Stress and Common Dermatological Disorders: The Psychophysiological Dermatoses

Nupur Goyal, Smitha S Prabhu
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Abstract

Abstract Primary dermatological disorders which are frequently exacerbated by stress and whose course is affected by the psychological state of the patient are called psychophysiologic or psychosomatic diseases. Psychosocial stress plays a major role in the onset and/or aggravation of these skin diseases. A close relationship between the skin and the mind mediated via hormones and neurotransmitters and altered cutaneous permeability barrier homeostasis by psychological stress constitute the basic psychopathology. The common skin conditions precipitated/aggravated by stress include psoriasis, vitiligo, atopic dermatitis, acne vulgaris, alopecia areata, urticaria, lichen planus, prurigo, seborrheic dermatitis, and hyperhidrosis. These cutaneous diseases often have a chronic, unpredictable course with multiple remissions and relapses leading to significant psychiatric morbidity, and disease-related stress further acts as an aggravating factor for the cutaneous disease leading to a vicious cycle. Increased awareness about these psychophysiologic diseases among dermatologists has helped to incorporate psychotherapeutic treatment in the form of psychotropic drugs and nonpharmacological interventions in the management of these patients. A multidisciplinary approach consisting of dermatologists along with psychiatrists and psychologists in a liaison framework has proven useful for these patients.
压力与常见皮肤病:心理生理皮肤病
原发性皮肤病常因应激而加重,其病程受患者心理状态影响,称为心理生理性或心身性疾病。心理社会压力在这些皮肤病的发病和/或加重中起着重要作用。通过激素和神经递质介导的皮肤与精神的密切关系以及心理应激对皮肤通透性屏障稳态的改变构成了基本的精神病理学。由压力引起或加重的常见皮肤病包括牛皮癣、白癜风、特应性皮炎、寻常性痤疮、斑秃、荨麻疹、扁平苔藓、痒疹、脂溢性皮炎和多汗症。这些皮肤病通常具有慢性、不可预测的病程,多次缓解和复发导致严重的精神疾病,疾病相关的压力进一步成为皮肤病的加重因素,导致恶性循环。皮肤科医生对这些心理生理疾病认识的提高,有助于将精神药物和非药物干预形式的心理治疗纳入这些患者的管理中。由皮肤科医生、精神科医生和心理学家在一个联络框架中组成的多学科方法已被证明对这些患者有用。
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