Een inkijk in de psychodermatologie

Skin disorders are one of the most prevalent conditions observed in general practice, and they are often accompanied by other physical conditions. At dermatological clinics, increasing attention is being paid to psychosocial problems in patients with chronic skin disorders such as psoriasis and eczema or skin-related oncology problems. Psychological adjustment problems, severe itch-scratch problems, shame, social fear, or low therapy adherence are frequent reasons for a referral to psychologists trained in dermatological problems and other psychosocial health professionals. In addition, the treatment of patients with primarily psychological problems within the dermatology domain, such as body dysmorphic disorder, trichotillomania or delusional parasitosis, generally requires a multidisciplinary approach. In this article, the impact of a skin disorder on the quality of life and the impact of psychodermatological factors on the course and development of a skin disorder are illustrated by means of 3 cases. The cases provide a brief overview of the psychological diagnostic and therapeutic approaches in different dermatological condition

Actinic keratosis and surrounding skin exhibit changes in corneocyte surface topography and decreased levels of filaggrin degradation products

Actinic keratosis (AK) is a frequent premalignant skin lesion mainly caused by chronic sun exposure. AK lesions are often surrounded by invisible, subclinical alterations, called field of cancerization (FoC). Definition of FoC is of importance for therapy management; however, the criteria and non-invasive tools to characterize FoC are lacking. Atomic force microscopy (AFM) proved to be a suitable tool for detection of changes in the corneocyte surface topography in inflammatory skin diseases, which share similar clinical features with AK such as hyper- and parakeratosis. Therefore, in this study we applied AFM to investigate AK and surrounding skin obtained by non-invasive collection of the stratum corneum (SC) with adhesive tapes. Furthermore, we determined degradation products of structural protein filaggrin (natural moisturizing factor, NMF), which previously showed association with the changes in corneocyte surface topography. Ten patients with multiple AK on the face were recruited from the outpatient clinic. SC samples were collected from the AK lesion, skin sites adjacent to the AK, 5 cm from the AK and retroauricular area. Corneocyte surface topography was determined by AFM, and NMF by liquid chromatography. The AK lesion showed alterations of the corneocyte surface topography characterized by an increased number of nanosize protrusions, which gradually decreased with the distance from the lesion. NMF levels show an inverse pattern. Atomic force microscopy showed to be a suitable tool to detect changes in the corneocyte surface topography on the AK lesion and surrounding skin in a non-invasive manner

Elderly travel frequencies and transport mode choices in Greater Rotterdam, the Netherlands

Demographic ageing is a key societal challenge in Europe as well as in many other western and non-western societies. A crucial dimension concerns elderly daily mobility patterns. While still partaking fewer and shorter trips than younger generations, today’s elderly have been found increasingly (auto)mobile. Although the elderly benefit from the independence, freedom of movement, and social inclusion, concerns may rise regarding the environmental and accessibility impacts of this induced mobility. The present study adds to the expanding literature on elderly mobility, an integrated analysis of the effects of socio-demographic, health, trip, spatial and weather attributes on elderly mobility. Utilizing travel diary data for Greater Rotterdam, The Netherlands, trip frequencies and transport mode choices of the elderly are analysed by means of zero-inflated negative binomial models as well as multinomial logit regression models, and contrasted to the non-elderly subpopulation to explore (dis)similarities. While the results show common determinants, the models also highlight important differences in the magnitude of the estimated coefficients and factors only influencing transport patterns for the elderly. Embedded in the context of an aging population, the empirical findings assist policy-makers and planners in several respects: For transportation plans and programs it is critical to recognize mobility needs of the elderly. As the seniors are becoming increasingly automobile, the results call for strategies to encourage older people to use more physically active and environmentally friendly transport modes such as public transport, walking and cycling