Dermatological disorders including atopic dermatitis has some features of psychosomatic disorders and/or co-morbidity of depression/anxiety. Significantly high odds ratio of depression and anxiety disorders was reported in patients with atopic dermatitis. Antidepressants and antianxiety drugs are representative agents that control the stress response. Especially, antidepressants are basic drugs which act via inhibition of transporter proteins of serotonin and/or noradrenaline. Behavioral modification is more important to treat stress-related disorders. Atopic dermatitis patients with psychosomatic features will have great gain if dermatologists diagnose depression/anxiety of them and treat them with psychopharmacotherapy and simple psychotherapy.Skin Research, Suppl. 20: 1-6, 2013

View full abstract

Music, such as music therapy, listening music and playing musical instruments, is not directory effective to atopic dermatitis. Effectiveness is mainly due to reduction of stresses. Depend on this point, there are some recommendations among other complementary and alternative medicine (CAM). Medical aromatherapy is one candidate. In this therapy, medicinal action of essential oil is used instead of fragrance. For example, sedative, anti-itching and anti-septic action of Lavender oil is useful for atopic dermatitis. The other profitable CAM candidate is Reiki. Reiki is a gentle hands-on healing therapy originated in Japan. This subtle energy can be blocked conduction from practitioner's hand to patient's body by placing a piece of aluminum foil between them. Aluminum foil conducts only body temperature but electromagnetic waves. This simple experiment means that Reiki is some kind of electromagnetic energy. By using this blocking technique, nature Reiki energy holders can be easily found. The past papers of Reiki experiments sometimes concluded that further study was needed. There exists a possibility that sham (placebo) Reiki practitioners of these experiments might be nature Reiki energy holders. Researchers, who are interested in clinical application of Reiki, must not ignore this point in their experiments. As a control group, sham Reiki practitioners must wear electromagnetic-shielded gloves. Reiki reduces muscle tension, eases pain, recovers peripheral circulation and reduces anxieties and stresses. As a result, Reiki promotes total relaxation of both of body and mind. For treatment of atopic dermatitis, Reiki can be used as an alternative therapy at home and as a complementary therapy at medical fields.Skin Research, Suppl. 20: 7-12, 2013

View full abstract

Evaluation of peripheral blood leukocytes has been considered as a popular window to the immune system and its reaction. Numeration of leukocytes has long been a practical clinical marker of acute inflammation. Yet, the numbers and function of circulating leukocytes may also change during and after exercise to an extent comparable to inflammatory responses. A considerable amount of effort to elucidate the underlying mechanism of such changes in circulating leukocytes, however, has revealed quite a different picture showing a major contribution of neuroendocrine system independent of inflammatory processes. Interestingly a good correlation of blood leukocyte profile with athletic performance in endurance runners was reported. It is therefore important to understand and interpret the observed changes depending on the context to avoid misinterpretation especially regarding potential immunological risks unlikely to happen upon exercise. It is therefore agreeable that literature review suggests a minor or negligible immune perturbation of exercise to autoimmune disease patients, which may also be applied to atopic dermatitis patients. Under a cautious care and good control of sweating, dermatitis patients may most likely benefit from exercise and physical activity rather than to keep them away from exercise.Skin Research, Suppl. 20: 13-18, 2013

View full abstract

More than ten years has passed after publication of Japanese guideline for atopic dermatitis treatment. However there are still considerable numbers of patients who suffer from severe symptoms which deteriorate their quality of life. In the author's view this is because atopic dermatitis is a tricky disease that has several pitfalls which traps even medical personnel. Three pitfalls are described and the way of solution and importance of appropriate anti-inflammatory treatment is emphasized. 1. Pitfall for therapeutic goal : Considerable numbers of patients loose the way of treatment because of obscure therapeutic goal and indefinite therapeutic schedule. They should be obvious. 2. Pitfall for situation of aggravating factor elimination and anti-inflammatory treatment : Persistent cutaneous inflammation induces more aggravating factors to fall into vicious circle. Management for emotional stress without anti-inflammatory treatment achieves no goal. Allergen specific IgE is not only a cause but product of skin inflammation. 3. Pitfall of topical corticosteroid treatment : Topical corticosteroid application method should be reconsidered precisely and scientifically. Several clinical evidences and practical benefit reveal that the concept of treatment strategy should be “tight control” which achieves early complete remission and long-term maintenance of scarce inflammation even subclinical. Precise procedures of adequate topical corticosteroid application based on “proactive therapy” acompanied with educational support to accomplish the treatment goal were proposed.Skin Research, Suppl. 20: 19-27, 2013

View full abstract

To study the role of the prefrontal cortex (PFC) in crying with tear, we continuously measured cerebral oxygenation in the PFC while subjects watched a movie that is expected to elicit emotional tear. Cerebral oxygenation was assessed by changes in the concentration of oxygenated hemoglobin (oxyHb) using multi-channel near-infrared spectroscopy. We found a small gradual increase in oxyHb in the medial PFC (mPFC) at 10-50 seconds prior to tearing, when subjects developed an increase in heart rate and felt “choked up”. Thereafter oxyHb in the mPFC showed a spiky larger increase, i.e., “tear-triggering phase” just before subjects started weeping bitterly. This result indicates that the crying response is triggered by the top-down command originating from the mPFC that is related with “theory of mind” or empathy. During the weeping we observed a recovery from the increased PFC oxyHb and tachycardia. The mood state, assessed by POMS questionnaire score after crying with tear, reduced confusion and tension-anxiety. Since the tearing response is induced by a vigorous excitation of the parasympathetic (facial) nervous system in the brain stem, even though dominant sympathetic tone is generally expected under the waking condition. Such unique change in the autonomic nervous system suggests that the crying behavior with weeping bitterly is likely to relieve a stressful condition.Skin Research, Suppl. 20: 28-30, 2013

View full abstract

It has been widely accepted that nocturnal sleep is the period having function for taking rest and relaxation of human body. After the onset of sleep, clear decrease in sympathetic function with reduced secretion of norepinephrine manifested as a decrease in heart rate, blood pressure and frequencies of sympathetic discharges from antigravity muscles is commonly observed. During sleep period, sympathetic function becomes lowest during slow wave sleep, while the function becomes higher in rapid eye movement (REM) sleep than that in awake period. This sleep related resting function may explain the mechanism of frequent occurrence of cardiovascular disease in chronically sleep deprived persons. On the other hand, increased sympathetic function coming from psychological stress may cause disturbance in initiation or maintenance of nocturnal sleep. That is, autonomic function and sleep mechanism correlate mutually.
Nocturnal sleep occurs depending on the change in circadian vegetative function. Just before the sleep onset, secretion of melatonin from pineal grand increases, leading to the rapid decrease in core-body temperature, which have a key role in initiating sleep. During slow wave period especially in the earlier period of nocturnal sleep, growth hormone and prolactin, both of which are essential for keeping metabolism of the body efficiently, are pulsatively secreted. In addition, secretion of sleep promoting cytokines becomes elevated during the night time and decreases early in the morning.
All these changes in vegetative functions contribute to the consolidation of sleep-awake control and metabolism of human body.Skin Research, Suppl. 20: 31-36, 2013

View full abstract

Gut microbiota have several beneficial effects on host physiological functions;however, little is known about whether or not such microbes can affect the development of brain plasticity and a subsequent central nervous system response. Recently, accumulating evidence has shown that gut microbiota can affect host stress response and behavioral phenotype. Our previous works using gnotobiotic mice demonstrated that hypothalamic-pituitary-adrenal reaction to restraint stress was substantially higher in germ-free (GF) mice than in specific pathogen free (SPF) mice. Moreover, GF mice were more active and anxious than EX-GF mice of which microbiota had been reconstituted with normal SPF microbiota. These results thus support the idea that gut microbes affect postnatal development of host stress response and behavioral phenotype.Skin Research, Suppl. 20: 37-41, 2013

View full abstract

We treated 6 patients with atopic dermatitis in hospital during the last one and a half year. In present study, we assessed exacerbation factors of the skin condition from psychosocial aspect by doctor's questions, nurse's records and others. The results demonstrated that the relationships in an office and in a family, steroid fobia, the Great East Japan earthquake, bacterial infection by scratching behavior were thought to be exacerbation factors of atopic dermatitis. All patients had improvement of skin eruption after hospital treatment.Skin Research, Suppl. 20: 42-46, 2013

View full abstract

Optimal management of atopic dermatitis (AD) requires patients to adhere to self-care behaviors. We make a novel interview sheet consisting of an exhaustive list of possible complicating factors in daily life, including diet, fitness, sleep, stress, bathing, soap or cleansing agent, cosmetics, laundry detergent, room cleaning, pet, and smoking. An additional check-up list of concurrent diseases, possibly worsen AD, including rhinitis, periodontal disease, dental caries, and metal allergy is also included. Several patients have found out their overlooked complicating factors by reviewing a personal record of results of the interview sheet and their intractable eruptions have improved. Our novel interview sheet is useful for atopic dermatitis patients to reveal complicating factors in daily life.Skin Research, Suppl. 20: 47-56, 2013

View full abstract

Topical therapies are currently the mainstay of treatment for atopic dermatitis. As with other chronic disease, medication compliance is an essential component of the successful treatment of patients with atopic dermatitis. Before planning for therapeutic patient education, we should know what they don't know.
77 patients who visited our hospital for atopic dermatitis answered a written questionnaire about topical therapy. As a result, many patients surveyed put steroid ointment on red and/or itchy area every day. But the amount of topical steroid that patients apply is not enough. Approximately 30% of them interpreted as eczema is improved if erythema and/or itch disappear. About half of patients stop using topical steroids when they consider that eruption improved. In this study, we investigated the knowledge level of atopic dermatitis patient about topical therapy.Skin Research, Suppl. 20: 57-62, 2013

View full abstract

Psychological factors play an important role in the course of atopic dermatitis. The psychosomatic scale for atopic dermatitis and state-trait anxiety inventory were examined in 63 adult outpatients with atopic dermatitis in order to estimate the possible need for psychosocial treatment. 27 patients were high scored in the psychosomatic scale for atopic dermatitis. Among 36 patients scored under cutoff value, 11 patients were high scored in the category of “exacerbation triggered by stress”. There was weak correlation between psychosomatic scale score and anxiety. Furthermore, stress coping strategies were assessed using the Japanese version of the way of coping questionnaires, Lazarus stress-coping inventory, and utilized in cognitive-behavioral therapy for psychosomatic patients.Skin Research, Suppl. 20: 63-71, 2013

View full abstract