Correlation of skin-related quality of life with anxiety and depression in chronic dermatoses: A cross-sectional study.

Background: Dermatology and psychiatry are two specialties which often have a bearing on each other. Multiple indices have been used to study the quality of life in skin diseases; however, very few studies have correlated these indices with questionnaires of common psychiatric comorbidities like anxiety and depression. Methods: The study was conducted in a dermatology out patient department (OPD) of a tertiary care hospital. All patients with chronic dermatological conditions (meeting the inclusion criteria) were included, and each patient was made to fill two questionnaires that are Skindex-29 for skin-related quality of life and Beck Depression Inventory (BDI-II) for depression. They were also assessed for anxiety using the Hamilton Anxiety Scale (HAM-A), which was filled under the supervision of a psychiatrist. Results: The scores for the common diagnoses were collated and analyzed using SPSS 20.0 software, and the results were tabulated. It was found that both the HAM-A and BDI-II had a moderate positive correlation with the Skindex which was statistically significant. Also, on correlating the individual domains of the Skindex with the HAM-A and BDI, the domain of emotions depicted the best correlation. Conclusion: The study brings to light that a relatively easy to administer quality of life questionnaire can be used as a screening tool to identify psychiatric morbidity and in a busy skin OPD, questions from the emotion domain can only be asked for early referral to a psychiatrist.

[Nosogenic psychosomatic disorders in patients with skin diseases]. / Nozogennye psikhosomaticheskie rasstroistva u patsientov s kozhnymi zabolevaniyami.

OBJECTIVE: Development of a clinical typology of nosogenic psychosomatic disorders in patients with skin diseases. MATERIAL AND METHODS: The study was carried out in the interclinical psychosomatic department of the Clinical Center and the Clinic of Skin and Venereal Diseases named after. V.A. Rakhmanov Sechenov University in 2007 to 2022. Nine hundred and forty-two patients (253 males, 689 females, average age 37.3±12.4 years) with nosogenic psychosomatic disorders in chronic dermatoses, including ichen planus (n=143), psoriasis (n=137), atopic dermatitis (n=132), acne (n=118), rosacea (n=115), eczema n=10), seborrheic dermatitis (n=88), vitiligo (n=52), pemphigus (n=48), were studied. Index of clinical symptoms (ICS); the Dermatology Quality of Life Index (DQLI); itching severity questionnaire - Behavioral rating scores (BRS); the Hospital Anxiety and Depression Scale (HADS) and statistical methods were used. RESULTS: In patients with chronic dermatoses, nosogenic psychosomatic disorders were diagnosed according to ICD-10 criteria within adaptation disorders [F43.8] (n=465; 49.3%); hypochondriacal disorder [F45.2] (n=235; 24.9%); constitutionally determined and acquired (hypochondriac development) personality disorders [F60] (n=118; 12.5%); schizotypal disorder [F21] (n=65; 6.9%); recurrent depressive disorder [F33] (n=59; 6.2%). A typological model of nosogenic disorders in dermatology has been developed: hypochondriacal nosogenies in severe clinical forms of dermatosis (pemphigus, psoriasis, lichen planus, atopic dermatitis, eczema) and dysmorphic nosogenies in objectively mild, but cosmetically significant forms of dermatosis (acne, rosacea, seborrheic dermatitis, vitiligo). When analyzing socio-demographic and psychometric indicators, significant differences were revealed between the selected groups (p<0.001). In turn, the selected groups of nosogenic disorders demonstrate significant clinical heterogeneity and include various types of nosogenies that form a unique palette of the nosogenic spectrum in the structure of an extensive psychodermatological continuum. Along with the severity of the skin process, the dominant role in the formation of the clinical picture of nosogeny, including cases of paradoxical dissociation of the quality of life with the severity of dermatosis, amplification and somatization of itching, has a premorbid personality structure and somatoperceptive accentuation of the patient, as well as the presence of a comorbid mental disorder. CONCLUSION: The typology of nosogenic psychosomatic disorders in patients with skin diseases requires consideration of both the psychopathological structure of the disorders under discussion and the severity/clinical features of the skin process.

Relação entre aspectos psicossomáticos e psoríase / Relationship between psychosomatic aspects and psoriasis / Relación entre aspectos psicosomáticos y psoriasis

Psoríase é uma dermatose de caráter inflamatório ligado a diversas composições do ser, sendo estas a genética, o sistema imune, o ambiente e o estado mental do paciente, apresentando evidências de ser um quadro clínico multifacetado. A composição da medicina psicossomática empenha-se na relação mental e emocional e do corpo, sendo importante mostrar a relação desta com a psoríase. Por isso, busca-se avaliar as evidências disponíveis na literatura sobre a relação entre a psoríase e os aspectos psicossomáticos. Foi realizado uma a revisão de literatura, por meio de seleção de artigos das base de dados Medical Literature Analysis and Retrieval System Online (PubMed/Medline), biblioteca virtual em saúde Scientific Electronic Library Online (SciElo), UpToDate e Google acadêmico. A busca por artigos científicos resultou em 20 artigos selecionados. Foi possível concluir, que há estudos fundamentados correlacionando a medicina psicossomática e a psoríase, além de que diversos fatores que afetam a homeostase corporal, provocam alterações nervosas, e consequentemente afetam as células da pele. Além disso, foi encontrado evidências que a estigmatização que os pacientes sofrem influenciam no aumento da gravidade da doença, sendo necessário a realização de um tratamento psico cognitivo-comportamental juntamente com o tratamento dos sinais e sintomas gerais da doença. Desta forma, o presente trabalho pôde olhar para a patologia com um olhar ampliado relacionado ao aspecto mental e emocional o que promove melhor compreensão e as consequências disto são a maior capacidade de intervenção sobre a psoríase.

Psoriasis is an inflammatory dermatosis linked to several compositions of the being, which are genetics, the immune system, the environment and the patient's mental state, that is, it shows evidence of being a multifaceted clinical picture. Since the composition of psychosomatic medicine is committed to the relationship between the mental, emotional, and body, it is important to show its relationship with psoriasis. Therefore, we sought to evaluate the available evidence in the literature on the relationship between psoriasis and psychosomatic aspects. A literature review was conducted by selecting articles from the Medical Literature Analysis and Retrieval System Online (PubMed/Medline), Scientific Electronic Library Online (SciElo), UpToDate and Google Scholar databases. The search for scientific articles resulted in 20 selected articles. It was possible to conclude that there are well-founded studies correlating psychosomatic medicine and psoriasis, and that several factors that affect the body's homeostasis cause nervous alterations, and consequently affect the skin cells. Moreover, it was found evidence that the stigmatization that patients suffer influences the increase of the severity of the disease, being necessary the realization of a psycho cognitive-behavioral treatment along with the treatment of the general signs and symptoms of the disease. Thus, the present work could look at the pathology with a broader view related to the mental and emotional aspect, which promotes better understanding and the consequences of this are a greater ability to intervene on psoriasis.

La psoriasis es una dermatosis inflamatoria vinculada a varias composiciones del ser, que son la genética, el sistema inmunitario, el medio ambiente y el estado mental del paciente, es decir, muestra evidencias de ser un cuadro clínico multifacético. Dado que la composición de la medicina psicosomática está comprometida con la relación entre lo mental, lo emocional y el cuerpo, es importante mostrar su relación con la psoriasis. Por lo tanto, se buscó evaluar la evidencia disponible en la literatura sobre la relación entre la psoriasis y los aspectos psicosomáticos. Se realizó una revisión bibliográfica seleccionando artículos de las bases de datos Medical Literature Analysis and Retrieval System Online (PubMed/Medline), Scientific Electronic Library Online (SciElo), UpToDate y Google Scholar. La búsqueda de artículos científicos dio como resultado 20 artículos seleccionados. Se pudo concluir que existen estudios bien fundamentados que correlacionan la medicina psicosomática y la psoriasis, y que diversos factores que afectan a la homeostasis del organismo provocan alteraciones nerviosas y, en consecuencia, afectan a las células de la piel. Además, se encontraron evidencias de que la estigmatización que sufren los pacientes influye en el aumento de la gravedad de la enfermedad, siendo necesaria la realización de un tratamiento psico cognitivo- conductual junto con el tratamiento de los signos y síntomas generales de la enfermedad. Así, el presente trabajo pudo contemplar la patología con una visión más amplia relacionada con el aspecto mental y emocional, lo que favorece una mejor comprensión y las consecuencias de ello son una mayor capacidad de intervención sobre la psoriasis.

Cemiplimab for Locally Advanced and Metastatic Cutaneous Squamous-Cell Carcinomas: Real-Life Experience from the French CAREPI Study Group.

Although cemiplimab has been approved for locally advanced (la) and metastatic (m) cutaneous squamous-cell carcinomas (CSCCs), its real-life value has not yet been demonstrated. An early-access program enrolled patients with la/mCSCCs to receive cemiplimab. Endpoints were best overall response rate (BOR), progression-free survival (PFS), overall survival (OS), duration of response (DOR) and safety. The 245 patients (mean age 77 years, 73% male, 49% prior systemic treatment, 24% immunocompromised, 27% Eastern Cooperative Oncology Group performance status (PS) ≥ 2) had laCSCCs (35%) or mCSCCs (65%). For the 240 recipients of ≥1 infusion(s), the BOR was 50.4% (complete, 21%; partial, 29%). With median follow-up at 12.6 months, median PFS was 7.9 months, and median OS and DOR were not reached. One-year OS was 73% versus 36%, respectively, for patients with PS < 2 versus ≥ 2. Multivariate analysis retained PS ≥ 2 as being associated during the first 6 months with PFS and OS. Head-and-neck location was associated with longer PFS. Immune status had no impact. Severe treatment-related adverse events occurred in 9% of the patients, including one death from toxic epidermal necrolysis. Cemiplimab real-life safety and efficacy support its use for la/mCSCCs. Patients with PS ≥ 2 benefited less from cemiplimab, but it might represent an option for immunocompromised patients.

Sleep quality among adult patients with chronic dermatoses.

Chronic dermatoses, including atopic dermatitis, psoriasis, prurigo nodularis, chronic spontaneous urticaria and hidradenitis suppurativa, as well as accompanying subjective symptoms (itch and pain), have a great impact on patients' well-being. Skin plays an important role in the physiological sleep process. This review attempts to analyze the association between chronic dermatoses in adults and sleep quality in recent studies. Polysomnography and actigraphy are performed for the objective assessment of sleep quality. Questionnaire-based subjective evaluations of sleep quality, including the Pittsburgh Sleep Quality Index and Medical Outcomes Study Sleep Scale, are useful in clinical studies and clinical practice. Subjective symptoms such as itch and pain have an essential influence on sleep quality and general quality of life in patients with chronic skin diseases.

Potential applications of topical oxygen therapy in dermatology.

BACKGROUND: Topical oxygen therapy is a cosmetic procedure that is becoming more and more popular in dermatology; however, only a few articles on this topic are present in the literature. In this work we report our group experience with oxygen therapy as an adjuvant treatment in various dermatological conditions. METHODS: Four studies were conducted. In the first study we used vehiculated oxygen therapy for diseases that cause hair loss. In the second study oxygen was used in the treatment of mild acne. In the third study moderate acne was treated with topical oxygen. In the fourth study chronic dermatological conditions such as psoriasis and atopic dermatitis were treated with this procedure. RESULTS: In studies 1 and 2 the outcomes in groups who used topical oxygen therapy as an adjuvant treatment were better than in the groups that did not use it. Studies 3 and 4 also showed very good results, but no control groups were present in the study. CONCLUSION: Topical oxygen therapy was useful in the treatment of hair loss conditions, mild and moderate acne, and in chronic cutaneous diseases, showing effectiveness as a support therapy in all of these conditions. Further and larger studies should be conducted to better evaluate its effectiveness in dermatological conditions.

Tratamento homeopático nas dermatoses crônicas do tipo líquen: estudo de caso revisitado após dez anos / Homeopathic treatment of lichen: 10 year follow-up-case reports

O objetivo do presente estudo foi a importância da homeopatia para o tratamento das patologias crônicas que não encontram boa resolução quando abordadas apenas de forma tradicional. Através de estudo de caso foram acompanhados e revisitados 2 casos clínicos com diagnóstico de líquen comprovados por biópsia que foram abordados inicialmente de modo convencional e que após tratamento sem sucesso, buscaram uma alternativa na homeopatia. Houve remissão dos processos crônicos em ambos os casos com bons resultados. Houve restabelecimento rápido duradouro e sem grandes efeitos indesejáveis no longo prazo em ambos os casos relatados, como preconizam os princípios da homeopatia em que "cura é o restabelecimento rápido, suave e duradouro da saúde". A homeopatia pode atuar de forma interdisciplinar junto ao tratamento convencional de doenças crônicas dermatológicas do tipo líquen, melhorando seus resultados. (AU)

The aim of the present study was to establish the relevance of homeopathy for treatment of chronic diseases when conventional treatment does not lead to satisfactory outcomes. We describe 2 cases of lichen confirmed on biopsy initially given conventional treatment. Due to therapeutic failure, the patients sought homeopathic treatment, which induced regression of disease. In both cases, cure occurred rapidly, was long-lasting action and without undesirable side effects, as established in homeopathy principles: "the highest ideal of cure is rapid, gentle and permanent restoration of health." Homeopathy might be considered for interdisciplinary treatment of chronic skin problems, such as lichen, together with conventional approaches to improve therapeutic outcomes.

A 6-year-old boy with Sulzberger and Garbe dermatosis: a case report and literature review.

Sulzberger-Garbe disease was described in 1937. Not more than a hundred of cases of the disease have been reported in the literature. Despite a quite specific picture, there are no features that could undeniably be attributed to this particular disease entity. Discoid exudative and lichenoid lesions are main lesions in this dermatosis. The disease is associated with severe pruritus. The lesions are located on the trunk and extremities as well as the genitals. Eosinophilia is frequently found in the course of the disease. Sulzberger-Garbe dermatosis has been diagnosed mainly in middle-aged males of Jewish origin but it can occur in both sexes at any age. Good therapeutic response to systemic corticosteroids has been observed. It is still controversial whether the disease should be classified as an independent clinical entity.

Enfermedad crónica ampollosa de la infancia por IgA lineal

Introducción. Se comunica un caso clínico de enfermedad ampollosa crónica de la infancia por IgA lineal; probablemente sea la primera comunicación en México. Caso clínico. Las características clínicas de su inicio fueron en la infancia con presencia de ampollas diseminadas dispuestas en roseta, sin afección del estado general y de evolución crónica. Los datos sugirieron el diagnóstico que se comprobó por biopsia de una lesión y estudio inmunopatológico; en el que aparece la IgA en disposición lineal en la membrana basal epidérmica. El tratamiento de elección es la diamino-difenil-sulfona (DDS), que se administró con éxito al paciente. Se observó remisión y ausencia de las lesiones ampollosas. Conclusión. Primer caso publicado en México con las características clínicas, histopatológicas y de inmunofluorescencia que permiten hacer el diagnóstico con relativa facilidad.

Introduction. To the best our knowledge this the first case of linear IgA chronic bullous dermatosis of infancy reported in Mexico. Case report. The clinical features of the patient: disseminated vesicular lesions in "closter of jewels" configuration, chronic evolution, and good general health, suggested the diagnosis Confirmation was obtained through immunopathologic study of a lesion showing linear IgA deposits in the epidermal basal cell membrane. Treatment with dapsone resulted in control of the disease. Conclusions. The clinical characteristics and immunopathological studies made possible the diagnosis of the disease.