The Influence of Psychosocial Stressors on Neuroimmunological Parameters and Skin Conditions in a Patient with Atopic Dermatitis

Abstract

Objective: The role of psychosocial stress in the onset and course of atopic dermatitis is widely accepted. However, validation of pathological models that integrate psychosomatic aspects and biochemical mediators is still missing. Longitudinal single case studies offer a possibility to examine the effects of psychosocial stressors on biochemical as well as on dermatological variables under naturalistic conditions. Patient and Methods: A 42-year-old patient suffering from life-long atopic dermatitis was observed for a period of 77 days in an integrated single case design. Psychosocial stressors and disease activity were measured daily by diary recordings and additionally with standardized weekly interviews (Incidents and Hassles Inventory). Cortisol, neopterin, and catecholamines were gauged on a daily basis by overnight (8 hour) urine samples. Intervening factors, such as medication and lifestyle, were controlled. Longitudinal data were studied with combined time-series (ARIMA modeling) and regression analysis. Results: Psychosocial variables explained up to nearly 50% of variance in skin condition and also nearly 50% of immunoendocrinological dynamics. The relationship between biochemical patterns and skin condition is weak (explained variance <25%). We also found differential effects dependent on different characteristics of psychosocial stressors (i.e., predictability vs. nonpredictability). Identical stressors showed variations in their effects on different dependent variables (i.e., a positive influence on arm skin but a negative influence on neck skin). Conclusions: The results confirm the assumed relationship between psychosocial stressors and disease activity in atopic dermatitis in the patient under study. The broad spectrum of differential effects found in only one single case underlines the complexity of psychobiological mechanisms and the necessity of further (single case) research.

Psychodermatology from the perspective of a psychologist

“…In connection with that, stress and strong emotions may be factors triggering or exacerbating the medical condition, or extending the course of it, in the case of, among others: psoriasis, atopic dermatitis, alopecia areata, prurigo nodularis, nettle rash, lichen planus, leucoderma, excessive hyperhidrosis, dyshidrotic pompholyx or recurring herpes (Juszkiewicz-Borowiec, 1999;Rabung, Schmidt, Hüther, & Schauenburg, 2003).…”