Stress and atopic dermatitis
Department of Dermatology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 697, Rochester NY 14642, USA. Current Allergy and Asthma Reports
(Impact Factor: 2.77).
08/2008; 8(4):312-7. DOI: 10.1007/s11882-008-0050-6
Atopic dermatitis (AD) is a complex disease traditionally involving interaction of genetic, environmental, and immunologic factors. Recent studies suggest psycho-neuro-immunologic factors and emotional stress are important in its evolution. The observations that internal (bacterial infections) or external (psycho-logic) stressors may induce AD flares is explained by studies showing that stress impairs the skin barrier function and favors a shift in immunity toward a T helper type 2 cell/allergic response. Furthermore, those with AD appear to have an inherited hypothalamic deficiency that impairs normal hypothalamic-pituitary-adrenal axis function. Neuropeptides released in the skin may also mediate neurogenic inflammation, including mast cell degranulation. AD causes significant stress and impaired quality of life in patients and their family members. Psychologic and stress-reduction interventions were recently shown to improve patient well-being, and to significantly improve cutaneous manifestations.
Available from: Manuela Boleira
- "The disease can
also emerge in adulthood (adult-onset atopic dermatitis).6 In addition to genetic heredity (80% agreement in
monozygotic twins and 20% in heterozygotes), other factors, such as stress, can also
affect its pathogenesis.7 "
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ABSTRACT: BACKGROUNDatopic dermatitis is directly related to psychological stress, reduced quality of
life and psychosomatic symptoms. The Psychosomatic Scale for Atopic Dermatitis is
the only questionnaire developed specifically for assessment of psychosomatization
in atopic dermatitis. OBJECTIVESthe objective of this study was to cross-culturally adapt and validate a
Brazilian-Portuguese version of the Psychosomatic Scale for Atopic Dermatitis.
METHODSadaptation consisted of independent translation and backtranslation by three
bilingual translators, followed by a pre-test. The Psychosomatic Scale for Atopic
Dermatitis and the Dermatology Life Quality Index were self-administered to 47
patients with atopic dermatitis. Disease severity was evaluated using the Eczema
Area and Severity Index. Factor analysis was used to identify the dimensions of
the Brazilian Portuguese version of the Psychosomatic Scale for Atopic Dermatitis.
Internal consistency and convergence validity were also analyzed. Reproducibility
was assessed using the Kappa coefficient. RESULTSfactor analysis revealed a two-dimensional structure: stress/laziness/insecurity
(I) and maladjustment/social relationships (II), explaining 54.4% of total
variance. All dimensions revealed excellent internal consistency. External
construct validity was confirmed by positive correlations between the
Psychosomatic Scale for Atopic Dermatitis and the Dermatology Life Quality Index.
Test-retest reliability was excellent, with k>0.7 for all questions. CONCLUSIONSthe Brazilian Portuguese version of the Psychosomatic Scale for Atopic Dermatitis
demonstrated acceptable psychometric properties and can be used for the evaluation
of psychosomatic symptoms in patients with atopic dermatitis and as a tool in
clinical and epidemiological research.
- "Theoharides and Kalogeromitros, 2006): (i) allergic inflammation is characterized by mast cell degranulation and altered neuropeptide levels (Sugiura et al., 1992; Black, 2002; Huang et al., 2003; Peters et al., 2006a; Cevikbas et al., 2007) and (ii) stress is able to degranulate mast cells in a neuropeptide-dependent manner even when generated by nonphysical, noninflammatory , perceived stressors such as noise or restraint (Singh et al., 1999; Peters et al., 2005, 2006a; Arndt et al., 2008). From these observations, it was concluded that stress leads to neurogenic inflammation, which in turn can worsen allergic inflammation, albeit scientific proof of this hypothesis was unavailable (Peters et al., 2006a; Arndt et al., 2008). "
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ABSTRACT: The skin, being the largest human organ, adopts the role of barrier between the environment and the body. This barrier is directed towards outside (physical penetration of foreign matter) as well as inward (loss of water and soluble substrates) challenges and also responds to psychosocial strain with a reduced function. Closure structures such as the epidermal tight junctions (TJ) that hold together the barrier-forming cells of the skin, the keratinocytes, may be key effectors of impaired barrier function. TJs comprise transmembrane closure proteins (eg claudins, occludins) and cytoplasmic plaque proteins (eg zonula occludens protein 1 [ZO-1]). We hypothesize that there is an influence of psychosocial stress on plasticity of TJ proteins. This would have particular relevance for the stress sensitivity of skin diseases with impaired barrier function, such as atopic dermatitis. We used an established mouse model of atopic dermatitis-like allergic dermatitis (AlD) in combination with noise-related stress to assess the barrier function by measuring the TEWL, inflammation, epidermal thickness, keratin-14 (K-14) expression and closure protein expression (occludin, ZO-1, claudin-1 [CLDN-1]) by immunofluorescence. First results show a dysfunction of the skin barrier in AlD, which increases under stress depending on neurotrophins. In the immunofluorescence a K-14+ hyperplasia of the epidermis is seen in AlD. As TJ-indicators of a disturbed barrier CLDN-1 seems sparsely available compared to the control group. Stress seems to enhance this dysregulation. Preliminary rtPCR data hint at a role of nicotinergic acetylcholine receptors. An inflammation and stress-associated down-regulation and redistribution of TJ proteins may therefore contribute to barrier disruption in AlD, especially under stress.
Available from: ncbi.nlm.nih.gov
- "Oh et al.  examined atopic dermatitis patients and concluded that anxiety was associated with the induction of pruritus in atopic dermatitis. Recent studies suggest that emotional stress is an important factor in the development of atopic dermatitis . "
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ABSTRACT: Stress is considered a causal factor in many diseases, allergic disease being one of them. The prevalence of allergic disease is increasing in Korea, but the relationship between allergic symptoms and stress is not empirically well known. We aimed to evaluate the relationship between allergy-related symptoms and stress in children and adolescents.
We investigated 698 children and adolescents living in Gwangyang Bay, Korea, using a multi-stage cluster sampling method. Using the International Study of Asthma and Allergies in Childhood and the Psychosocial Well-being Index, these subjects were surveyed on allergy-related symptoms and psychosocial stressors in their lives, respectively. We used a multivariate logistic analysis for odds ratios for the complaint rate of allergic symptoms, after adjusting for age, gender, household income, body mass index, and residence.
After adjustments, lifetime rhinitis (odds ratio [OR], 1.024), rhinoconjunctivitis (OR, 1.090), diagnosis of itchy eczema (OR, 1.040), treatment of itchy eczema (OR, 1.049), 12-month allergic conjunctivitis (OR, 1.026), diagnosis of allergic conjunctivitis (OR, 1.031), and treatment of allergic conjunctivitis (OR, 1.034) were found to be significantly associated with stress.
Our results support the notion that there is a relationship between stress and allergic symptoms in children and adolescents. Further research into any causal relationship between stress and allergies, as well as preventative public health plans for decreasing stress in children and adolescents are needed.
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