Atopic dermatitis and psyche

[automatthias]

There is a recurring theme which seems to have all the properties of nonsense, but it doesn't seem that there is consensus even in medical circles. I'm talking about atopic dermatitis (AD) being a psychosomatic disease, meaning that it is, according to some people, at least partially, caused by person's psyche.

This view may manifest by someone saying "It's all in your head", but it may also show when a doctor asks you: "Are your rashes exacerbated after stressful situations?"

Calling this disease psychosomatic, seems to be basically saying that "We have no idea, so we'll just blame the victim", as Susan Sontag described it in "Illness as Metaphor". Certain diseases, especially the ones with unclear causes, or the ones that are not easily treatable, retain packages of cultural meaning. In the Romantic era we had tuberculosis being a manifestation of a romantic personality, today we have cancer as a manifestation of negative emotions, and atopic dermatitis as being a result of a loss of a loved one, or something similar. However, when a scientific explanation is
presented, and the cure is devised, the cultural meaning disappears -- we no longer consider it noble to be sick from tuberculosis. Before, it was a manifestation of an artistic personality, now it's just bacteria in the lungs.

Currently, one of the centers propagating the view is a Children's Clinic in Gelsenkirchen, Germany. The main proponent is Ernst August Stemmann[1]. The term "atopic dermatitis" is not used however; Stemman makes an explicit reference to psyche, using a sciencey-sounding prefix: he calls it "neurodermitis"[2] (or in English form, "neurodermatitis"). Gelsenkirchen treatments are described in German Wikipedia as non-scientific[3], Stemmann was being accused of fraud, and it all fits together as a full-blown woo.

So I thought it's all bunk. But then I found out, that the neurodermatitis diagnosis is actually present in ICD-10[4]. Also, rashes exacerbation after stress is one of the minor criteria for diagnosing AD (however, I didn't find a good source on the Interwebs). Also, when you search for "atopic" and "psychosomatic" on pubmed, you get tons of hits, so there's something going on.

I also thought that the whole psychosomatic business in AD is bunk, but there is a new branch of medicine (or is it?) called "neuropsychoimmunology". Is it just relabeling of the old, out-of-fashion psychosomatic medicine? Or is it sound science?

If it is sound, however, why we don't hear anything about new psyche-related AD treatment methods, or new findings?

I'm really confused by this, and I don't know how to make up my mind. Should I buy a subscription to a medical journal (which one?) and dig through full-text publications?

[1] http://www.prof-stemmann.de/
[2] http://www.kinderklinik-ge.de/Neurodermitis.pdf
[3] http://translate.google.com/transla...handlungsverfahren&hl=en&ie=UTF-8&sl=de&tl=en
[4] http://www.who.int/classifications/apps/icd/icd10online/?gl20.htm+l208

 

[Scazon]

If a placebo can make people better, why can't a molestibo make them worse?

 

[El Greco]

Why on earth would you assume that it is bunk ? I don't know much about the specific condition but what I know is that stress, joy, grief etc can generate very powerful hormonal responses. Cortisol, for example, has been found to rise in response to stressful situations. The mechanisms are very complex so we can't know much about the pathogenesis but it's not like it's something with no scientific basis.

 

[Rolfe]

Er, I don't think atopic dermatitis is in the "we have no idea" category. And it's certainly true that stress hormones can do very definite things to the body, and in particular the skin. For example, after his 18-year-old son dropped dead literally beside him with no warning, my cousin's hair fell out. (It all grew back when he began to get over it.) Sayin to Alan, "you're bald because of the stress of your son's sudden death" is hardly telling him it's his fault. OK, I know that's not atopic dermatitis, but I use it as an example because there are similarities in the endocrinology.

Rolfe.

 

[sol invictus]

I don't know much about atopic dermatitis, but if it's an autoimmune problem (as I believe it's suspected to be) it wouldn't be surprising if it is strongly affected by stress/mood. The immune system is very complicated and rather poorly understood, and is known to be affected by mental state in various ways.

That doesn't make it "all in your head" (far from it), or even psychosomatic, precisely - but what's going on in your head could play an important role.

 

[Smackety]

neuropsychoimmunology

Well - the immune system can be conditioned, just like skinner's pigeons.
Maybe someone can convince your immune system that attacking your skin is a bad thing.
I read somewhere that the recent rise in allergies may be due to the reduction in parasites, that is, our immune system gets bored and decides to wage war on pollen to keep itself busy.
I saw this cool study on babies that had recieved heart transplants from someone with a different blood type. When they grew up, they were able to recieve transfusions of either type of blood. Their baby immune systems did not know what to attack and decided that both types were normal.

There is an experiment with rats where they ring a bell and inject an immunosupressant drug, then measure immune reaction to see how much effect the drug had. After a few trials, they could shut down the rats immune system just by ringing the bell.

Who knows how much inadvertent conditioning we have all done to ourselves with misuse of medicine and whatnot.

I imagine someday there will be a regimen babies will go through similar to immunizations that will train the immune system to recognize certain threats and ignore common allergens, etc.

Anyway, I didn't google it, because for once in my life I thought I would try to go off-the-cuff (I know that is a serious crime here but oh well), but I think that might be what
neuropsychoimmunology means

 

[Dancing David]

The issue is the difference between the old use of the word 'psychosomatic' versus the current use of the term 'stress related'.

The problem is as usual the old bagage from the term psychosomatic.

 

[Dancing David]

neuropsychoimmunology

Well - the immune system can be conditioned, just like skinner's pigeons.
Maybe someone can convince your immune system that attacking your skin is a bad thing.
I read somewhere that the recent rise in allergies may be due to the reduction in parasites, that is, our immune system gets bored and decides to wage war on pollen to keep itself busy.
I saw this cool study on babies that had recieved heart transplants from someone with a different blood type. When they grew up, they were able to recieve transfusions of either type of blood. Their baby immune systems did not know what to attack and decided that both types were normal.

There is an experiment with rats where they ring a bell and inject an immunosupressant drug, then measure immune reaction to see how much effect the drug had. After a few trials, they could shut down the rats immune system just by ringing the bell.

Maybe you should have googled that.

Did you make this up?

 

[Smackety]

Maybe you should have googled that.

Did you make this up?

Well, someone else made up psychoneuroimmunology!

ETA: I told you all posting without googling is a cardinal sin! They got me in 2 minutes!

 

[Smackety]

The rats..sorry no bell, a flavored drink.

The babies, pretty much what I said

Parasites and Allergies - not a study, okay, but is it woo?

Any other claims I need google to defend for me today?

 

[Baby Nemesis]

There was a television programme about allergies recently. It said there's been quite a rise in allergies over the past few decades, and the causes are still being investigated. But it said part of the reason people get them is that certain people have higher levels of an antibody that comes in useful in developing countries for fighting off parasitical worms; but it fixates onto other things if there aren't any around.

But also, it said a major cause is thought to be that the top layer of skin forms a protective barrier against things that can cause allergic reactions, and with modern washing techniques, such as harsh scrubbing or abrasive detergent-type things that can remove the top layer of skin, it's easier for allergens to cause a reaction. So people could do with washing a bit less vigorously.

As for stress, it can cause or lead to all kinds of symptoms, for a few reasons. It can cause pains by increasing muscle tension; it can make people more susceptible to illness because they might not look after themselves so well, for instance if they used to eat a healthy balanced diet but gave it up in favour of a diet of junk food under stress because they wanted to go for something quick and comforting all the time; and stress has been scientifically demonstrated to temporarily impair the immune system, so people are more susceptible to infection and other things.

From an article called Stress Weakens the Immune System:

What the Research Shows

Stressed out? Lonely or depressed? Don't be surprised if you come down with something. Psychologists in the field of “psychoneuroimmunology” have shown that state of mind affects one's state of health.

In the early 1980s, psychologist Janice Kiecolt-Glaser, PhD, and immunologist Ronald Glaser, PhD, of the Ohio State University College of Medicine, were intrigued by animal studies that linked stress and infection. From 1982 through 1992, these pioneer researchers studied medical students. Among other things, they found that the students' immunity went down every year under the simple stress of the three-day exam period. Test takers had fewer natural killer
cells, which fight tumors and viral infections. They almost stopped producing immunity-boosting gamma interferon and infection-fighting T-cells responded only weakly to test-tube stimulation.

Those findings opened the floodgates of research. ...

It follows that sorting your life out boosts your immune system.

 

[Professor Yaffle]

The rats..sorry no bell, a flavored drink.

The babies, pretty much what I said

Parasites and Allergies - not a study, okay, but is it woo?

Any other claims I need google to defend for me today?

Its OK Smakety - I believed you. I was just off googling to find the links to defend you, but it turns out you didn't need my help.

 

[Smackety]

Its OK Smakety - I believed you. I was just off googling to find the links to defend you, but it turns out you didn't need my help.

Thanks, I appreciate the support. I know those things sound strange, but the immune system is proving to be a sophisticated animal, independent of our brain to a large degree yet capable of highly evolved learning and adaptation. It is one of the great secrets for medicine to unlock and solve, the cure for the virus, for cancer, etc. may all come through understanding the immune system and how it learns.

Next we need to figure out how the brain learns and remembers!

 

[Dancing David]

Well, someone else made up psychoneuroimmunology!

ETA: I told you all posting without googling is a cardinal sin! They got me in 2 minutes!

I retract my statement, I haven't read all the studies and some are really, really old, but it does seem that i found at least one from 2002 on a test sample of 34.
http://www.fasebj.org/cgi/content/full/16/14/1869

2005
http://www.jneurosci.org/cgi/content/full/25/9/2330

But the hits are rather sparse, so i am still sort of wonedring.

 

[Baby Nemesis]

There was a television programme about allergies recently. It said there's been quite a rise in allergies over the past few decades, and the causes are still being investigated. But ...

Talking of allergies, this is interesting: Fear Of Nuts Creating Hysteria Of Epidemic Proportions:

... A peanut on the floor of a school bus leading to evacuation and decontamination for fear that it might be eaten by the 10 year old passengers, and schools declaring themselves "nut free" by banning nuts, peanut butter, homebaked goods and any foods without ingredient labels, are just some examples cited in this article.

According to Professor Nicolas Christakis from Harvard Medical School, there is no evidence that any of these extreme restrictions work better than more circumscribed policies or that they are worth the money and disruptions they create.

In the US, 150 people die each year from food allergies. This is compared to the 50 who die from bee stings, the 100 who die from lightening strikes, the 45,000 who die in motor vehicle accidents, and the 10,000 who are hospitalised for traumatic brain injury from playing sport. But these issues do not incur such extreme reactions, such as calling for an end to sport. ...

 

[fls]

This issue came up in "The powerlessnes of prayer" thread. That physical processes can be influenced by mental processes (which are, after all, just another physical process) doesn't somehow make that result 'lesser' in quality or importance. But I think you are failing to distinguish the difference between a disease that can be exacerbated by (among other things) alterations in mental state (atopic dermatitis) and a condition that is not objectively present except through the beliefs of the sufferer. Neurodermatitis is not atopic dermatitis. Instead, it is a skin reaction brought about by the actions of a person who believes that they are inconsolably itchy.

Linda

 

[Baby Nemesis]

I presume that was addressed to the OP. The thread started talking about allergies in general and the immune system after that, so it veered away from it.

Also addressed to the OP:

I doubt a doctor would say stress was the only cause of atopic dermatitis. Here's an article on different causes of such skin conditions.

Multiple factors can trigger or worsen atopic dermatitis, including dry skin, seasonal allergies, exposure to harsh soaps and detergents, new skin products or creams, and cold weather. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.

But some doctors do say stress can cause flare-ups in people who already have the condition. Here's a page with some Basic stress reduction techniques recommended by dermatologists. But they won't all work for everyone, and there's a cautionary note about stress reduction techniques on another page of the site:

Bottom line. Finding ways to relieve stress can have a positive effect on your skin — and your life. Before trying a new stress-reduction technique, talk with your dermatologist. *While stress-reduction techniques seem harmless, some can have a powerful effect. Biofeedback can change a diabetic’s need for insulin. Massage can do more harm than good if the person giving the massage does not know how to treat someone who has a skin condition.

 

[Zeuzzz]

Interesting. I get transient red dermatitis like rashes all the time. And my knuckles are always red. It tends to be around my joints, with elbows and knees usually effected the most. Doctor thinks its circulation, I'm not convinced, and am beginning to think it may be an autoimmune issue. Trouble is they usually last so briefly whever I go to see the GP about them they've long vanished. Comes up in big red blotches sometimes on my chest. Some other guy I talked to suggested it may be focal vasculitis seen at the joints, mediated by the compliment pathway of the immune system clogging up capillaries.

Maybe I just have to convince myself its not real and alter my psyche, and it will go away

 

[automatthias]

From an article called Stress Weakens the Immune System...)

Stress weakens the immune system? This doesn't make any sense. Let's take the most modern ointment for the AD. The active substance is Tacrolimus, which works by... weakening the immune system! You put it on the skin, it weakens - locally - the immune system, this stops the allergic reaction from happening in your skin, and AD clears up.

Now, if stress weakens the immune system, it should be the *cure* for AD, not a (partial) cause.

Why on earth would you assume that it is bunk ? I don't know much about the specific condition but what I know is that stress, joy, grief etc can generate very powerful hormonal responses. Cortisol, for example, has been found to rise in response to stressful situations. The mechanisms are very complex so we can't know much about the pathogenesis but it's not like it's something with no scientific basis.

I can say, as legitimately, that why on earth would you assume that AD is caused by mental processes? It seems like we have an issue of the burden of proof. Is it up to me to prove that AD isn't caused by mental processes (I'm on the “AD has got nothing to do with the mental” side), or is it up to other people to prove that it is?

The stress-relatedness of AD is referred to something that “everybody knows”, and nobody actually verifies if it's true. Was there any study to actually show that? (I've seen only one, on mice.)

There's nothing wrong in advising to avoid stress. But there is something wrong with declaring that the psyche, which is one the things we identify the most - “I *am* my psyche” - is the cause of the disease. Here's how this thinking goes wrong:
1. AD is caused by mental processes.
2. Mental processes are what makes me me.
3. AD is caused by who I am.

Or

1. AD is caused by mental processes.
2. My will is one of my mental processes.
3. AD is caused by my will. I'm sick because I want to be sick.

And so forth.

Er, I don't think atopic dermatitis is in the "we have no idea" category.

Generally, no. People who promote the psychosomatic view say it is.

And it's certainly true that stress hormones can do very definite things to the body, and in particular the skin. For example, after his 18-year-old son dropped dead literally beside him with no warning, my cousin's hair fell out. (It all grew back when he began to get over it.)

My cousin X, therefore Y? You're kidding, right?

Stress hormones probably can do things in the body, but again, I doesn't seem right to use them as a 'catch all' explanation. Isn't it what creationists are doing? If we see no obvious explanation for X, therefore God did it. Here, you're saying that “we don't know why my cousin's hair fell out, so we'll just assume it's stress”.

I don't know much about atopic dermatitis, but if it's an autoimmune problem (as I believe it's suspected to be) it wouldn't be surprising if it is strongly affected by stress/mood. The immune system is very complicated and rather poorly understood, and is known to be affected by mental state in various ways.

You're saying two things in one breath:
1. X is very complicated and rather poorly understood
2. X is known to be affected by Y, which is even more complicated and even less understood than X

How is it known? Is there any research behind it?

The issue is the difference between the old use of the word 'psychosomatic' versus the current use of the term 'stress related'.

The problem is as usual the old bagage from the term psychosomatic.

Probably. Should then the term be used at all?

The psychosomatic view varies. The thinnest version of it (I think of it as of the Intelligent Design-like) says that stress is a partial cause of AD, without specific claims of how strong the link is, or how it works. It offers a generally sensible advice to “avoid stress”, and there's hardly anything wrong with it, except that I haven't seen any decent research on that. There might be one out there, if so, I'd like to see it.

The other side of the spectrum is the thick version (I think of it as of the Young-Earth Creationist-like), which makes specific claims like “the AD is caused by relationship with your mother”, or that AD is most prevalent in people with some specific personality type (whatever “personality” is, there is a number of conceptions of personality in psychology).

Where is the truth, I don't know. Perhaps AD is in fact caused, or worsened by stress. If so, some evidence should be eventually found. What really turns me off here, is that I've seen a number of a very *bad* studies that were trying to show just that. It's like with homeopathy trials: you have claims that “there are trials that show the efficacy of homeopathy”, but if you're conducting 100 trials of a non-existinant thing with 0.05 significance level, about 5 of them will come out positive! (false positive, of course) If people are performing trials of X and many of them are bad trials, while others are negative, it's a sign that there's a drive to prove something that isn't necessarily there.

I'll give you one example. This study shows how “AD is worsened by stress”. What's wrong with the study? First of all, N=11. Duh. Secondly, if you read the abstract, they say “Eleven patients with AD with histories of stress worsening were included.” They assumed the link even before they even started the study! And thirdly, there's no mention of a control group. There are more examples, you can find links here (website is in Polish but links lead to publications in English).

This issue came up in "The powerlessnes of prayer" thread. That physical processes can be influenced by mental processes (which are, after all, just another physical process) doesn't somehow make that result 'lesser' in quality or importance. But I think you are failing to distinguish the difference between a disease that can be exacerbated by (among other things) alterations in mental state (atopic dermatitis) and a condition that is not objectively present except through the beliefs of the sufferer. Neurodermatitis is not atopic dermatitis. Instead, it is a skin reaction brought about by the actions of a person who believes that they are inconsolably itchy. Linda

That a physical process can be influenced by a mental process doesn't necessary mean that any given physical process is actually influenced by a mental process.

Wikipedia article cites AD as one of the forms of neurodermatitis.

Speaking of imaginary diseases, large part of skin damage in AD comes from scratching, which is definitely an action of the sufferer. Other than that, it's basically red and dry skin. Scratching is caused by itching. Itching is a feeling. Not necessarily mental thing, I think animals can also feel the itching. Is itching real, or only in my mind?

 

[Professor Yaffle]

Short term stress seems to boost the immune system, while chronic stress seems to weaken it.

http://mentalhealth.about.com/od/stress/a/stressimmune604.htm