Flora Balieva

The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants––3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67–3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68–2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33–2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

The burden of common skin diseases assessed with the EQ5D: a European multicentre study in 13 countries

Generic instruments measuring health‐related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical conditions, as well as calculation of utility data.

Contact dermatitis to captopril

A 35-year-old non-atopic woman, with no previous skin disorder except intolerance to costume jewellery, developed skin problems shortly after giving birth to her first child. At birth, the baby was diagnosed with a heart malformation necessitating treatment with captopril and aspirin, administered by the mother. The patient developed hand eczema and eyelid swelling and eczema. Her condition gradually worsened and responded poorly to treatment. She was patch tested with the European Baseline Series and there were reactions to nickel sulfate and cobalt chloride, which were of old relevance. An open test with the baby’s captopril syrup was performed. One drop of the syrup was applied on the volar aspect of the forearm. An immediate itchy erythema was observed. The next day the reaction was eczematous with vesicles. To exclude the patient reacting to any of the other substances in the syrup (captopril 5 mg/ml, ascorbic acid, sorbitol, citric acid, benzoic acid, sodium citrate), patch testing with captopril in pet. was performed. For patch testing with captopril (1,2), we prepared 1%, 3%, 10% and 30% dilutions of captopril in petrolatum from a powdered capoten tablet (containing 12.5 mg captopril, microcrystalline cellulose, corn starch, lactose and stearic acid; BristolMyers Squibb, Norway). Finn chambersTM were used. After 1D, she experienced itching on the back and removed the patches. Table 1. Captopril patch test results

Attachment styles of dermatological patients in europe : A multicentre study in 13 countries

Attachment styles of dermatological outpatients and satisfaction with their dermatologists were investigated within the framework of a multicentre study conducted in 13 European countries, organized by the European Society for Dermatology and Psychiatry. Attachment style was assessed with the Adult Attachment Scale. Patient satisfaction with the dermatologist was assessed with an 11-degree scale. A total of 3,635 adult outpatients and 1,359 controls participated in the study. Dermatological outpatients were less able to depend on others, were less comfortable with closeness and intimacy, and experienced similar rates of anxiety in relationships as did the controls. Participants who had secure attachment styles reported stressful life events during the last 6 months significantly less often than those who had insecure attachment styles. Patients with secure attachment styles tended to be more satisfied with their dermatologist than did insecure patients. These results suggest that secure attachment of dermatological outpatients may be a protective factor in the management of stress.

Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations

It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists.

The Role of Therapy in Impairing Quality of Life in Dermatological Patients: A Multinational Study

Skin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%). The largest reduction in HRQoL attributable to therapy, as a percentage of total DLQI, adjusted for confounders, was seen in blistering conditions (10.7%), allergic/drug reactions (10.2%), psoriasis (9.9%), vasculitis/immunological ulcers (8.8%), atopic dermatitis (8.7%), and venous leg ulcers (8.5%). In skin cancer, although it had less impact on HRQoL, the reduction due to therapy was 6.8%. Treatment for skin disease contributes considerably to reducing HRQoL: the burden of dermatological treatment should be considered when planning therapy and designing new dermatological therapies.

The self-assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries

Prurigo is defined by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions.

Wells syndrome: a case of successful treatment with omalizumab

Wells syndrome (eosinophilic cellulitis) is an uncommon inflammatory dermatosis characterized by great clinical variability and suggestive, but not specific, histopathological findings. The condition is usually recurrent with tender erythematous plaques (sometimes urticarial), possibly with vesicles and bullae, and may be difficult to treat. We present a 45-year-old woman with a 10-year history of intermittent appearance of erythemathous noduli and plaques lasting typically 3 days, sometimes longer, remitting with erosions and postinflammatory hyperpigmentation. The lesions first appeared after mosquito bites and were often painful and sometimes very pruritic, worsening if scratched. Lesions could appear “anywhere” but typically on ears, back, hands, and scalp. Once she discovered her whole leg red and swollen after using tight slalom boots. Physical examination revealed deep erythematous noduli, several ulcerated (Fig. 1). Complete blood count with differential, liver function tests, antinuclear antibodies, complement, and serum electrolytes were normal. Urticarial pressure test was negative.

The psychosocial burden of hand eczema: Data from a European dermatological multicentre study

The essential physical role, visibility and social importance of the hands place a major psychological burden on patients with hand eczema.

Occurrence, Chronicity and Intensity of Itch in a Clinical Consecutive Sample of Patients with Skin Diseases: a Multi-centre Study in 13 European Countries

Itch is an unpleasant symptom, affecting many dermatological patients. Studies investigating the occurrence and intensity of itch in dermatological patients often focus on a single skin disease and omit a control group with healthy skin. The aim of this multi-centre study was to assess the occurrence, chronicity and intensity (visual analogue scale 0-10) of itch in patients with different skin diseases and healthy-skin controls. Out of 3,530 dermatological patients, 54.3% reported itch (mean ± standard deviation itch intensity 5.5 ± 2.5), while out of 1,094 healthy-skin controls 8% had itch (3.6 ± 2.3). Chronic itch was reported by 36.9% of the patients and 4.7% of the healthy-skin controls. Itch was most frequent (occurrence rates higher than 80%) in patients with unclassified pruritus, prurigo and related conditions, atopic dermatitis and hand eczema. However, many patients with psychodermatological conditions and naevi also reported itch (occurrence rates higher than 19%).