Psychosomatics and Dermatology: Comparison between Objective Data and Subjective Impressions Given by Patients and Dermatologists

Abstract

The authors wanted to assess the psychological part in the etiology of different skin diseases in adult outpatients in a dermatological university clinic. The other aim of this study was to explore the dermatologist’s perception of a psychological involvement in the etiology of some skin diseases. This was compared with the patients’ perception of it and with objective data obtained by self-rating questionnaires. 554 outpatients consulting for psoriasis, alopecia areata, eczema, and benign tumors were studied with multiple comparison statistics about family functioning, depression, tendency to complain, perceived stress, life events, and coping skills. When based on the dermatologist’s impression of a psychosomatic involvement, significant mean differences do exist about tendency to complain, depression, life events before the onset of the disease, and coping with the treatment. When comparing psoriasis, alopecia areata and eczema patients with patients consulting for benign tumor, significant differences are quite the same. According to the patients, life events with an impact on the onset of the disease happened during the last year for psoriasis and during the years before for alopecia areata. Only about 35% of patients with difficulties in family relationships and 48% of patients with depression are correctly recognized by dermatologists. They seem to be influenced by the patients’ assumptions and by the dermatological diagnosis. This suggests that patients who are not aware of a psychological influence in the etiology of their disease could not be recognized by the dermatologist and could thus not be treated optimally. The authors point out the necessity of better tools in order to recognize the psychological part in the etiology of skin diseases.

Secondary individual prevention of occupational skin diseases in health care workers, cleaners and kitchen employees: aims, experiences and descriptive results

“…As the BGW oVers a separate course on psychological factors for patients with skin diseases, stress factors and stress management in the job, these aspects are not addressed in this skin protection course. This procedure is in accordance with a study demonstrating that eczema patients may show psychosomatic involvement and that dermatologists tend to underestimate and misjudge this aspect (Poot et al 2000). All medical records (e.g.…”

Basic knowledge in psychodermatology

“…Research on the structure and dynamics of families with psychosomatic patients have clearly revealed that one of the most typical dysfunctional characteristics in these families is the tendency to avoid expressing conflicts and emotional tensions. We can then understand and verify how difficulty in verbalizing emotional experiences is not the consequence of a lack of imagination and emotions, but results rather from the fact that emotions are carefully filtered so as to avoid tensions and conflict, and so as to conserve a pseudo‐harmony in the family system 33 . It should be noted, in addition, that not only the patient, but also all family members cooperate to achieve this aim.…”

Hypnose bij patiënten met alopecia areata, areata totalis en alopecia universalis – gedeeltelijke of totale kaalhoofdigheid

“…In een gerandomiseerde placebogecontroleerde studie werd het gunstig effect van het antidepressivum imipramine aangetoond (Perini et al, 1994 ). Er werden verder successen beschreven met inzichtgeorie¨nteerde psychotherapie (Koblenzer, 1995 ), met familietherapie (Poot et al, 2000 ) en met hypnose (Shenefelt, 2000 ). Harrison en Stepanek (1991) behandelden vijf patie¨nten met alopecia universalis en twee met uitgebreide alopecia areata met hypnosesessies.…”