Atopic dermatitis and distress

Abstract

Atopic dermatitis (AD) is a chronic, inflammatory skin condition characterized by itching, redness, and skin lesions, affecting approximately 10–20% of children and 1–3% of adults worldwide. Distress associated with AD can negatively impact quality of life, work, and daily activities.

The research aims were to explore the role of stress in AD patients and to further investigate brain activity during stress in AD patients compared with controls. Further, one possible mediator related to skin inflammation and stress, calcitonin gene-related peptide (CGRP), was studied in skin from AD patients and controls, and related to psychodemographic measurements.

The initial parts of the project involved focus groups with patients and an online survey. Results from the focus group study and the survey study underlined the importance of stress as a trigger and worsening factor for patients with AD. Both studies indicated that stress, especially chronic stress, could be an important worsening factor. Decision-making and unforeseen events were often mentioned as stress triggers. In both the focus groups and the survey study, patients rated stress as of greater importance than climate factors. Itch was reported to be a result of stress and the type of stress possibly affected the nature of the pruritus experienced by patients. Furthermore, physical exercise was reported to have beneficial effects, something that was found in both the focus groups and the survey.

Differences were found in possible mechanisms for stress processing in AD patients compared with controls. Reduced deactivation in the default mode network in response to stress (an arithmetic test) indicated that there is likely a cognitive functional variability in AD patients compared with healthy control subjects, manifested as lowered inhibition ability under psychological stress. This was also supported by different correlations between brain activities and various psycho-demographic data. Findings from a functional magnetic resonance imaging study indicated that psychological stress affected brain activities in the motor cortex, the somatosensory association cortex, and perception and sensory integration processing among AD patients.

An immunohistochemical study showed an increase of CGRP in nerve-like fibers and inflammatory cells in inflamed skin of AD patients compared with non-lesional skin. The increase of CGRP-positive nerve-like fibers in skin correlated with depressive and anxiety scores in the patients.

The results showed that psychological stress was an important trigger factor for AD and both differences in central processing of stress in AD and peripheral changes in CGRP levels in skin were observed. This emphasizes the importance of a holistic approach to treatment of AD, with the possibility for healthcare to offer more individualized treatment depending on each patient’s challenges and needs.