne grading system (GAGS) to assess acne severity in relation to stress using the Perceived Stress Scale (PSS). The questionnaire also included some confounding factors involved in acne severity. Results The results indicated an increase in stress severity strongly correlated with an increase in acne severity, which was statistically significant (p<0.01). Subjects with higher stress scores, determined using the PSS, had higher acne severity when examined and graded using the GAGS. Conclusion On the basis of this study, it is concluded that stress positively correlates with acne severity.
Article
Background: University can be a source of considerable psychological stress owing to converging academic, cultural and financial pressures. A recent US college study showed an association between increased psychological stress levels and various skin conditions using validated questionnaires. Using the same design, this study aimed to further investigate this relationship in an Australian university cohort. Method: Five-Thousand University of New South Wales students aged between 18 and 30 were randomly selected and emailed an invitation to participate in a cross-sectional web-based survey. To assess stress levels, we used the perceived stress questionnaire (PSQ). To assess skin complaints, we used a modified version of the self-reported skin questionnaire. Students were divided into low ≤25th percentile), medium (>25th and ≤75th percentile) and high stress (>75% percentile) groups. Results: 471 students both enrolled and completed the survey. 120 were designated low stress, 232 moderate stress and 119 high stress subjects. When perceived stress level and skin conditions were compared, high stress subjects reported statistically significantly more pruritus, dry sore rash, scaly skin, alopecia, other rashes on face, itchy rash on hands, hyperhidrosis and trichotillomania than low stress subjects. No significant differences were found for pimples, warts, onychophagia or oily, waxy patches on scalp and/or flaky scalp. Conclusion: The results of this study demonstrated that perceived stress levels in those who answered the questionnaires are statistically significantly associated with a number of common skin complaints. These findings provide valuable insights into the potential role of perceived stress for health care practitioners caring for patients with both new skin symptoms and/or exacerbation of an existing dermatosis.
Chapter
Der konsiliarisch tätige Psychiater bzw. Psychosomatiker wird von Kollegen anderer Fachdisziplinen angefordert, einen bestimmten, zugewiesenen Patienten hinsichtlich psychischer Störungen hin zu untersuchen und die Kollegen zu beraten. Bei der Liaisonpsychiatrie ist der Psychiater bzw. Psychosomatiker fest und regelmäßig in das Behandlungsteam auf einer primär nicht psychiatrischen bzw. nicht psychosomatischen Station integriert. Spezifikationen der Konsiliar- und Liaisonpsychiatrie und -psychosomatik umfassen u. a. die Psychodermatologie, Psychoinfektiologie und Transplantationspsychiatrie /-psychosomatik. Ein Viertel der dermatologischen Patienten leidet an behandlungsbedürftigen psychischen Erkrankungen. Psychische Komorbiditäten einer HIV-Infektion können durch das HI-Virus selbst oder die virusbedingte Immunsuppression und damit verbundene Folgeerkrankungen verursacht sein oder reaktiv. Patienten vor oder auch nach einer Organtransplantation sehen sich mit erheblichen Belastungen und Herausforderungen konfrontiert.
Article
Vitiligo is a depigmented disease featured as diagnosis simplicity and cure difficulty. Its occurrence and development are associated with a variety of factors, including oxidative stress, heredity and immunity, etc. Existing drugs for the treatment of vitiligo are to reduce the death of melanocytes and induce pigment accumulation as the main treatment strategy. Ermanin, a member of the flavonoids, is extracted from bee glue which is wildly used to treat vitiligo in Traditional Chinese medicine. Therefore, this article discusses the relationship between melanogenesis and ROS production by ermanin via biochemical and free radical approaches in vivo and in vitro. In this study, we found that ermanin effectively increased the melanin content at the in vivo model (zebrafish). Moreover, the melanin levels at the in vitro models (B16F10 cells and primary melanocytes) were also increased significantly accompanied with an increase in ROS levels. Ermanin also significantly enhanced the activity of tyrosinase. Meanwhile, ermanin increased the expression levels of TYR, TRP-1, and DCT genes, while ROS mediated the accumulation of pigments caused by ermanin, which increased the production of pigments and regulated the expression mRNA levels of TYR and DCT genes. From the perspective of pigment production regulation pathways, western blot showed that the pigment accumulation caused by ermanin was closely related to the CREB-MITF pathways, it activated CREB, TYR, TRP-1, and DCT proteins. The use of CREB specific inhibitor 666-15 and MITF inhibitor ML329 confirmed that the pigment accumulation caused by ermanin was positively correlated with CREB and MITF proteins. Our findings revealed the potential mechanisms by which ermanin promoted the production of melanin through activated CREB-MITF signaling pathway and ROS function as signaling messengers are beneficial to melanin production and thereby will help develop novel therapeutic approaches for vitiligo.
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The skin senses external environment, including ultraviolet light (UV). Hippocampus is a brain region that is responsible for memory and emotion. However, changes in hippocampus by UV irradiation to the skin have not been studied. In this study, after 2 weeks of UV irradiation to the mouse skin, we examined molecular changes related to cognitive functions in the hippocampus and activation of the hypothalamic-pituitary-adrenal (HPA) axis. UV exposure to the skin decreased doublecortin-positive immature neurons and synaptic proteins, including N-methyl-D-aspartate receptor 2 A and postsynaptic density protein-95, in the hippocampus. Moreover, we observed that UV irradiation to the skin down-regulated brain-derived neurotrophic factor expression and ERK signaling in the hippocampus, which are known to modulate neurogenesis and synaptic plasticity. The cutaneous and central HPA axes were activated by UV, which resulted in significant increases in serum levels of corticosterone. Subsequently, UV irradiation to the skin activated the glucocorticoid-signaling pathway in the hippocampal dentate gyrus. Interestingly, after 6 weeks of UV irradiation, mice showed depression-like behavior in the tail suspension test. Taken together, our data suggest that repeated UV exposure through the skin may negatively affect hippocampal neurogenesis and synaptic plasticity along with HPA axis activation.
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en Linked Article: Hesselvig et al. Br J Dermatol 2018; 179:1095–1101.
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The fluoroquinolones absorb light in the 320 to 330 nm ultraviolet A (UV‐A) wavelength and produce reactive oxygen species (ROS) such as superoxide anion, hydroxyl radical, and hydrogen peroxide; thus, the photodynamic generation of ROS may be the basis of phototoxicity of quinolones in human beings and animals. This study aimed to evaluate the damaging effects of UV‐A radiation at different periods of exposure on rats' brains administered with ciprofloxacin. Ciprofloxacin administration in UV‐A exposed animals exaggerated the brain‐oxidative stress biomarkers and decreased the locomotor activity. Exposure of rats to UV‐A for 60 minutes induced a significant increase of malondialdehyde (MDA), myeloperoxidase (MPO), and a decrease in the values of superoxide dismutase (SOD), glutathione (GSH) compared to a normal one; these changes were UV‐A exposure time–dependent. However, the administration of vitamin C to the UV‐60‐treated group decreased the values of MDA, MPO, and shifted the values of SOD, GSH toward the normal values. Vitamin C, probably due to its strong antioxidant properties, could improve and partially counteract the toxic effect of UV‐A on oxidative stress parameters and prevent the damage in rat's brain tissues.
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Neural hypothesis has become an important aspect of vitiligo, yet without corresponding diagnostic indicators. We preliminarily found 32 cases of vitiligo patients with certain aggregation of mental factors. In peripheral blood mononuclear cells (PBMCs) of these patients, transcriptome analyses revealed that the circulation expression of a type I interferon (IFN-I)-dependent genes was induced. Also, serum IFNα was elevated in vitiligo patients with depression. Therefore, our hypothesis is whether IFNα levels predict the occurrence of psychiatric vitiligo. Through the establishment of stress-induced depigmentation model, serum IFNα also showed increase. Intracerebroventricular and subcutaneous IFNα injection can both elicit not only depressive behavior but also vitiligo-like characteristics. Mechanistically, central IFNα induces the release of dorsal root ganglion (DRG) substance P (SP) to inhibit melanogenesis. Peripheral IFNα disturbs cutaneous-neuro-endocrine microenvironment. Type I IFN (IFNα) pathway-related genes in stress vitiligo were significantly discriminating from non-stress vitiligo, while that of type II IFN pathway was not.
Chapter
It is the heterogeneous changes of hypothalamic functions that determine the chronological sequence of aging in mammals. Recently, it was hypothesized by Cai the decrease in slow-wave sleep (SWS) resulting from skin aging as responsible for the degeneration of hypothalamic suprachiasmatic nucleus (SCN). It was soon hypothesized by the European people in television that the increase in body fat as responsible for the degeneration of male preoptic sexually dimorphic nucleus (SDN-POA), via the aromatase converting testosterone to estradiol as proposed by Cohen. It is the hypothalamic paraventricular nucleus (PVN) that remains unchanged in neuron number during aging for psychological stress. In this chapter, it is briefly reviewed more manifestations of hypothalamic related mammalian aging processes, including (1) the aging of ovary by lipid, estradiol and hypothalamus; (2) the aging of muscle, stomach, intestine, thymus, and the later aging of brain, regulated by growth hormone/insulin-like growth factor 1(GH/IGF1); (3) the cardiovascular hypertension from PVN activation, the bone and other peripheral aging by psychological stress, and that of kidney by vasopressin. It is classified these aging processes by the primary regulation from one of the three hypothalamic nuclei, although still necessary to investigate and supplement their secondary regulation by the hypothalamic nuclei in future. It is the hypothalamic structural changes that shift the functional balance among these three hypothalamic systems toward aging.
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The nervous system and the skin develop next to each other in the embryo and remain intimately interconnected and interactive throughout life. The nervous system can influence skin conditions through psychoneuroimmunoendocrine mechanisms and through behaviors. Understanding the pathophysiology aids in selection of treatment plans for correcting the negative effects of the psyche on specific skin conditions. Medication options include standard psychotropic medications and alternative herbs and supplements. Other options include biofeedback, cognitive-behavioral methods, hypnosis, meditation, progressive relaxation, the placebo effect, and suggestion. When simple measures fail, combining medications with other therapeutic options may produce better results. Skin conditions that have strong psychophysiologic aspects may respond well to techniques such as biofeedback, cognitive-behavioral methods, hypnosis, meditation, or progressive relaxation that help to counteract stress. Treatment of primary psychiatric disorders that negatively influence skin conditions often results in improvement of those skin conditions. Abnormal conditions of the skin, hair, and nails can also influence the psyche negatively. Treatment of secondary psychiatric disorders such as anxiety or depression that are triggered or exacerbated by the appearance of these skin conditions or the associated discomfort may also be required.
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Compulsive skin picking generally has limited potential health consequences. We describe a case with severe neurologic sequelae and review the literature to assess factors that likely contributed to the failure to prevent this severe outcome. Despite efforts to integrate treatment, our patient had severe medical complications, an epidural abscess and subsequent paralysis, as a result of compulsive skin picking. Psychogenic excoriation should not be underestimated as a cause of medical complications or as a treatment challenge, particularly in light of the numerous complicating factors often present in such cases.
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Background: More treatment options for bipolar depression are needed. Currently available antidepressants may increase the risk of mania and rapid cycling, and mood stabilizers appear to be less effective in treating depression than mania. Preliminary data suggest that lamotrigine, an established antiepileptic drug, may be effective for both the depression and mania associated with bipolar disorder. This is the first controlled multicenter study evaluating lamotrigine monotherapy in the treatment of bipolar I depression. Methods: Outpatients with bipolar I disorder experiencing a major depressive episode (DSM-IV, N = 195) received lamotrigine (50 or 200mg/day) or placebo as monotherapy for 7 weeks. Psychiatric evaluations, including the Hamilton Rating Scale for Depression (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), Mania Rating Scale, and the Clinical Global Impressions scale for Severity (CGI-S) and Improvement (CGI-I) were completed at each weekly visit. Results: Lamotrigine 200mg/day demonstrated significant antidepressant efficacy on the 17-item HAM-D, HAM-D Item 1, MADRS, CGI-S, and CGI-I compared with placebo. Improvements were seen as early as Week 3. Lamotrigine 50mg/day also demonstrated efficacy compared with placebo on several measures. The proportions of patients exhibiting a response on CGI-I were 51 percent, 41 percent, and 26 percent for lamotrigine 200mg/day, lamotrigine SOmg/day, and placebo groups, respectively. Adverse events and other safety results were similar across treatment groups, except for a higher rate of headache in the lamotrigine groups. Conclusion: Lamotrigine monotherapy is an effective and well-tolerated treatment for bipolar depression.
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The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.
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Background Withdrawal of the drug(s) that cause severe cutaneous adverse reactions is usually recommended without proof that it alters the course of those reactions. Objective To determine whether the timing of causative drug withdrawal is related to the prognosis of patients with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS). Design A 10-year observational study (January 1, 1987, through October 30, 1997) of patients admitted to a dermatological intensive care unit, using binary logistic regression analysis. Setting A single referral unit in a university hospital. Patients Consecutive sample of 203 patients with TEN or SJS. Exclusion criteria included causative drug undetermined, lack of information on disease evolution, the date of causative drug(s) withdrawal, or the date when the first definite sign of TEN or SJS appeared. Main Outcome Measure Death before hospital discharge. Results One hundred thirteen patients were included; 74 had TEN and 39 had SJS; 20 died. The drug causing TEN or SJS was withdrawn early in 64 patients and late (after the first definite sign of TEN or SJS) in 49 patients. After adjustment for confounding variables (age, maximum extent of detachment, admission year, human immunodeficiency virus status), our model showed that the earlier the causative drug was withdrawn, the better the prognosis (odds ratio, 0.69 for each day; 95% confidence interval, 0.53-0.89). Patients exposed to causative drugs with long half-lives had an increased risk of dying (odds ratio, 4.9; 95% confidence interval, 1.3-18.9). The variables did not interact. Conclusions Prompt withdrawal of drug(s) that are suspected to cause SJS or TEN may decrease mortality. Prompt withdrawal of causative drugs should be a priority when blisters or erosions appear in the course of a drug eruption.
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Vitiligo is an acquired depigmentary skin disorder of unknown etiology. Vitiligo is not only a disease of melanocytes of the skin. Human melanocytes are derived from the neural crest and are located on various parts of the body. The involvement of skin melanocytes is the most visible one, but a systemic involvement of melanocytes can be observed. Some types of vitiligo (nonsegmental vitiligo) may also be associated with various diseases, mainly with autoimmune pathogenesis. Vitiligo represents a spectrum of many different disorders with different etiologies and pathogeneses, causing a common phenotype: the loss of melanocytes and/or their products. This phenotype is always consistent with a systemic involvement.
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Objective: Typically regarded as an adolescent condition, acne among adult females is also prevalent. Limited data are available on the clinical characteristics and burden of adult female acne. The study objective was to describe clinical characteristics and psychosocial impact of acne in adult women. Design: Cross-sectional, web-based survey. Setting: Data were collected from a diverse sample of United States females. Participants: Women ages 25 to 45 years with facial acne (≥25 visible lesions). Measurements: Outcomes included sociodemographic and clinical characteristics, perceptions, coping behaviors, psychosocial impact of acne (health-related quality of life using acne-specific Quality of Life questionnaire and psychological status using Patient Health Questionnaire), and work/productivity. Results: A total of 208 women completed the survey (mean age 35±6 years), comprising White/Caucasian (51.4%), Black/African American (24.5%), Hispanic/Latino (11.1%), Asian (7.7%), and Other (5.3%). Facial acne presented most prominently on cheeks, chin, and forehead and was characterized by erythema, postinflammatory hyperpigmentation, and scarring. Average age of adult onset was 25±6 years, and one-third (33.7%) were diagnosed with acne as an adult. The majority (80.3%) had 25 to 49 visible facial lesions. Acne was perceived as troublesome and impacted self-confidence. Makeup was frequently used to conceal acne. Facial acne negatively affected health-related quality of life, was associated with mild/moderate symptoms of depression and/or anxiety, and impacted ability to concentrate on work or school. Conclusion: RESULTS highlight the multifaceted impact of acne and provide evidence that adult female acne is under-recognized and burdensome.
Book
Ageing is an inevitable biological process that affects most living organisms. The link between metabolic rate and reactive oxygen species production is an important and long-standing question, and a source of much controversy. A by-product of cell respiration in mitochondria is the formation of reactive oxygen species due to electron leakage from the electron transport chain during oxidative phosphorylation. In simple terms, humans are ageing due to oxygen consumption. Damage induced by oxygen appears to be the major contributor to ageing and the degenerative diseases of ageing such as cancer, cardiovascular disease, immune system decline, and brain dysfunction. This book presents the reasons for oxidative stress formation and the answer to why during the course of evolution the process of free radical damage and defense did not become more perfect so as to produce less free radicals.
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Psychogenic excoriation (also called neurotic excoriation, acne excoriée, pathological or compulsive skin picking, and dermatotillomania) is characterised by excessive scratching or picking of normal skin or skin with minor surface irregularities. It is estimated to occur in 2% of dermatology clinic patients and is associated with functional impairment, medical complications (e.g. infection) or substantial distress. Psychogenic excoriation is not yet recognised in the DSM. We propose preliminary operational criteria for its diagnosis that take into account the heterogeneity of behaviour associated with psychogenic excoriation and allow for subtyping along a compulsivity-impulsivity spectrum. Psychiatric comorbidity in patients with psychogenic excoriation, particularly mood and anxiety disorders, is common. Patients with psychogenic excoriation frequently have comorbid disorders in the compulsivity-impulsivity spectrum, including obsessive-compulsive disorder, body dysmorphic disorder, substance use disorders, eating disorders, trichotillomania, kleptomania, compulsive buying, obsessive-compulsive personality disorder, and borderline personality disorder. There are few studies of the pharmacological treatment of patients with psychogenic excoriation. Case studies, open trials and small double-blind studies have demonstrated the efficacy of selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors in psychogenic excoriation. Other pharmacological treatments that have been successful in case reports include doxepin, clomipramine, naltrexone, pimozide and olanzapine. There are no controlled trials of behavioural or psychotherapeutic treatment for psychogenic excoriation. Treatments found to be effective in case reports include a behavioural technique called ‘habit reversal’ a multicomponent programme consisting of self-monitoring, recording of episodes of scratching, and procedures that produce alternative responses to scratching; and an ‘eclectic’ psychotherapy programme with insight-oriented and behavioural components.
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Rosacea is a skin condition of abnormal inflammation and vascular dysfunction. The active contribution of a microbial agent in the development or progression of rosacea continues to be debated. Research supports the presence of commensal Demodex folliculorum mites at increased density in the skin and associates Helicobacter pylori infection of the gut with rosacea. Fewer studies implicate Staphylococcus epidermidis, Chlamydophila pneumoniae, and the Demodex-associated bacteria Bacillus oleronius. No research, however, provides a mechanism by which colonization by a microorganism translates to manifestation of the condition. Prevailing and emerging principles in the biology of the microbiome and the pathophysiology of rosacea may help to reconcile these lingering questions. Here the microorganisms implicated in rosacea are reviewed and the reaction of the microbiome to inflammation and to changes in microenvironments and macroenvironments are discussed to explain potential roles for microorganisms in rosacea pathophysiology.
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Some people are very easily hypnotized, while others are extremely resistant. This common observation suggests that a study of the personality correlates of susceptibility might prove of interest not only in explaining the nature of the hypnotic trance, but in telling something about the organization of personality, about self-control and persuasibility. The investigation reported here is concerned with susceptibility as such. The importance of such measures for carrying on the study of personality correlates is evident. The 124 university undergraduates (64 men and 60 women) whose scores are here considered were volunteers fulfilling part of the course requirement in introductory psychology at Stanford. Analyses were made of the responses of college students to a newly developed scale of hypnotic susceptibility known as the Stanford Hypnotic Susceptibility Scale. The scale has been prepared in two highly similar forms, each yielding scores ranging from 0 to 12. For the purposes of these analyses hypnotic susceptibility is defined as the number of responses representative of hypnosis yielded within the standard procedures of attempted induction and testing. The historical reports on susceptibility usually have referred to the greatest depth of hypnotic trance achieved under various methods of induction, and with repeated sessions. Results yield about 17% refractory, 35% drowsy-light, 25% moderate, and 23% deep or somnambulistic, thus falling very much in line with earlier studies. Various analyses of item intercorrelations lead to the belief that the scale is essentially unidimensional.
Article
Epidemiological studies have shown that cigarette smoke (CS), a very common environmental factor, plays an important role in skin aging. Although some in vivo studies have suggested that CS affects skin aging, the detailed effects of CS on skin cells in vitro remain largely unknown. In this study, we investigated the effects of cigarette smoke extract (CSE) on the growth, proliferation, and senescene of skin fibroblasts and the possible mechanism underlying these effects. Primary cultured human fibroblasts were exposed to a range of concentrations of CSE. Cell viability and cell proliferation after CSE exposure were analyzed with the methyl thiazolyl tetrazolium (MTT) assay and bromodeoxyuridine incorporation assay, respectively. Growth curves of fibroblasts exposed to different concentrations of CSE were developed and prolonged CSE-exposed cells were observed. Morphological and ultrastructural changes in fibroblasts were assessed by inverted light microscopy and transmission electron microscopy (TEM). Dying cells were stained with senescence-associated β-galactosidase (SA β-gal). Intracellular reactive oxygen species (ROS) levels, superoxide dismutase (SOD) activity, and glutathione peroxidase (GSH-Px) activity were determined by a colorimetric method. We found that proliferative capacity and growth were inhibited by CSE exposure in a dose- and time-dependent manner. Fibroblasts exposed to even low concentrations of CSE for a long period of time (5 passages) showed significantly increased SA β-gal activity and typical features of aging cells. Meanwhile, CSE inhibited superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities and augmented ROS levels. Our observations suggest that CSE exposure impairs fibroblast growth and proliferation and leads to features similar to those seen in senescent cells. Oxidative stress injury and inhibition of antioxidant defense activity may be involved in CSE-induced fibroblast senescence.
Article
Primary psychiatric conditions encountered in dermatology include dermatitis artefacta, trichotillomania (TTM) and neurotic excoriations. For these disorders, the primary pathologic condition involves the psyche; therefore, any cutaneous findings are self-induced. Herein, we review common primary psychiatric conditions in dermatology - dermatitis artefacta, neurotic excoriations and TTM - and examine their epidemiology, clinical presentation, differential diagnosis and treatment strategies. For all primary psychiatric disorders, the most effective underlying strategy is to first establish a strong therapeutic rapport with the patient. Various pharmacologic and non-pharmacologic therapies can then be attempted afterwards to successfully manage these patients.
Article
We measured enzymic and non-enzymic antioxidants in human epidermis and dermis from six healthy volunteers undergoing surgical procedures. Epidermis was separated from dermis by currettage and antioxidants were measured by high-performance liquid chromatography (HPLC) or standard spectrophotometric methods. The concentration of every antioxidant (referenced to skin wet weight) was higher in the epidermis than in the dermis. Among the enzymic antioxidants, the activities of superoxide dismutase, glutathione peroxidase, and glutathione reductase were higher in the epidermis compared to the dermis by 126, 61 and 215%, respectively. Catalase activity in particular was much higher (720%) in the epidermis. Glucose-6-phosphate dehydrogenase and isocitrate dehydrogenase, which provide reduced nicotinamide adenine dinucleotide phosphate (NADPH), also showed higher activity in the epidermis than the dermis by 111% and 313%, respectively. Among the lipophilic antioxidants, the concentration of α-tocopherol was higher in the epidermis than the dermis by 90%. The concentration of ubiquinol 10 was especially higher in the epidermis, by 900%. Among the hydrophilic antioxidants, concentrations of ascorbic acid and uric acid were also higher in the epidermis than in the dermis by 425 and 488%, respectively. Reduced glutathione and total glutathione were higher in the epidermis than in the dermis by 513 and 471%. Thus the antioxidant capacity of the human epidermis is far greater than that of dermis. As the epidermis composes the outermost 10% of the skin and acts as the initial barrier to oxidant assault, it is perhaps not surprising that it has higher levels of antioxidants.
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Traces the development of the cognitive approach to psychopathology and psy hotherapy from common-sense observations and folk wisdom, to a more sophisticated understanding of the emotional disorders, and finally to the application of rational techniques to correct the misconceptions and conceptual distortions that form the matrix of the neuroses. The importance of engaging the patient in exploration of his inner world and of obtaining a sharp delineation of specific thoughts and underlying assumptions is emphasized. (91/4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Summary Background: Among our dermatologic outpatients who respond little or only temporarily to dermatologic therapeutic methods alone patients with psychogenic pruritic disorders are frequently seen. Objective: This study was conducted to uncover the underlying psychopathologies of the patients suffering from psychopruritic disorders. Methods: Patients who came to our dermatologic clinic were screened by a dermatologist for possible underlying psychopathologies. In order of their reference 65 patients, 16 male and 49 female, were introduced to a psychiatrist for identification of their mood, personality and thought disorders. These cases included 36 patients with lichen simplex chronicus (LSC), 20 with neurotic excoriation (NE), 1 with prurigo nodularis (PN), and 8 with more localized or generalized intermittent, short-term, and usually very severe pruritus without any physical signs (i.e. with no lichenification or no signs of scratching) who were labeled as psychogenic pruritus (PP). A semi-structured interview based on multiaxial DSM-IV interview criteria as well as Beck’s and Tailor’s inventories for depressive and anxiety disorders were performed with all patients. Results: All 65 patients were found to have affective disorders including depressions (20 cases), anxieties (6 cases), and mixed anxiety and depressive disorders (39 cases). 12 patients also had associated personality disorders. No thought disorder was identified. Conclusion: Patients with psychogenic pruritus had one or more underlying psychopathologies. These should be identified and approached for helpful and successful management of their skin condition.
Article
Background. Psoriasis has been associated with depressive disease and case reports of completed suicide. Methods. 217 consenting psoriasis patients completed the Carroll Rating Scale for Depression (CRSD), a 52-item self-rated scale, with four of the Items directly addressing wishes to be dead and suicidal ideation. The patients also self-rated the severity of their psoriasis. Results. 9.7% of patients reported a wish to be dead, and 5.5% reported active suicidal ideation at the time of the study. The death wish and suicidal ideation were associated with higher depression scores (P < 0.0001) and higher patient self-ratings of psoriasis severity (P < 0,05). Patient self-reports of psoriasis severity correlated directly with the overall depression scores (r = 0.39), P < 0.0001). Conclusions. The comorbidity between depressive symptoms, suicidal ideation, and psoriasis severity is in contrast with reports that severe depression and suicidal ideation are mainly a feature of life-threatening medical disorders such as malignancies. Our finding may have important implications in the management of psoriasis.