Psychologic interventions in patients with the chronic dermatologic itch in atopic dermatitis and psoriasis: A step forward with family constellations seminars

Abstract

Chronic itch is a complex psychophysiological sensation, which can severely affect the quality of life in patients with atopic dermatitis and psoriasis. Itch depends on the irritation of receptors in the skin and the processing of sensory information in the central nervous system. Severe itch leads to activation and later on to disruption of the stress response, resulting in disorders of skin repair, functional and microstructural changes in the areas of the central nervous system that are responsible for the perception of itch. Psychosocial stress can be an essential factor, activating neurohumoral mechanisms which lead to increased itch and scratch, exacerbating skin damage. Patients with chronic itch often have sleep disorders, increased irritability, and depletion of the nervous system. They are characterized by disrupting social relationships, high incidence of anxiety, depressive disorders, and suicidal tendencies. Psychological methods of intervention can effectively influence various mechanisms in the pathogenesis of itch and scratch and improve social functioning in patients with chronic dermatological itch. In this mini-review, we discuss family constellation seminars as an effective method of psychological intervention that can reduce the intensity of itch, and improve sleep and performance in patients with atopic dermatitis and psoriasis. This method is insufficiently described in previous reviews of psychological interventions in atopic dermatitis and psoriasis patients. The positive impact of family constellations seminars in patients with chronic dermatological itch may be related to reducing stress by improving understanding of the family situation, appropriate management of family secrets, and enhancing interactions with the social environment.

Automated Machine Learning Analysis of Patients With Chronic Skin Disease Using a Medical Smartphone App: Retrospective Study

“…Itching, also known as pruritus, affects up to 25% of the population at some point in their lives [ 52 ]. In the context of chronic skin conditions, itching becomes a chronic and potentially severe problem, often leading to a vicious cycle of skin damage, psychological distress, and a significant reduction in QoL [ 53 ]. Chronic itching is one of the main symptoms of atopic dermatitis, occurring at least once a day in up to 91% of patients with atopic dermatitis [ 54 ].…”

White paper on psychodermatology in Europe: A position paper from the EADV Psychodermatology Task Force and the European Society for Dermatology and Psychiatry (ESDaP)

“…11,[27][28][29] The psychodermatological approach aims to identify such associations between psychological factors and signs of skin conditions in patients with skin diseases in order to offer certain psychological or psychopharmacological therapies or interventions to these patients. Interventions comprise pharmacological interventions and/or psychological interventions, for example cognitive behavioural therapies, psychodynamic therapies, mindfulness-based interventions, stress management and relaxation trainings as well as family systemic therapies [30][31][32][33] in addition to appropriate and contemporaneous management of any cutaneous disease.…”

Chronic pruritus in atopic dermatitis – mechanisms and different ways of treatment, affect on quality of life

“…Długotrwały stres powoduje także zwiększenie endogennej produkcji glikokortykoidów, co utrudnia procesy regeneracji skóry. Wielu pacjentów dermatologicznych z przewlekłym świądem w pewnym momencie zaczyna odczuwać przyjemność podczas drapania, nawet jeżeli nie czują świądu, przez co mogą wykorzystywać drapanie jako sposób na łagodzenie stresu [15].…”

“…U pacjentów z bardziej nasilonymi objawami choroby istotne są wysokie koszty leczenia, co może prowadzić do niewystarczającej kontroli objawów i dalszych frustracji [4]. U pacjentów z atopowym zapaleniem skóry z przewlekłym świądem częściej obserwuje się skłonności do uzależnień emocjonalnych, do uzależnienia od alkoholu i narkotyków, tworzenie niestabilnych związków, problemy rodzinne i zaniedbania w dzieciństwie [15].…”

“…Na ten moment jednak brak wystarczających danych co do skuteczności takiego działania, główne doniesienia pochodzą z opisów przypadków i obserwacji prowadzonych na małych grupach pacjentów. Powstały natomiast pierwsze badania wykazujące pozytywne efekty zastosowania psychoterapii u osób z silną korelacją przewlekłego świądu ze stresem [15].…”