Biomedical subjects
Publications and source records attributed to U Gieler.
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Most therapists recognize that emotional factors influence the course of neurodermitis (ND). Most studies concerning the influence of experimental, acute stressors brought only inconsistent results in ND. Most likely, the experimental stressors chosen thus far were only able to poorly simulate the reactions to real stressors in neurodermitis patients. More recent articles, however, were able to demonstrate changes in psychoimmunological parameters under experimental stress conditions in ND in comparison with a control group of persons with healthy skin. Retrospective studies, serial analyses over time and psychotherapeutic evaluation studies were able to demonstrate even more clearly that emotional factors influence the course of ND.
The effectiveness of concurrent psychotherapeutic treatment for various skin diseases can be regarded as sufficiently validated. Contributions on in-patient treatment concepts are rare, and there are up to now no reports on methods integrating psychotherapeutic treatment approaches. Our concept of a 4-week short-term psychotherapy-starting from a conflict hypothesis in the complaint intensifying, acute situation-includes the bimodal work on both understanding and practice oriented treatment focus. By means of 2 case studies with 1-year-follow-up, insight is given into the treatment approach from which effective factors of psychotherapeutic treatment were tentatively in with patients with skin diseases.
The present study investigated how patients with acne vulgaris cope with their disease. By means of questionnaires, relations and interactions between acne and psyche were evaluated. In addition to the evaluation of a specific questionnaire for patients with chronic skin disorders (CSD), assessing psychosocial impairment by the disease, depression and social anxiety were investigated in patients with acne. The study included 50 patients with acne. The CSD showed significant correlations with Beck's depression inventory, the interaction-anxiety questionnaire and the health locus of control scale. The CSD revealed significant differences compared to a control group of 33 patients with healthy skin. Furthermore the patients' attitudes towards triggering factors and disease-related limitations in everyday life are presented. The results of the study demonstrate that patients with acne suffer from emotional distress and psychosocial problems caused by their disease; however, impairment is not correlated with the objective severity of acne.
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Fifty-three patients with psoriasis, 24 patients with atopic eczema and 52 controls with healthy skin were compared with regard to their sexual behavior. For the test, questionnaires developed by Arentewicz as well as our own questionnaire on sexuality and partnership were used. Patients with skin diseases had a significantly impaired sex life, compared to those with healthy skin. There was a highly significant reduction in the exchange of tenderness in patients of both sexes, and in the capacity for orgasm in female patients. On the other hand, no significant difference was found concerning the frequency of intercourse. Patients with psoriasis felt more impaired than those with atopic eczema. Ninety-three percent of psoriatics and 96% of patients with atopic eczema had not been asked about their sexual life by their attending doctor. We discuss to what extent skin diseases are possibly involved in the regulation of nearness and distance among partners. The dermatologist should a be knowledgeable and understanding source for patients which skin diseases who have questions about their disease and its effect on their sex life.
Immunological and biochemical alterations in atopic dermatitis have been attributed to a deficient conversion of omega-6 fatty acids (i.e. linoleic acid, gamma-linolenic acid, and dihomo-gamma-linolenic acid) to prostaglandin (PG) E1. In patients with atopic dermatitis, however, the formation of PGE1 has not been evaluated so far. We therefore measured plasma concentrations of 15-keto-13,14-dihydro-PGE1, which reflects endogenous PGE1 release, by gas chromatography-mass spectrometry in 31 patients with atopic dermatitis (aged 18-41 years, median 26 years) and in 31 healthy, age- and sex-matched control subjects. In order to exclude a metabolic shift from PGE1 to PGE2, we also measured the plasma levels of 15-keto-13,14-dihydro-PGE2. There was no difference between patients and control subjects with respect to plasma concentrations of 15-keto-13,14-dihydro-PGE1 (3.9-49.6, median 10.3 pg/ml vs. 3.2-80.4, median 8.3 pg/ml, P = 0.22), 15-keto-13,14-dihydro-PGE2 (11.6-201.0, median 24.8 pg/ml vs. 8.6-201.0, median 19.6 pg/ml, P = 0.10), and the ratio of 15-keto-13,14-dihydro-PGE1 to 15-keto-13,14-dihydro-PGE2 (0.17-1.39, median 0.41 vs. 0.2-1.17, median 0.45, P = 0.29). These results indicate that the endogenous formation of both PGE1 and PGE2 is normal in our patients. The results do not confirm the pivotal role that other authors have attributed to a deficient PGE1 formation in the pathogenesis of atopic dermatitis.
A randomized controlled trial compared the effectiveness of 4 group treatments for atopic dermatitis, a chronic skin disorder characterized by severe itching and eczema: dermatological educational program (DE), autogenic training as a form of relaxation therapy (AT), cognitive-behavioral treatment (BT), and the combined DE and BT treatments (DEBT). BT comprised relaxation, self-control of scratching, and stress management. Group treatments were also compared with standard medical care (SMC). Assessments at 1-year follow-up showed that the psychological treatments (AT, BT, and DEBT) led to significantly larger improvement in skin condition than intensive (DE) or standard (SMC) dermatological treatment, accompanied by significant reductions in topical steroids used. The results corroborate preliminary reports that psychological interventions are useful adjuncts to dermatological treatment in atopic dermatitis.
To assess the relation among eosinophil-related variables in the peripheral blood, bronchial hyperreactivity, and the presence of atopic dermatitis in children aged 5-14 years, we studied 11 patients with atopic dermatitis alone, six with asthma and atopic dermatitis, 12 with asthma alone, and 12 healthy controls. Eosinophil counts, levels of eosinophil cationic protein, and the capacity of eosinophils to generate leukotriene (LT) C4, as well as bronchial hyperreactivity and a severity score for atopic dermatitis, were determined. Eosinophil variables were significantly higher in both patient groups with atopic dermatitis than in normal controls. In particular, ionophore A 23187 LTC4 generation was higher in patients with atopic dermatitis alone (median 82, range 25-273 ng/10(6) cells) and patients with combined asthma and atopic dermatitis (median 68, range 32-583 ng/10(6) cells) than in normal controls (median 9, range 1-67 ng/10(6) cells). However, there was no difference between the group of atopic dermatitis patients with asthma and without asthma. We conclude that eosinophil variables in the peripheral blood are mainly influenced by the presence of atopic dermatitis, and not the presence and the severity of asthma in patients with both asthma and atopic dermatitis.
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Clinical reports have related stressful social interactions to the course of atopic dermatitis (AD). Controlled behavioral observations of interaction patterns of AD patients and their significant others, however, were lacking. In two studies, adult AD patients and their mothers (N1 = 26) or partners (N2 = 67) engaged in a discussion of a mutual problem. Their verbal and nonverbal communication behavior was analyzed with a reliable standardized interactional coding system and compared to that of control dyads (N1 = 18, N2 = 28). Although AD patients and their significant others did not differ from controls in their self-reported satisfaction with the relationship, the behavioral observations showed less positive and more negative communication patterns compared to the control dyads. Negative interactions with significant others may prevent the solution of everyday problems and may add to the patients' stress level.
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Parents who have a child suffering from atopic dermatitis usually have to deal with a lot of problems. They seldom find support in coping with this problem. If families are left alone with these difficulties for a long period of time, chronical problems have to be expected, that might disturb the relationship between the parents and their child. A counseling program for parents of children suffering from atopic dermatitis is presented which was developed to prevent distress and helplessness of the parents. The program involved the following topics: 1. Medical information 2. Coping with scratching and itching 3. Care of the skin 4. Relaxation training. 5. Educational problems. Preliminary experiences with 23 parents indicate the usefulness of the counseling program as an important adjunct to the dermatological therapy of atopic eczema in childhood.
The biological role of T cell receptor (TCR) gamma delta bearing cells is currently not fully understood. Recently, a monoclonal antibody (TCR delta 1) reacting against the whole molecule became available which facilitates the direct analysis of TCR-gamma delta+ cells. We studied 11 children with atopic dermatitis, 20 children with atopic asthma, 18 adults with atopic dermatitis and 38 healthy age matched controls aged 4-51 years. Lymphocytes were isolated from heparinized peripheral blood and the proportion of TCR-gamma delta+ lymphocytes was determined by FACS analysis. Patients with atopic diseases yielded a significantly (P less than 0.01) lower proportion of TCR-gamma delta+ cells compared with normal controls (median 4.8% versus 7.1%). The percentage of TCR-gamma delta+ cells showed an age-dependent decline in both the patient group (r = -0.49, P less than 0.01) and the control group (r = -0.40, P less than 0.01). In addition, the proportion of cells which expressed CD8, TCR-gamma delta or CD4, TCR-gamma delta simultaneously was determined by double labelling immunofluorescence. Whereas CD4+, TCR-gamma delta+ cells could be identified in only a few individuals, CD8+, TCR-gamma delta+ cells were found in nearly all controls (median 2.4%, range 0.0-10.8%); atopic patients displayed significantly (P less than 0.01) lower proportions of CD8+, TCR-gamma delta+ cells.
25 male patients suffering from acne vulgaris were examined by means of endocrinological, morphological, and 5 psychometric procedures in order to check the correlations and interactions between the psychological and dermatological aspects of the disease. In comparison with a control group, the acne patients did not show any striking endocrinological abnormalities; we found no correlation between the extensiveness of the lesions and the level of DHEA sulphate. All the psychological tests yielded results deviating from those achieved by the representative controls, but they were comparable with those of other patients suffering from psychosomatic diseases. The individual feeling of being "disfigured" found its expression in self-consciousness, lack of trust in his/her own body, as well as the clinically relevant difference between his/her conception of self and the ideal of self. During times of enhanced psychosocial strains subjectively assumed by the patients, the lesions increased and the patients were disturbed in social interaction and communication. Surprisingly, we did not find any correlation between the clinical status and significant psychometric findings. Our results show that in acne vulgaris, the individual experience of wanting physical attractiveness, associated with a predominantly neurotic depressive personal structure, may play a central part in a disturbed process of interaction with the environment and suggest the influence of psychic factors in the pathogenesis of acne vulgaris.
Delusional parasitosis can apparently run in families. Three out of 9 members of a German family were fully convinced that their skin had been invaded by 'tiny running animals' even though there was no physical evidence of any infestation. Although the family was reluctant to be injected with neuroleptic drugs as this would have been an acknowledgement that their symptoms were in fact of psychological origin, they eventually agreed to be treated. When last contacted, 3 years after diagnosis, they still believed in the existence of the parasites but admitted that some of their symptoms had improved.