Stress reactivity in psoriatic patients

Aim. This investigation aims at evaluating the correlation between stressful life events, as those listed in the Social Readjustment Social Scale (SRRS), and the onset of the disease in psoriatic patients, as well as investigating on the existence of specific personality traits. Methods. A group of 33 patients affected by moderate-severe stable plaque psoriasis has been interviewed; all of them were offered to fill in the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), so that 30 tests could be validated (15 men and 15 women). Results. The MMPI-2 results exhibited different profiles between the 2 genders: as to men, significant statistic differences were to be found in scales displaying irritability and anger, while women appeared to be affected by anxiety, depression and somatization. As a result of these clinical interviews, a psychological support based on the cognitive therapy has also been offered to 26 patients and 2 different types of patients have been singled out: a first group reporting intolerance to adverse environmental situations, a second group complaining for insufficient affective and social support. Conclusion. Our data, collected by means of clinical interviews and questionnaires, seem to confirm the correlation between the somatic aspect of the disease and the protective function of the skin against the outer world. These elements are fundamental to the psychosomatic interpretation of this chronic-relapsing dermatosis, which often poses a threat for the bodily self-image of each patient

Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts

Summary Background Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective. Objectives To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique. Methods Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean ± SEM sensitivity, specificity and diagnostic accuracy, and kappa (κ) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests. Results There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the κ intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training. Conclusions We demonstrated that Web-based training is an effective tool for teaching dermoscopy