Assuntos
Ficusina/uso terapêutico , Hidroterapia/psicologia , Terapia PUVA/psicologia , Preferência do Paciente , Fármacos Fotossensibilizantes/uso terapêutico , Psoríase/tratamento farmacológico , Adolescente , Adulto , Idoso , Banhos , Terapia Combinada , Feminino , Humanos , Hidroterapia/métodos , Masculino , Pessoa de Meia-Idade , Terapia PUVA/métodos , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Patients report well-being as they are treated with phototherapy. We investigated hormone parameters and psychological well-being after phototherapy in a placebo-controlled study. METHODS: A total of 77 patients with dermatological conditions and 22 healthy volunteers were divided into four groups. The patients received phototherapy either on the whole body or only on hands and/or feet. The volunteers were given either whole-body phototherapy or placebo light. Serum or plasma samples were analysed for cortisol, calcium, magnesium, phosphate, TSH, T(4), T(3) and 25-hydroxyvitamin D, and urine samples for cortisol. Patients and volunteers answered a questionnaire before and 6 weeks after phototherapy/placebo light. Psychiatric ratings were performed according to the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes, a self-report version of which has been transformed to correspond to the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: In the patients who received whole-body irradiation, we observed a significant improvement in both MADRS score and cognitive-symptom score after the completion of phototherapy. We also observed a significantly higher level of 25-hydroxyvitamin D after phototherapy, but no difference in the other hormone parameters. CONCLUSION: Whole-body phototherapy of patients with dermatological conditions results in improved well-being and significantly higher levels of 25-hydroxyvitamin D in serum.
Assuntos
Hormônios/sangue , Dermatopatias/psicologia , Dermatopatias/radioterapia , Terapia Ultravioleta/métodos , Terapia Ultravioleta/psicologia , Adulto , Afeto , Pé , Mãos , Humanos , Hidrocortisona/sangue , Pessoa de Meia-Idade , Terapia PUVA/métodos , Terapia PUVA/psicologia , Placebos , Testes Psicológicos , Inquéritos e Questionários , Tiroxina/sangue , Tri-Iodotironina/sangue , Vitamina D/análogos & derivados , Vitamina D/sangue , Irradiação Corporal Total/métodos , Irradiação Corporal Total/psicologiaRESUMO
OBJECTIVE: To assess whether psychological distress affects treatment outcome in psoriasis. DESIGN: Cohort study of patients with psoriasis receiving psoralen-UV-A (PUVA) photochemotherapy. SETTING: Two university hospital dermatology departments. PATIENTS: One hundred twelve patients with chronic plaque psoriasis. MAIN OUTCOME MEASURES: We assessed clinical severity of psoriasis, psychological distress, and other potential confounders of treatment outcome such as skin phototype, family history of psoriasis, and alcohol intake before starting PUVA therapy. Clinical severity of disease and response to therapy were assessed at every fourth appointment. RESULTS: Pathological or high-level worry was the only significant (P =.01) predictor of time taken for PUVA to clear psoriasis. Event curves of time to clearance significantly differed between high- and low-level worry groups (log rank test, 6.64; df = 1; P =.01). Patients in the high-level worry group cleared with PUVA treatment at a rate 1.8 times slower than that of the low-level worry group (ExpB = 1.81; 95% confidence interval, 1.13-2.90). Fiftieth percentile time to clearance of psoriasis in the high- and low-level worry groups showed a median difference of 19 days. CONCLUSIONS: Psychological distress, in the form of excessive worrying, has a significant and detrimental affect on treatment outcome in patients with psoriasis. Patients with psoriasis who are classified as high-level worriers may benefit from adjunctive psychological intervention before and during treatment. These findings provide further evidence of the existence of a brain-skin axis.
