Comparison of personality traits among patients with psoriasis, atopic dermatitis, and stress: a pilot study

Background: Psoriasis and atopic dermatitis are chronic skin diseases that greatly affect the quality of life. Both diseases can be triggered or exacerbated by stress. Objective: We aimed to differentiate personality traits between patients with chronic skin conditions and people treated for stress in a pilot study. Methods: Patients participating voluntarily in educational programs in Belgium and Switzerland were recruited to complete personality trait questionnaires, including the Temperament and Character Inventory (TCI) and the Tridimensional Personality Questionnaire (TPQ). A comparison was made with patients treated for work-related stress. Results: A total of 48 and 91 patients suffering from skin diseases and work-related stress, respectively, were included in the study. Based on the questionnaires, we found that dermatology patients were less persistent and impulsive than those with work-related stress. Dermatology patients also exhibited more rigidness and less focus on performance. Finally, patients with work-related stress seem more likely to change in response to health-promoting programs than patients with chronic dermatoses. Conclusion: Patients with chronic skin diseases may perceive and cope with stress differently in comparison to patients with work-related stress due to inherent personality traits. Therefore, stress coping mechanisms may differ among different diseases. More research is needed into the design of educational interventions and the impact of personality traits in disease-specific groups

HautTief Multidisciplinary Educational Program for Patients with Psoriasis or Atopic Dermatitis: A Randomized Controlled Study

BACKGROUND Improving health-related quality of life (HRQoL), disease severity, and treatment adherence through patient education is an increasingly important, yet relatively new area in dermatology. This randomized controlled trial aims to contribute to this growing area of research by exploring the effects of a 9-week educational program for patients with chronic skin diseases. OBJECTIVE The aim of the study was to evaluate the effect of a multidisciplinary educational program on HRQoL and disease severity in patients with psoriasis or atopic dermatitis (AD). METHODS Sixty-four patients with diagnosed psoriasis or AD were recruited from University Hospital Zurich and randomized (1:1) to the intervention or control group. To assess HRQoL, the following self-reported questionnaires were used: Dermatology Life Quality Index (DLQI), Skindex-29, EuroQol-5D (EQ-5D), RAND 36-Item Short Form Survey (SF-36), and Beck Depression Inventory (BDI) to measure depression symptoms. Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI) were used to capture disease extent. These scores were assessed at four study visits, which were performed at baseline and 3, 6, and 9 months after the start of the program. RESULTS At month 6, an improvement of at least 25% in BDI was recorded in 15 (68.2%) of 22 patients in the intervention group and 6 (27.3%) of 22 patients in the control group (difference 40.9%, p = 0.016). 53.3% (16 of 30) of patients achieved an improvement in one subdomain of the SF-36 score (role limitations due to emotional problems) at 6-month follow-up, compared with 23.1% (6 of 26) of those not attending the educational program (difference 30.2%; p = 0.042). No significant differences in DLQI, Skindex-29, EQ-5D, PASI, and EASI between both groups at the three time points were found. CONCLUSION An educational program may improve HRQoL and depression status of patients with psoriasis or AD

Phototoxic and photoallergic cutaneous drug reactions

A variety of topical and systemic drugs can induce cutaneous photosensitive reactions. These drugs and their metabolites accumulate in the skin and increase photosensitivity of the skin typically in the UVA spectrum of light. Concerning the underlying biochemical mechanisms and the phenotype of reactions, photosensitivity can be divided into phototoxic and photoallergic reactions. In phototoxic reactions, often highly reactive oxygen molecules are formed that induce tissue damage. Skin changes resemble sunburn and develop within hours after incubation with the drug together with sunlight. In contrast, photoallergic reactions are type IV hypersensitivity reactions, and therefore resemble eczema. They usually develop within days and are less common than phototoxic reactions. Diagnosis is based on a synopsis of complete history, clinical examination, phototesting for minimal phototoxicity dose, patch testing including photopatch tests, and histopathology. Mainstays of treatment are the withdrawal of the culprit drug, and avoidance of sunlight by wearing protective clothing and broadband sunscreens with UVA filters

Human papillomavirus and squamous cell cancer of the skin--epidermodysplasia verruciformis-associated human papillomavirus revisited

As squamous cell cancer (SCC) is the most common malignancy in organ transplant recipients, a viral etiology has been proposed. Human papillomavirus (HPV) is found more often in organ transplant recipients than in the general population, but its role in cancer development has been debated for years. As a model of susceptibility of HPV the inherited disease epidermodysplasia verruciformis (EV) has been investigated intensively. EV is an autosomal-recessive skin disease leading to multiple flat warts and pityriasis versicolor-like macules in early youth. EV patients are at great risk of developing skin cancer due to a lack of defense against beta HPV. Beta HPV are causally involved in the formation of skin cancer in patients afflicted with EV. Beta HPV has frequently been detected in SCC and its early lesions such as actinic keratoses. Depending on the methods used, a prevalence of 30-90% has been reported for beta HPV for SCC in organ transplant recipients, while this prevalence in the general population is lower, but still considerable at 50%. Epidemiologic studies in the general population seem to suggest that beta HPV plays a role in the formation of SCC, both for invasive and in situ lesions

Skin cancer in organ transplant recipients

Organ transplant recipients (OTR) are at a significantly increased risk for developing a wide variety of skin cancers, particularly epithelial skin cancer, Merkel cell carcinoma and Kaposi's sarcoma. Melanoma, skin adnexal neoplasm and cutaneous lymphomas are also more common in OTR and may differ in their clinicopathologic presentation from tumors in immunocompetent patients. The accuracy of clinical diagnosis of suspected premalignant and malignant skin lesions in OTR is modest. Therefore, histopathological diagnosis is an essential element for the diagnostic workup of skin cancers and, in addition, provides important information on prognosis. Squamous cell carcinoma and intraepithelial neoplasias (actinic keratosis, squamous cell carcinoma in situ or Bowen's disease) are the most common forms of skin cancer in OTR. The risk of Merkel cell carcinoma and Kaposi's sarcoma is dramatically increased in OTR. Merkel cell carcinoma shows a highly aggressive course. Kaposi's sarcoma tends to spread to extracutaneous sites. Primary cutaneous lymphomas developing after organ transplantation are rare. The spectrum of cutaneous B cell lymphomas in OTR, in particular, differs significantly from that of the general population, with a predominance of Epstein-Barr virus-driven posttransplant lymphoproliferative disorder. This review discusses the clinical and histopathological aspects of skin cancers in OTR, the impact of dermatopathological analysis on prognosis and the understanding of the pathogenesis of these neoplasms

Critical skin cancer in organ transplant recipients--a dermatopathological view

Organ transplant recipients (OTR) are at significantly increased risk to develop a wide variety of skin cancers, particularly epithelial skin cancer, Merkel cell carcinoma and Kaposi's sarcoma. In addition, melanoma, skin adnexal neoplasm and cutaneous lymphomas are more common in OTR and may differ in their clinicopathological presentation from tumors in immunocompetent patients. The accuracy of clinical diagnosis of suspected premalignant and malignant skin lesions in OTR is modest. Therefore, histopathological diagnosis is an essential element for the diagnostic workup of skin cancers, and additionally provides important information on prognosis. This review discusses the histopathological aspects of skin cancers in OTR, the impact of dermatopathological analysis on prognosis and understanding of the pathogenesis of these neoplasms