Psychosomatic disease is a general term of the diseases in which pathomechanism of mind-body correlation is recognized. For solving this illness, psychosomatic treatment that treats not only biological factors but also psychological and social factors is effective. Atopic dermatitis complicated with school phobia or depression is one of symbolized example of mind-body correlation. The correlation of atopic dermatitis and each complication were briefly elucidated respectively in this article. Relations are not “cause and result” but “correlative” or “circular” which make dermatitis treatment-resistant by vicious circle. In most cases psychological treatment and/or social intervention with simultaneous dermatological medication are quite effective for solution of this complicated status.

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Brain receives its own external and internal information through sensory and afferent autonomic nerves, and immune system also monitors external (nonself) and internal (autoantigen and tumor) information. However, it is evident that there is a crosstalk of information between these systems. This crosstalk is recognized as the neural-immune interaction, and suggested to be involved in the regulation of responses to external and internal stress stimuli. In this review article, (1) mechanisms of immobilization-induced suppression of splenic natural killer cell activity, (2) role of nociceptive C fibers in allergic contact dermatitis, and (3) central mechanisms of immunologically induced fatigue are discussed as models of the neural-immune interaction to investigate its significance in these stress responses.

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It has been proposed that atopic dermatitis could be classified into two subtypes; allergic type and non-allergic type with some characteristics as syndrome. The former is triggered and progresses by a classical acquired immunity and the latter is triggered by disintegrated innate immunity and neuro/endocrine/immune system or aberrant skin barrier function. The relationship of sweating dysfunction, abnormal vascular response to the physical stumuli or alloknesis and exacerbation of dermatitis has been the matter of discussion. On the basis of the recent dynamic change of etiology and pathogenesis of atopic dermatitis, we should reconstruct the therapeutic strategy of atopic dermatitis.

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In order to clarify the neurophysiologcal mechanism of maladaptation to stress and its treatments, we conducted neuroimaging studies by using functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG). Then, we showed some data from our experiments in this paper as below. At first, cognition of psychological stress is related to a network with the prefrontal cortex (PFC) and the limbic system. Secondly, the anticipation of stressful stimuli regulate the sensory input in the perception area via activation in the PFC. Thirdly, serotonin controls the future reward prediction in human brain. Lastly, the emotional support regulates psychological pain in ostracism via the PFC.

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A variety of stressors associated with the exacerbation of atopic dermatitis was described. These stressors were revealed by interview in daily clinic and at bed side or in the group meeting of the patients. In adults, job-related stressors were frequently noted, especially over-working or over-adjustment. In children, relationship with mother is important. Although stressor is different in each patient, acceptance of patient’s thought with sympathetic and receptive attitude and appreciation of the hardship and effort are more important than to define the stressors and to eliminate them or to relieve from them. Through such consultation, patients may notice habitual scratching triggered by stressors. Even if stressor itself is not reduced, dermatologists should encourage the patient to change the attitude to the stress and to cope with them.

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It has been pointed out that psychosocial factors such as psychological stress and anxiety relates to the maintenance and aggravation of the atopic dermatitis AD symptoms. It is also pointed out that patients with AD show the deterioration of their quality of life due to AD symptoms. The purposes of this article were 1) to review previous research which showed the significance of psychosocial factors affecting the maintenance and aggravation of the atopic dermatitis AD symptoms, 2) to point out the importance of the modification of psychosocial factors, and 3) to point out the importance of the functional analysis. Furthermore, the importance of the cognitive behavioral stress management was pointed out and clinical tips of stress management were discussed.

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When relation of stress is suspected by the atopic dermatitis patient, it is good to hear a patient’s talk first. If diagnosis of a psychosomatic disease is difficult, we will recommend dermatologists to use psychological tests. If symptom is mild, the talk may be heard, and it may improve by understanding the patient’s hardness. Moreover, it may improve by making it notice that an eruption gets worse for stress. Furthermore, the device which makes the burden of skin treatment ease is also required. Also by these, if an improvement is unsatisfactory, psychotherapies, such as an autogenic training method and behavior therapy, and a psychotropic drug are used together. In psychotherapy, the most important thing will be not working, if the patient itself does not have a motivation. There are some psychotropics which even a dermatologist can use. It is the point how we make a patient to take a psychotropic drug.

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I regard atopic dermatitis as a psychosomatic disorder and conduct a psychosomatic therapy based on a brief therapy. I join a patient and his/her system and externalize various internalized emotions that are brought about by a chronic course. In addition, I have conducted various interventions based on a solution-oriented interview to release a patient and his/her family from repeating attempted solutions and introduced sample conversations for a patient’s problem and a formulation of behavior, etc., for scratching behavior.

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The Morita Therapy is a psychotherapy developed by Sh_ma Morita in 1919, and it has become known as a treatment for neurosis.
It aims to break down obsessions about symptoms and behaviors resulting from anxiety tension, and to redress a patient’s strong perfectionistic way of life. It takes particular note of a patient’s desire for self-fulfillment, which exists inextricably linked to anxiety. like two sides of the same coin, and it makes a patient realize ‘a way of life actualizing oneself in spite of having anxiety’, in another words, ‘learn from his experience of living, accepting things as they are’.
Initially, these treatments were provided to hospitalized patients, but in recent years they are very often provided as outpatient treatments (Outpatient Morita Therapy).
There are quite a number of adult patients with resistant atopic dermatitis, who, often at the time of facing the reality of entrance exams or other incidents, become sensitive to itchiness due to psychic interaction( vicious circle of attention and consciousness )caused by anxiety, or escape into scratching behavior under pressure, and become obsessed with habitual scratching behaviors.
When a patient successfully reaches a stage, through the Outpatient Morita Therapy, that his behaviors of scratching and obsession with atopic dermatitis are broken down, and he starts addressing the challenges of life and feeling joy in self realization, in spite of still having anxiety, his skin symptoms starts improving remarkably.

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Atopic dermatitis (AD) is a chronic disease, the prevalence of which shows an increasing tendency worldwide. While there have been no fundamental or radical treatment methods, the patient need to have a long-term treatment. AD infant and their family has more problem than the healthy infant and their family, because AD has a peculiar symptom and a complex treatment. So the teamwork of the medical staff will be very important for supporting the patient (AD infant) and the family.
I will express the roll of nurse that be demanded by the patient and the family, through the results of the study on evaluating the effectiveness about skincare educational program.

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When a patient gets admitted to hospital by becoming worse in their symptoms, we, nursery stuffs, have to receive whole life of the patient. In the case of atopic dermatitis, in which rhythms of patient life are seriously damaged, and mind and body are becoming stressful, keys for hospitalization is not only treating disease, but also to take a chance to manage his disease by re-evaluating and directing. Here, I will give an opinion how to support a life of atopic dermatitis patient, which is a well known disease, but their nursing is not well-established.

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Hospitals or Institutions capable of conducting psychotherapy for atopic dermatitis (AD) patients are limited. In order to conduct psychotherapy in an ordinary dermatology outpatient clinic, group orientated psychotherapy seems to be adaptive, considering the present circumstances. Previous research has revealed that a combination of approaches to scratching behavior and stress management including relaxation techniques is effective. However, our preliminary study on group psychotherapy constructed by these elements revealed that the method of recruiting participants is an important issue. Adopting the transtheoretical model and considering approaches appropriate for each stage of change may be helpful.

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Since 2007, the former education system for the handicapped changed into the special supporting education system to ensure more individual education for each pupil who has chronic diseases or handicap. Osaka Prefectural Habikino Hospital School which has been supporting the education of hospitalized diseased pupils changed the name to Habikino Supportive School since 2008. Since then we are accomplishing supporting movement as a supportive center for diseased pupils in cooperation with hospital, regional school and local society.
This article includes three contents for solving problems of atopic dermatitis at school. Firstly disturbances of school life by atopic dermatitis which was realized by questionnaire survey to nursing teacher were reported. Secondly role of supportive school were visualized from an experience to establish the supporting team with medical personnel and supportive school staff for post-discharge from hospital of a pupil who had hospitalized for treatment of atopic dermatitis and maladjustment to regional school. Finally practical application of guiding table for management of school life of pupils who have allergic diseases was introduced.

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To examine the effects of depression and anxiety on skin eruption and itch, immunological condition and scratch behavior in atopic dermatitis (AD), 37 AD patients were enrolled this study and 12 of them were treated with tandrospirone (anti-anxiety drug) or paroxetine (anti-depressant) according to their mental conditions. Their mental conditions were assessed with Self-rating Questionnaire for Depression (SRQ-D) and state-trait anxiety inventory (STAI). Their skin condition and itch level in daytime and night were scored. in vitro analysis were done with total serum IgE levels, peripheral eosinophil count, serum LDH levels ,Th1/Th2 ratio, NK cell activity and CD16+CD56+cell percentage in peripheral mononuclear cells, which seem to decrease at chronic mental stress. As the results, depression and anxiety (state anxiety and trait anxiety) was correlated and trait anxiety was correlated positively with serum total IgE level. Surprisingly, percentage of scratch time during bed time was correlated positively with NK cell activity and CD16+CD56+cell percentage in peripheral mononuclear cells. This might indicate that the scratch behavior releases AD patients from mental stress. Treatment with tandrospirone or paroxetine improved not only mental condition but also skin condition in some patients, although the number of patients assessed was so small that correlation between the treatment and effects was not shown. In conclusion, the treatment with anti-depressant and anti-anxiety drug might be effective in AD patients with high depression and anxiety.

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The quality of life (QOL) of 224 patients with atopic dermatitis (AD) in 2643 Japanese new outpatients who visited the Department of Dermatology, Kyushu University Hospital from January 2007 to December 2008 was assessed by using Japanese version of Skindex-16 and DLQI. We found that patients with AD had a significantly more impaired QOL irrespective of gender and age compared with those with other skin diseases.

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Background : Atopic dermatitis (AD) is one of skin diseases that involve psychological stress. So we placed an AD mouse model and control mice under chronic repetitive stress and determined epidermal thickness, mast cell degranulation rates, and substance P (SP) levels.
Objective : Our aim was to clarify the mechanism that chronic stress aggravates AD.
Methods : AD like mice and control were placed under restraint stress for two hours per day for two weeks by immobilizing them in a restrainer. We measured epidermal thickness, mast cell degranulation rates, and SP levels.
Results : After chronic stress, the control mice demonstrated only a slight increase in mast cell degranulation rates and SP levels in the skin tissue, with no changes in epidermal thickness. However, AD like mice showed a marked elevation in both degranulation rates and SP levels as well as increased epidermal thickness (P>0.05).
Conclusion : These results indicate that there are differences in chronic stress responses between control and AD like mice, that is consistent with clinical data showing that AD patients are more susceptible to stress.

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Chronic stress inhibits the recovery of permeability barrier function via induction of glucocorticoids as an end-product of hypothalamic - Pituitary - Adrenal axis. In this study, we examined an effect of acute stress on the barrier function in mice. Acute stress, which was induced by transfer of mice to a new cage and keeping them with a crowded condition for 12 hours, inhibited the recovery of barrier function after acute disruption by tape stripping. Chemical denervation by capsaicin abolished the inhibitory effect of the stress. Intradermal administration of substance P, which is a candidate of stress mediator in this system, inhibited the barrier recovery. These results suggest that acute stress inhibits the barrier recovery as well as chronic stress via activation of peripheral nerve.

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Atopic dermatitis (AD) is a chronic relapsing skin disease. Multiple exogenous and endogenous provocation factors are hypothesized. Psychosocial stress is one of these exacerbation factors in patients with atopic dermatitis. We report three cases of atopic dermatitis which showed correlation of psychological state. In the first case a 8-year-old boy exhibited school-related problems, in the second case a 38-year-old man showed the relation between exacerbation and job strain, and in the third case a 26-year-old young adult woman seemed to have a distorted emotional relationship with her mother.

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A 36 year old company man with atopic dermatitis visited me presenting generalized prurigos. He had subacute prurigo nodules mainly on the face and extremities but rather few on the trunk. The skin between nodules was normal. He was treated with the same level and same strength of external corticosteroid as before, but the course was unsatisfactory. Moreover, skin symptoms became worse and worse with time and reached the maximum state despite corticosteroid treatment was strengthened. Four months before he became worst, he confessed that his boss managed him badly and hindered his jobs because he was scheduled to take over boss’s post. The symptoms gradually ameliorated after the boss’s movement to other post although prurigos still continue at almost the same or slightly worse level of the first visit.

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A case of atopic dermatitis complicated with Asperger’s disorder and learning disorder was reported and our effort and measure are described to manage this complex disorder. The patient is a 13-year-old boy who has a severe atopic dermatitis since infant. At the age of 9, he was diagnosed having Asperger’s disorder and learning disorder by child psychiatrist. He also had elaborate family problems, his parents’ divorce and his mother’s suffering from depression and panic disorder. His skin care has not been enough because of his unstable temper and poor familial support. In addition panic with acting out happened and increased its frequency of attack. When his desire was not gratified, he lost control of himself to act violence, to break surrounding goods, and to injure himself. Child psychiatrist was consulted for relieving and managing his behavior disorder. His weekly visit to her for psychiatric treatment including psychotropic drugs started. The strategy based on behavior therapy was established by meeting of our team consisting of dermatologist, nurse and school teacher to manage his disorder and to achieve good control of his skin lesion. The essentials of the strategy were listening to him supporting his narrative story, giving compliment to his effort or improvement, guiding his improper behavior by pointing out just simply, using concrete words avoiding vague expression.For his panic action we ignored his behavior observing until getting to be calm down and took care the surroundings not to be injured. As concerns of eczema treatment, explaining topical application as easy as possible by using colored figure, and keeping his treatment motivation by having him come repeatedly to us. As a result, his panic action gradually decreased in frequency as his mental status got stability and his skin lesion was getting improved. Attainment of mental stability by management considering his disorder played a great role for improving not only his daily life but also his dermatitis.

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