Eighty-seven out of 100 adult patients with intractable atopic dermatitis (AD) were strongly suggested of having addictive scratching behavior from interviews, clinical findings, or diaries of scratching, which is habitual, and often induced by emotional stress. Psychosocial stress, especially that stemming from familial or occupational problems, was shown to have exacerbated the dermatitis in 70 (80.5%) of those patients with addictive scratching behavior. The most frequent psychiatric diagnosis was psychological factors affecting the medical condition[DSM-IV]in 63 out of 87 patients (72.4%). The relationship between the clinical course of AD and the degree and recognition of addictive scratching was studied among 63 patients who were followed up for at least 6 months. Forty-seven patients (74.6%) recognized their addictive scratching, but 16 (25.4%) did not. Among those who did, scratching was reduced in 46.8% and the AD inproved in 46.8%, slightly improved in 44.7%, and unchanged in 8.5%. Contrarily, among patients who failed to recognize it, scratching reduced only in 31.3% and AD improved in 31.3%, slightly improved in 31.3%, and was unchanged in 37.5%. Thus patients who recognized their addictive scratching behavior showed better long-term clinical improvement. Psychosocial stress should always be carefully considered, and encouraging patients to recognize and reduce their addictive scratching is beneficial.
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