Atopische Dermatitis und psychischer Stress

Abstract

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Its main features are eczematous skin lesions with a typical distribution and severe pruritus. Allergens, skin irritants, systemic or local infections, environmental pollutants and hormonal changes have a role in the pathophysiology of AD. A further important trigger factor for both intrinsic and extrinsic AD is emotional stress. Recently published observations point to direct psychoneuroimmunological and -endocrinological mechanisms: Psychological stress causes a transient increase of peripheral blood eosinophil count and an increase in both CD8+/CD11b+ and CLA+ T-cells. In addition, stress changes the cytokine and the hormone profile with increased levels of IFN-gamma and IL-5, and decreased levels of cortisol in AD patients in contrast to healthy controls. These findings underline the role of immunological changes and a possible suppressed hypothalamic-pituitary-adrenal (HPA) axis closing the loop for the final aggravation of AD.

The Non-Neuronal Cholinergic System in Health and Disease

“…Allergens, infections, environmental pollutants and emotional stress trigger the clinical onset of disease with main features being eczematous skin lesions [25]. In a mouse model the histopathology of atopic dermatitis could be completely prevented by pretreatment with corticotropin-releasing hormone which is released in response to cholinergic stimulation [26].…”

Is the alternative medicine a real alternative in adult atopic dermatitis? Experiences of 125 patients

“…In up to 70% of AD patients (mainly women) emotional events and stress are responsible for the worsening of skin symptoms [24][25][26]. In atopics stress causes a temporary rise of eosinophil count in the peripheral blood; IgE, IFNγ and IL-5 levels increase too, whereas that of cortizol decreases [26].…”

“…In atopics stress causes a temporary rise of eosinophil count in the peripheral blood; IgE, IFNγ and IL-5 levels increase too, whereas that of cortizol decreases [26]. The interpretation of stress is very subjective, anxiety, frustration, aggression may lead to a flare up of dermatitis in adults.…”

“…Due to the visible skin symptoms stigmatisation, partnership and existential problems may occur. Autogen training, relaxation techniques, behaviour, family, group and art therapies can support the dermatological treatments [25,26]. According to the interesting study results of Kimata [27,28], a relaxed, good mood is useful for atopic patients.…”

Atopic Dermatitis

“…Immunological differences occur in the levels of Th2 cytokines, as the extrinsic type of AD is characterized by increased levels of IL-4 and IL-13, known to induce isotype switching to IgE synthesis, increased levels of IL-5 which increase eosinophil survival whereas the intrinsic type of AD displays less production of IL-4 and IL-13 [Akdis and Akdis, 2003]. A potent trigger factor for AD exacerbation is mental stress [Raap et al, 2003]. Recently, we could show that psychological stress increases the subpopulation of CD8+/CD11b+ T lymphocytes in AD in contrast to healthy controls [Schmid-Ott et al, 2001a].…”