Release of Cervical Muscle Tension Improves Psychological Stress and Symptoms of Moderate-to-Severe Atopic Dermatitis: a Case Series with 20 Patients

Abstract

Introduction: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease that is triggered by intense pruritus, impaired skin barrier function, and immune responses to allergenic substances. Break-through therapies for AD include molecular-targeted drugs and the effective management of severe symptoms of AD. However, patients with clinical improvements may continue scratching owing to the influence of psychological stress, which might lead to quick relapses of stressors and subsequent intensive scratching. New drugs may be ineffective because of such scratching behavior caused by stressors. Therefore, it may be useful to consider adjunctive treatment options that focus on external stressors as triggers of deterioration of AD. We hypothesized that improvement of psychological stress by relieving cervical muscle tension would reduce pruritus and atopic symptoms. Methods: Overall, 21 patients with moderateto-severe AD were treated to relieve cervical muscular tension using Spineliner SA201, which assists in osteopathic manipulative treatment. We assessed the subjective and objective symptoms of AD, cervical muscle tension, which was evaluated using cervical range of motion (ROM), and psychological burden. Only moisturizers were applied topically during the study period, and no topical corticosteroid therapy was used. Results: Twenty patients who completed the treatment demonstrated improvement in the symptoms of AD: changes on the visual analog scale (VAS) for pruritus were -44.2%, Eczema Area and Severity Index (EASI) was -67.9%, thymus and activation-regulated chemokine (TARC) was -56.2%, Hospital Anxiety and Depression Scale (HADS) was -27.2%, sleep disturbance was -49.7%, and Dermatology Life Quality Index (DLQI) was -46.7%. Additionally, the cervical muscle tension improved significantly: changes in cervical ROM were 14.7%. Conclusions: Release of cervical muscle tension may improve psychological stress and have an effect on moderate-to-severe AD.The manuscript was prepared according to the guidelines provided in the CONSORT guidelines.

Interventions for anxiety and depression in patients with atopic dermatitis: a systematic review and meta-analysis

“…Bae, et al found that PMR intervention consisting of physical and mental components for 4 weeks significantly reduced anxiety and depression. Several other case series, both in adults and pediatrics, have shown similar results 30 , 88 .…”

Atopic Dermatitis: Beyond the Skin and Into the Gut

“…A recent RCT conducted in Germany revealed potential beneficial changes to patient-reported baseline itching intensity, disease severity, and disease-associated quality of life after undergoing hypnotherapy and treatment with an intermittent fasting program [39]. Another case series studying the use of an osteopathic manipulative treatment to relieve cervical muscle tension in 20 patients with moderateto-severe AD on no other medicated topical or systemic treatments demonstrated overall improvement in the visual analog scale score for pruritus, and the total hospital anxiety and depression score was also notably reduced [40]. Addressing the psychological impact of AD as adjunctive disease treatment has shown benefit in multiple clinical trials and should be included as a method in multimodal disease management [38][39][40].…”