HS evaluated with the SF-36 can be a very useful additional outcome criterion in clinical studies with pemphigus. The management of the disease must take into account its impact on various aspects of life of the patient.

Alopecia areata is not painful or life-threatening, but its aesthetic repercussions can lead to profound changes in patients' psychological status and relationships. The psycho-logical status and personality traits of 73 patients and 73 controls were evaluated with the Minnesota Multi-phasic Personality Inventory (MMPI-2). Analysis of the MMPI-2 profile showed that scores for some scales (i.e. Depression, Anxiety, Family relationships) were higher for patients with alopecia areata than for controls. Patients with alopecia appeared to experience more depressive, hysterical and anxiety feelings, have more hypo-chondriac tendencies, and to be more in conflict with their social environment. In order to provide more effective management, the psychological status of patients with alopecia areata should be evaluated in dermatological settings.

Family history can provide important information about a patient's psychological status, and thus their disease risk. A multicentric case-control study on family dysfunction was performed on 59 patients with psoriasis (63.7%), atopic dermatitis (11.9%) or alopecia areata (25.4%), and 47 patients with minor skin problems (controls), all attending a dermatological clinic or a psychodermatological consultation. The mean age of subjects was 47.7 years in the cases and 48.8 years in the controls. Women represented 53% of cases and 62% of controls. Patients and controls first completed the General Health Questionnaire (GHQ-12) and the Toronto Alexithymia Scale (TAS-20) questionnaire. The overall prevalence of anxiety and/or depression in cases was 43.3% (71.4% in atopic dermatitis). To collect the family history a genogram was built by the interviewer during a semi-structured interview. It can show dysfunction in the family, as it highlights alliances and ruptures, generational repetition of behaviours of dependence or vulnerability, and traumatic events. The mean (± standard deviation) genogram score was 6.7 ± 3.3 in the cases and 3.0 ± 2.4 in the controls (p<0.001). The cases had three times the risk of having moderate family dysfunction compared with controls and 16 times the risk of having a severe family dysfunction. The genogram score was correlated with the severity of the disease as evaluated by the patient. In conclusion, family dysfunction may play an important role in the onset or the exacerbation of psoriasis, alopecia, and atopic dermatitis.

This study suggested that psychosocial issues are quite relevant in patients with SS and underscored the need for a biopsychosocial approach to the clinical management of these patients. Timely detection of psychosocial difficulties and appropriate psychological or psychiatric intervention may represent important steps toward better adherence to medical treatment and improved psychological well-being and quality of life.

Our results are compatible with the idea that some forms of psychological distress could be in part due to one's perception of his/her own body image.