Volker Niemeier

Hautkrankheit und Sexualität Eine empirische Studie zum Sexualverhalten von Patienten mit Psoriasis vulgaris und Neurodermitis im Vergleich mit Hautgesunden

ZusammenfassungEs werden 53 Patienten mit Psoriasis, 24 Patienten mit Neurodermitis und eine hautgesunde Stichprobe von 52 Personen bezüglich ihres Sexualverhaltens miteinander verglichen. Als Testverfahren wurden Fragebögen zum Sexualverhalten nach Arentewicz und ein eigener Fragebogen zur Sexualität und Partnerschaft eingesetzt. Die untersuchten Hautkranken unterscheiden sich signifikant von Hautgesunden im Sinne eines beeinträchtigten Sexuallebens. Der Austausch von Zärtlichkeiten ist bei beiden Geschlechtern, die Orgasmusfähigkeit ist bei den weiblichen Patienten hochsignifikant reduziert. Demgegenüber zeigt sich bezüglich der Koitushäufigkeit kein signifikanter Unterschied. Psoriatiker fühlen sich im Vergleich zu Patienten mit Neurodermitis stärker beeinträchtigt. 93% der Psoriasispatienten und 96% der Patienten mit Neurodermitis sind von ihrem behandelnden Arzt bisher nie auf ihr Sexualleben angesprochen worden. Bei aller Problematik, diesen intimen Bereich anzusprechen, sollte der Arzt für Haut- und Geschlechtskrankheiten jedoch ein kompetenter Gesprächspartner für Fragestellungen, die die Hautkrankheit und ihre Folgen für das Sexualleben betreffen, sein. Es wird diskutiert, inwieweit die Hautkrankheit möglicherweise zur Regelung von Nähe und Distanz eingesetzt wird.SummaryFifty-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.

S2k-Leitlinie - Chronischer Pruritus

© 2012 The Authors • DDG

Diagnostisches und therapeutisches Vorgehen beichronischem Pruritus

Abteilung Klinische Neurodermatologie, Klinik und Poliklinik fur Hautkrankheiten, Universitatsklinikum Munster, Dermatologische Klinik Inselspital Bern, Schweiz, Zentrum fur Allergie und Umwelt, Klinik und Poliklinik fur Dermatologie und Allergologie am Biederstein, Technische Universitat Munchen, Zentrum fur Psychosomatische Medizin, Psychosomatische Dermatologie, Universitatsklinikum Giessen, Hautarztpraxis, Nurnberg, Dermatologie Bad Bentheim, Paulinenkrankenhaus, Bad Bentheim, Klinik fur Dermatologie und Venerologie, Universitatsklinikum Magdeburg, Klinische Sozialmedizin, Berufs und Umweltdermatologie, Universitatsklinikum Heidelberg

Atopic Eczema Prevention Programs – a New Therapeutic Concept for Secondary Prevention

Patient education for atopic eczema patients are programs for prevention or relapse prevention. A combination of dermatological education and psychological behavior training has proved effective. Recent studies with long follow-up periods and randomized controlled study designs show the positive aspects of patient education programs. The main aim is not the reduction of symptoms, but the improvement of coping behavior, of subjective impairment, and of life quality are central aspects of the patient program. In the meantime, the atopic eczema prevention program has been standardized, and a certification of the instructors has been established. Different studies and the contents of the patient prevention programs are presented.

Mental Stress in Atopic Dermatitis – Neuronal Plasticity and the Cholinergic System Are Affected in Atopic Dermatitis and in Response to Acute Experimental Mental Stress in a Randomized Controlled Pilot Study

Rationale In mouse models for atopic dermatitis (AD) hypothalamus pituitary adrenal axis (HPA) dysfunction and neuropeptide-dependent neurogenic inflammation explain stress-aggravated flares to some extent. Lately, cholinergic signaling has emerged as a link between innate and adaptive immunity as well as stress responses in chronic inflammatory diseases. Here we aim to determine in humans the impact of acute stress on neuro-immune interaction as well as on the non-neuronal cholinergic system (NNCS). Methods Skin biopsies were obtained from 22 individuals (AD patients and matched healthy control subjects) before and after the Trier social stress test (TSST). To assess neuro-immune interaction, nerve fiber (NF)-density, NF-mast cell contacts and mast cell activation were determined by immunohistomorphometry. To evaluate NNCS effects, expression of secreted mammal Ly-6/urokinase-type plasminogen activator receptor-related protein (SLURP) 1 and 2 (endogenous nicotinic acetylcholine receptor ligands) and their main corresponding receptors were assessed by quantitative RT-PCR. Results With respect to neuro-immune interaction we found higher numbers of NGF+ dermal NF in lesional compared to non-lesional AD but lower numbers of Gap43+ growing NF at baseline. Mast cell-NF contacts correlated with SCORAD and itch in lesional skin. With respect to the NNCS, nicotinic acetylcholine receptor α7 (α7nAChR) mRNA was significantly lower in lesional AD skin at baseline. After TSST, PGP 9.5+ NF numbers dropped in lesional AD as did their contacts with mast cells. NGF+ NF now correlated with SCORAD and mast cell-NF contacts with itch in non-lesional skin. At the same time, SLURP-2 levels increased in lesional AD skin. Conclusions In humans chronic inflammatory and highly acute psycho-emotional stress interact to modulate cutaneous neuro-immune communication and NNCS marker expression. These findings may have consequences for understanding and treatment of chronic inflammatory diseases in the future.

Psychosomatic Aspects of Pruritus

Pruritus is an uncomfortable sensation that induces craving for scratching. This overview shows some aspects of the recent research on itch and its etiology. Although pruritus is often correlated with a somatic disease, psychogenic pruritus and psychosocial factors can play an important role in the etiology. Itch is probably a specific sensation. It is generally accepted that there are specific and discrete pathways for pain and itch, which are described as ‘itch-units’ in slowly conducting C-fibers. Itch is mostly neuropeptide-induced and recent data suggest that it is limited to their mast-cell activating effect. The close connection between epidermal nerve fibers and brain is pointed out by some newer studies in brain research. An activation of the anterior cingulate cortex, supplementary motor area, premotor area and inferior parietal lobe by itch was seen, which was different from pain-induced activation. Measurement of itch is mostly evaluated by a visual analogue scale. The Itching Cognition Questionnaire assesses coping cognitions related to itching. Psychological factors showed a comorbidity of itch with depression and anxiety, a decrease of life quality and mentally inducible pruritus. Pruritus sine materia is an autologous somatoform disorder.

Psychosomatische Dermatologie in Deutschland*: Eine Umfrage an 69 Hautkliniken

ZusammenfassungHintergrund und Fragestellung. Eine Umfrage zur Situation und Entwicklung der psychosomatischen Dermatologie in deutschen Hautkliniken sollte die Ist-Situation 10 Jahre nach einer ähnlichen Studie erheben. Patienten/Methodik. Es wurden 170 Hautkliniken mittels eines Fragebogens angeschrieben. 76 wurden zurückgeschickt, 69 hiervon (40,6%) konnten ausgewertet werden. Die Fragebögen wurden überwiegend von dermatologischen Chefärzten (38/69=55,1%) beantwortet. Ergebnisse. Fast 85% der Hautkliniken geben an, dass psychosomatische Aspekte in der Therapie berücksichtigt werden. Eine psychotherapeutische Zusatzqualifikation haben 5,1% der Hautärzte in den Kliniken. Die Verbesserung der Krankheitsbewältigung sollte wesentliches Ziel der psychosomatischen Intervention sein. Die Bedeutung psychischer Faktoren wurde insgesamt im Vergleich zur Studie vor 10 Jahren bei fast allen Dermatosen deutlich höher angegeben. Schlussfolgerungen. Psychosomatische Aspekte scheinen nach den Angaben der Umfrage inzwischen zu einem obligaten Bestandteil dermatologischer Versorgung in den Hautkliniken geworden zu sein. Die Häufigkeit einzelner Störungen wird jedoch im Vergleich zu Studienergebnissen aus der Literatur immer noch unterschätzt.AbstractBackground and Objective. A questionnaire study of German dermatological clinics was designed to show the situation and development of psychosomatic dermatology 10 years after a similar study. Patients/Methods. A questionnaire was sent to 170 dermatological clinics. 76 were send back; 69 of them (40.6%) were evaluable. The questionnaires were mostly answered by the heads of the dermatological clinics (38/69=55,1%). Results. Nearly 85% of the dermatological clinics answered that they take psychosomatic aspects into consideration in the therapy. 5,1% of the dermatologists working in clinics have additional psychotherapeutic certification. The improvement of coping behaviour seems to be the main goal of psychosomatic interventions. The importance of psychic factors increased in the last 10 years in comparison to a former study in regard to most of the dermatological diseases. Conclusions. Psychosomatic aspects seem to be an obligatory part of inpatient dermatological therapy. The frequency of some diseases was underestimated in comparison with results from literature.

Reduced expression of nicotinic a subunits 3, 7, 9 and 10 in lesional and nonlesional atopic dermatitis skin but enhanced expression of a subunits 3 and 5 in mast cells

Background  The skin cholinergic signalling system is modulated in atopic dermatitis (AD).

Sense of Coherence among Psoriatics as a Predictor of Symptom-Free Time Following Dermatological Inpatient Therapy

Objective: In the present study, we investigated the health-protective resources of psoriatics, operationalized via their sense of coherence. Our objective was to determine whether the strength of these resources has an influence on the duration until relapse. Patients and Methods: 72 patients were examined three times (before, immediately after, and 15–18 months after treatment). Along with the Psoriasis Area Severity Index score and determination of the subjective estimation of severity, patients were asked to answer questionnaires relating to how they were dealing with their illness as well as to lifequality, sense of coherence (SOC), and critical life events. Results: Personal estimation of severity of condition and PASI values at the commencement of therapy highly correlated. At follow-up after balneophototherapy, subjective severity of condition had almost returned to the initial value. 76.7% of the patients experienced relapse within the first 6 months following therapy. The level of the score for manageability correlates with the length of time until the first relapse. Patients with low SOC suffered their first relapse 3.5 months after therapy, while patients with high SOC underwent first relapse after 10 months on average. Conclusion: The data suggest that the SOC could play a protective role in respect of the tendency towards relapse among psoriatics.

Vitiligo – Coping Behavior

Thirty-three inpatients with vitiligo were compared at the Tomesa Klinik (Bad Salzschlirf, Germany) to a healthy control group using the Beck Depression Inventory, Interaction Anxiety Questionnaire (German version: Interaktions-Angst-Fragebogen, Becker), and the Questionnaire on Health Locus on Control Scales (in the German version: Fragebogen zu Kontrollüberzeugungen von Krankheit und Gesundheit – KKG – by Lohaus und Schmitt). The groups were matched for age, sex and social situation. 27.3% of patients attributed their vitiligo to emotional stress. The patients were not characterized by elevated depression values, but the depression scores tended to increase with the duration of illness. Com-pared to the control group, the patients had higher scores in some specific areas of anxiety. This could be reduced by early improvement in coping strategies by means of psychotherapeutic measures. Compared to the control group, the vitiligo patients considered the locus of control to be more external. When a large percentage of the body surface was affected, the patients had in-creased scores indicating fatalistic Health Locus of Control.