Negative Emotions in Skin Disorders: A Systematic Review

Construction and Validation of a Novel "Pruritus Impact Scale" (PIS) for Assessment of Chronic Pruritus

Background

Currently available pruritus assessment tools may not always fulfill the needs of the Indian population and populations who share similar sociocultural backgrounds. To overcome this limitation, a new assessment tool "Pruritus Impact Scale (PIS)" was constructed and validated.

Aims and Objectives

The primary objective is to construct and validate the novel PIS. The secondary objective is to evaluate the responsiveness of PIS to changes in symptoms.

Patients and Methods

This study design was cross-sectional for the primary objective and longitudinal for the secondary objective. The study recruited 435 patients of chronic pruritus of different etiologies for the construction of the PIS scale. Patients were asked to fill out four different pruritus measuring tools i.e., Numerical Rating Scale (NRS), Dermatology Life Quality Index (DLQI), 12-item Pruritus Severity Score (PSS), and newly constructed PIS. The PIS was derived from existing standard assessment tools with certain modifications to keep a balance of psychometric properties of the scale and the sociocultural needs of the population. The validity and reliability of the scale was assessed. For detecting the response of PIS to change in pruritus intensity, 276 patients were followed and were instructed to refill all four scales at 6 weeks from the baseline. The responsiveness was judged by comparing the mean score of all scales at baseline with the mean score at 6 weeks. In addition, the changes in the scores among all 4 scales were correlated and compared.

Results

PIS showed strong internal consistency (Cronbach α = 0.882) and positively correlated with other validated pruritic tools such as NRS (ρ = 0.938, P < 0.0001), DLQI (ρ = 0.914, P < 0.01) and 12- PSS (ρ = 0.913, P < 0.001) at baseline. PIS showed satisfactory reproducibility at 3-hour intervals (Cronbach α = 0.994). Responsiveness to change in pruritus as measured by PIS at 6 weeks reassessment was correlated well with the changes in NRS (ρ = 0.689, P value < 0.0001), DLQI (ρ = 0.586, P value < 0.0001) and 12-PSS (ρ = 0.928, P value <0.0001).

Limitations

A noteworthy limitation of the present study is the lack of comparison of different items (within a construct) comprised in different tools used for comparison.

Conclusions

The newly constructed PIS is a valid tool in the studied population.

Assessing the health-related quality of life of cutaneous Leishmaniasis patients in Draa-Tafilalet, southeastern Morocco

Cutaneous leishmaniasis is a significant public health concern globally. This study aims to evaluate the impact of cutaneous leishmaniasis on the quality of life of patients in the Draa-Tafilalet region of Morocco. In this cross-sectional study, data were collected from 87 patients between December 2022 and July 2023 using the Skindex-16 questionnaire. The results revealed that cutaneous leishmaniasis has a mild to moderate impact on health-related quality of life, with 26.4 % of participants reporting a low impact and 73.6 % reporting a moderate impact. A significant gender difference was observed in Skindex-16 scores, with moderate impact being more prevalent among females (60.90 % vs. 30.10 %, p = 0.002). Furthermore, facial lesions were associated with a statistically significant reduction in quality of life, particularly in the emotional (p < 0.001) and functioning (p = 0.01) domains. These findings highlight the need for targeted management strategies that address the substantial impact of cutaneous leishmaniasis on patients' quality of life. Future studies with larger sample sizes and extended follow-up periods are warranted to further elucidate the effects of cutaneous leishmaniasis on patients' well-being.

Unlocking the psycho-social-dermal axis: A double blinded randomized placebo controlled study unveiling the influence of a novel topical formulation on skin quality, attractiveness, quality of life, and sexual satisfaction

BACKGROUND

Improved skin appearance is closely linked to higher self-esteem, favorable first impressions, and enhanced quality of life, with skincare products often being formulated with biostimulatory and regenerative ingredients to both enhance skin health and provide psychological benefits. Certain components, such as phospholipids and botanicals, may not only improve skin quality, but also impact mood, romantic bonding, and sexual attraction.

AIMS

To assess whether a novel topical skin care product formulated with a proprietary combination of proteins, lipids, and botanical derivatives, can potentially result in a robust psycho-social-dermatological benefit via modulation epidermal oxytocin and pheromonal pathways.

PATIENTS/METHODS

In this single-center prospective, randomized, controlled, double-blinded study, 40 female subjects were randomly assigned to use of either active novel skincare products, or placebos, for 4-8 weeks. Skin assessments, standardized photography, first impression ratings, and questionnaires on confidence and sexual satisfaction were conducted.

RESULTS

Thirty-nine subjects completed the study and demonstrated a statistically significant improvement in skin quality following 4 and 8 weeks of use, with improvements of greater magnitude demonstrated with a longer duration of use. Product users projected a better first impression and appeared on average 3 years younger than their actual age, with 86% of subjects reporting increased confidence. Product users found random people of the opposite sex to be more attractive 88% of the time and reported improvement in sexual satisfaction in 90% of the categories.

CONCLUSIONS

The use of this novel topical product culminated in statistically significant improvements in skin quality, confidence, sexual relationship satisfaction, perceived attractiveness, and youthfulness, highlighting its potential in anti-aging and mood enhancement.

Neuroticism and inflammatory skin diseases: a bidirectional Mendelian randomization study

Previous observational studies have linked inflammatory skin diseases with mental health issues and neuroticism. However, the specific impact of neuroticism and its subclusters (i.e. worry, depressed affect, and sensitivity to environmental stress and adversity) on these conditions remains underexplored. In this work, we explored causal associations between common inflammatory skin diseases and neuroticism. We conducted a two-sample, bidirectional Mendelian randomization (MR) analysis using data from genome-wide association studies in psoriasis, atopic dermatitis, neuroticism and relevant genetic subclusters conducted on participants of European ancestry. Corrections for sample overlap were applied where necessary. We found that psoriasis was causally associated with increased levels of worry (odds ratio, 95% confidence intervals: 1.011, 1.006-1.016, P = 3.84 × 10-6) while none of the neuroticism subclusters showed significant association with psoriasis. Sensitivity analyses revealed considerable evidence of directional pleiotropy between psoriasis and neuroticism traits. Conversely, genetic liability to atopic dermatitis did not exhibit any significant association with neuroticism traits. Notably, genetically predicted worry was linked to an elevated risk of atopic dermatitis (odds ratio, 95% confidence intervals: 1.227, 1.067-1.41, P = 3.97 × 10-3). Correction for overlapping samples confirmed the robustness of these results. These findings suggest potential avenues for future interventions aimed at reducing stress and worry among patients with inflammatory skin conditions.

Co-culture of iNeurons with primary human skin cells provides a reliable model to examine intercellular communication

OBJECTIVE

The skin is a sensory organ, densely innervated with various types of sensory nerve endings, capable of discriminating touch, environmental sensations, proprioception, and physical affection. Neurons communication with skin cells confer to the tissue the ability to undergo adaptive modifications during response to environmental changes or wound healing after injury. Thought for a long time to be dedicated to the central nervous system, the glutamatergic neuromodulation is increasingly described in peripheral tissues. Glutamate receptors and transporters have been identified in the skin. There is a strong interest in understanding the communication between keratinocytes and neurons, as the close contacts with intra-epidermal nerve fibers is a favorable site for efficient communication. To date, various coculture models have been described. However, these models were based on non-human or immortalized cell line. Even the use of induced pluripotent stem cells (iPSCs) is posing limitations because of epigenetic variations during the reprogramming process.

METHODS

In this study, we performed small molecule-driven direct conversion of human skin primary fibroblasts into induced neurons (iNeurons).

RESULTS

The resulting iNeurons were mature, showed pan-neuronal markers, and exhibited a glutamatergic subtype and C-type fibers characteristics. Autologous coculture of iNeurons with human primary keratinocytes, fibroblasts, and melanocytes was performed and remained healthy for many days, making possible to study the establishment of intercellular interactions.

CONCLUSION

Here, we report that iNeurons and primary skin cells established contacts, with neurite ensheathment by keratinocytes, and demonstrated that iNeurons cocultured with primary skin cells provide a reliable model to examine intercellular communication.

The use of SCL-k-9 to measure general psychopathology in women and men with skin conditions

Objectives

To measure general psychopathology in dermatologic outpatients using the Symptom-Checklist-K-9 (SCL-K-9); to investigate whether the SCL-K-9 is able to categorize patients with and without significant non-psychotic disorders; and to perform a single-item analysis of the SCL-K-9, with a focus on gender differences.

Methods

Cross-sectional study on consecutive dermatological patients. We used two self-administered questionnaires to assess general psychopathology symptoms: General Health Questionnaire-12 (GHQ-12) and SCL-K-9. Sociodemographic information was collected with standardized forms. The performance of the SCL-K-9 in classifying patients according to their current emotional distress severity was assessed using a ROC procedure. Finally, we measured differences in scores obtained among women and men in SCL-K-9 single items.

Results

A total of 292 patients were studied (71.2% women). We observed statistically significant differences in SCL-K-9 total mean scores and in most single items among genders. We found that it would be more appropriate to use gender-specific cut-offs when using SCL-K-9 to screen dermatological patients for general psychopathology.

Conclusion

The SCL-K-9, with its compact format could provide, in a short time, a wide range of information related to critical areas that challenge the mental health of patients with skin diseases.

It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis

Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents.

Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis.

Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships.

Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.

An Open Trial on the Feasibility and Efficacy of a Mindfulness-Based Intervention with Psychoeducational Elements on Atopic Eczema and Chronic Itch

(1) Background: Mindfulness-based interventions (MBI) are psychological group interventions conducted over several weeks. Their effects on reducing stress and improving physical and psychological health have been proven in various clinical populations. Growing evidence suggests that MBIs might be beneficial for dermatology patients. This article reports on a novel Mindfulness-based Training for chronic Skin Conditions (MBTSC) with psychoeducational elements that was developed with the goal of improving self-regulation including stress management and emotion regulation in patients and to help in coping with disease symptoms such as itch and scratching. The intervention was tested in a pilot efficacy trial in order to examine feasibility and to collect preliminary data on the effectiveness of the intervention on disease severity including itch perception and on psychological distress in an atopic dermatitis (AD) sample. (2) Methods: Following an uncontrolled pre-test-post-test design based on standardized self-report measures, nine adult AD patients were recruited from a dermatology clinic. Data were collected at baseline, post-treatment and 3 month follow-up. Patients completed questionnaires assessing disease severity, itch perception, stress, anxiety and depression, mindfulness and intervention acceptability. The 7 week intervention included seven weekly sessions and a daily home-practice requirement, supported by guided audio-meditations and reading material. (3) Results: Quantitative data showed improvements in disease severity, itch perception and stress levels with small to medium effect sizes. Psychological distress increased at post-treatment—significantly in the case of depression. Qualitative data highlighted the mixed effects of MBTSC on symptoms. Treatment acceptability was high and 100% of the participants completed the intervention; (4) Conclusions: These data indicate that MBTSC is feasible and that it might be a useful tool as adjunct therapy for AD. Further studies with larger samples and control groups are needed.

The Impact of Mindfulness Meditation on the Psychosomatic Spectrum of Oral Diseases: Mapping the Evidence

The psychological aspect of dis-ease, which is indeed a lack of ‘ease’ is generally overlooked in the management of myriad maladies that affect the human body. The concept of mindfulness meditation, which is an interesting hybrid born from the meditative discipline of the east and the intellectual discipline of the west is gaining attention in the past two decades for its benefits in the holistic development of individuals. When individuals with ailments are trained under therapists supervised by the clinicians, significant results can be seen in alleviating symptoms like pain, stress, anxiety and an improvement in the quality of life is observed. This review article focuses on the structure and basics of mindful meditation and the mechanisms of mindfulness and its positive effects on various diseases like lichen planus, urticaria, psoriasis, eczema, myofacial pain dysfunction syndrome, to name a few. There are various arenas within the discipline of oral and maxillofacial medicine where mindfulness-based techniques can be explored for its effectiveness in combating psychosomatic conditions. The article highlights the importance of holistic approach in treating diseases in which mindfulness meditation techniques play an important role.

Multi-Method Approach in the Assessment of Alexithymia in Patients With Scleroderma: Use of Two Different Tools

Objective: Alexithymia is frequent in patients with some chronic dermatological conditions. The aim of the study was to measure the prevalence of alexithymia in patients with systemic sclerosis (SSc) using two different tools. Methods: Consecutive patients diagnosed with SSc were recruited at day hospital and hospitalization regimen. Alexithymia was measured using the self-administered questionnaire 20-item Toronto Alexithymia scale (TAS-20) and the semi-structured interview 24-item Toronto Structured Interview for Alexithymia (TSIA). Results: The study sample consisted of 67 female patients, aged from 29 to 82 years. According to TAS-20, 22.4% of patients were alexithymic and 17.9% were borderline alexithymic. Also, in our sample mean TAS-20 value was 48.9 and TSIA mean value was 20.3. Spearman's correlation coefficient between TAS-20 total score and TSIA total score was 0.603. A high correlation was observed between TAS total score and the "Affective Awareness" (AA) scale of the TSIA. TSIA total score significantly correlated with the "Difficulty describing feeling to others" (DDF) scale of the TAS-20. The highest correlation between scales of the two instruments was that between TAS-20 DDF and TSIA AA (r = 0.675). Conclusion: The prevalence of alexithymia in SSc patients was higher than in the general population, and similar to that of psoriasis patients. The measurements obtained using the TAS-20 and the TSIA were highly correlated. However, they also showed some diversities in the scales, indicating that they may measure different domains.

An analysis of qualitative responses from a UK survey of the psychosocial wellbeing of people with skin conditions and their experiences of accessing psychological support

BACKGROUND

Skin conditions have a large emotional, psychological and psychiatric impact on the individual. The All-Party Parliamentary Group on Skin (APPGS) commissioned a qualitative survey to further explore this relationship alongside the experiences of those accessing services in relation to these difficulties in the UK.

AIM

To examine the experiences of UK individuals living with a skin condition, and their views of seeking and receiving psychological treatment. This survey formed part of the evidence collected in the preparation of the APPGS Mental Health and Skin Disease report.

METHODS

A free-text electronic survey was widely distributed by professional bodies and skin-related charities. Responses were analysed using descriptive thematic analysis and descriptive statistics. Data for each question were classified and labelled, leading to the development of a coding frame. Inter-rater reliability was assessed using Cohen kappa statistic.

RESULTS

In total, 544 participants (84% female) completed the survey. The majority of respondents had inflammatory skin diseases such as eczema (43%) or psoriasis (33%). The thematic analysis revealed five key themes associated with impact on mood; impact of intimacy; impact on activities of daily living; lack of recognition from others of the impact; and lack of accessible services.

CONCLUSION

The survey demonstrates that there is an urgent need to improve both awareness of the impact that skin conditions can have, and for the provision of psychological services to address this impact.