Thesis Reference
The skin and the mind.
Aust Fam Physician . 2006 Sep ; 35 (9 ): 723-5
Chuh A , Wong W , Zawar V.

Habits related to psychological problems may lead to skin problems such as lichen simplex chronicus and acne excoriee. Skin disease can exert a profound effect on the psychosocial dimension of a patient's life . Its effect on quality of life can be objectively assessed and documented by validated tools specific for the skin . Patient rated measures should be taken into account when evaluating the efficacy and adverse effects of treatments for skin disease.

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The skin is the mirror which reflects the state of the mind. Skin is one of the  target organ of the stress reaction. (1) The skin and the nervous system have a common embryological origin; this supports a positive connection between skin changes and psychological phenomenon. Stress and other psychological factors trigger the onset and exacerbation of many dermatological diseases. Every person has a shock organ that is sensitive to stress, which is defined by environmental and genetic factors and this shock organ is the skin, in people who display dermatological symptoms under stress. (3)

Most dermatologic disorders influenced by psychosocial factors are associated with both psychosocial stress, which exacerbates the condition, and body image problems Psychodermatology focuses on the boundary between psychiatry and dermatology. Understanding the psychosocial and occupational context of skin disease is critical to the optimal management of psychodermatologic disorders.

Aims and objectives
To study the psychological profile of patients of acne excoriee, lichen planus and macular amyloidosis and lichen amyloidosis.
- To study various psychological disorders such as anxiety and depression and stress as the etiological factors for causing acne excoriee, lichen planus and macular amyloidosis and lichen amyloidosis.
- To compare the stress levels of the cases and controls.
- To analyze the psychological problems in patients and controls by various
psychiatric scales.

Materials and methods
The study included  80 cases i.e. 20 cases of acne excoriee, 20 cases of macular
amyloidosis and lichen amyloidosis, 20 cases of lichen planus and 20 controls.
Patients with previously diagnosed psychiatric disease and those on any psychiatric medications were excluded from this study.
Controls were normal people who were not suffering from any skin disease.
All subjects included in the study were subjected to a detailed history including history and examination. Detailed psychological evaluation was done using the following scales with the help of a psychiatrist-
 1) Hamilton rating scale for depression.(134)
2) Hamilton anxiety rating scale.(135)
3) Gurmeet Singh’s Presumptive Stressful Life Events Scale.(136)

Skin biopsy was performed for confirmation of diagnosis for patients of lichen planus, macular amyloidosis and lichen amyloidosis.
The data was analyzed statistically using various tests like Pearson’s(chi)2, Fischer’s, t-test and p-value of < 0.05 was considered significant.

Results

Age distribution

Since the p-value (0.027) is less than the significance level (0.05), we can conclude that
there is a relationship between age and cutaneous diagnosis group.
Age distribution in acne excoriee group is inclined towards younger age group, whereas
remaining cutaneous diagnosis groups and control group are almost distributed equally
among three age groups (15-29 years, 30-44 years, more than or equal to 45 years)

Sex

Out of total 80 subjects, 41.2 % are males while 58.8 % are females.
Since the p-value is 0.528 which is greater than the significance level (0.05), we conclude that there is no relationship between sex and cutaneous diagnosis groups.

Table 4. Marital status
p-value is 0.002 which is less than the significance level 0.05, we conclude that
there is a relationship between marital status and cutaneous diagnosis groups.

Education & Religion
Since p>0.05, hence no relationship between education status or religion and skin disease was noted.

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FREE COMMUNICATIONS
FC01 ATOPY, ATOPIC ECZEMA, URTICARIA AND OTHER INFLAMMATORY SKIN DISEASES
FC01.12
Stress involvement in atopic dermatitis and urticaria patients
L. Manolache* & V. Benea
*Cetatea Histria Polyclinic, Scarlat Longhin Clinic of Dermatology,
Bucharest, Romania
Two groups of patients were compared (one with atopic dermatitis, the other with urticaria) regarding stress involvement as precipitating or aggravating factor.
173 patients with atopic dermatitis-(AD), 195 patients with urticaria-U (both groups matched with control-groups with skin diseases not related to stressful events: impetigo, different types of tinea). Life Events and Difficulties
Scale (Holmes and Rahe) was used. Mean age for AD group was 6.96 years old and for U group was 24.52 years old. 12% of AD patients had stressful events before the onset (5.8% in control group), with a difference between men (5.8%) and women (18%). Stress influences were more often related to aggravation of skin condition. Stress involvement in U group was in 38% of cases (control-group 20%); in 55% of physical urticaria cases, in 30% of acute urticaria cases Women were more reactive to stress. Odds ratio was 2.26 in AD group and 2.44 in U group. Most of the patients with AD were children, so the stressful events were related to school (beginning/ ending school, examination periods). In 40% of U cases there were also involved these times of beginning or ending of school with increased solicitations. In U group other potential stressful events were: financial problems, changing job conditions, divorce or other personal illnesses. We have used in 60% of cases of urticaria, psychotropic drugs as adjutants (40% anxiolytics, 20% antidepressants) with good results in 85 % of treated cases. Stress seems to play an important role, mostly as aggravating factor, both in AD and U (double risk than control-group). School events and over-solicitation could be vulnerable times for children and adolescents. Psychotropic drugs could be helpful as adjutants in urticaria patients.

References 1. Koblenzer CS, Psychologic aspects of skin disease. In: Fitzpatrick TB,
Eisen AZ, Wolf K, Dermatology in General Medicine, New York: McGraw-Hill,
1993: 14–26.
2. Gupta MA, Gupta AK, Psychodermatology: an update, J Am Acad Dermatol 34
(6): 1030–46, 1996.
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2005 Journal of the European Academy of Dermatology and Venereology,
volume 19, supplement 2
ISSN: 0929-0168