Development and validation of the psychosomatic scale for atopic dermatitis in adults.

Psychosocial factors play an important role in the course of adult atopic dermatitis (AD). Nevertheless, AD patients are rarely treated for their psychosomatic concerns. The purpose of the present study was to develop and validate a brief self-rating scale for adult AD in order to aid dermatologists in evaluating psychosocial factors during the course of AD. A preliminary scale assessing stress-induced exacerbation, the secondary psychosocial burden, and attitude toward treatment was developed and administered to 187 AD patients (82 male, 105 female, aged 28.4 +/- 7.8, 13-61). Severity of skin lesions and improvement with standard dermatological treatment were assessed by both the dermatologist and the participant. Measures of anxiety and depression were also determined. In addition, psychosomatic evaluations were made according to the Psychosomatic Diagnostic Criteria for AD. Factor analysis resulted in the development of a 12-item scale (The Psychosomatic Scale for Atopic Dermatitis; PSS-AD) consisting of three factors: (i) exacerbation triggered by stress; (ii) disturbances due to AD; and (iii) ineffective control. Internal consistency indicated by Cronbach's alpha coefficient was 0.86 for the entire measure, 0.82 for (i), 0.81 for (ii), and 0.77 for (iii), verifying the acceptable reliability of PSS-AD. Patients with psychosomatic problems had higher PSS-AD scores than those without. PSS-AD scores were positively associated with the severity of the skin lesions, anxiety and depression. The scores were negatively associated with improvement during dermatological treatments. In conclusion, PSS-AD is a simple and reliable measure of the psychosomatic pathology of adult AD patients. It may be useful in dermatological practice for screening patients who would benefit from psychological or psychiatric interventions.

[A case of food-dependent exercise-induced anaphylaxis caused by various foods which contained flour for thirty years].

The patient was a 65-year-old man with chief complaints of flare, swelling, itching and loss of consciousness. He had a history of diabetes diagnosed at the age of 34 years and was receiving medication from a local doctor. He had experienced systemic flare, swelling and loss of consciousness 20 minutes after drinking beer at a party at the age of 34 years. Since that time, he had frequently experienced urticaria and loss of consciousness while taking a walk after eating various foods (all of which contained flour). In February 2001, he experienced systemic flare, swelling and loss of consciousness when he returned home from a walk after eating a meal that included meat dumplings. Laboratory tests on admission showed a serum IgE level of 253 IU/ml, and the IgE level for flour in a RAST was 2.13 UA/ml (class 2). The results of exercise tolerance tests were normal during fasting, after ingestion of food that did not include allergens (wheat, shrimps and crab) and after ingestion of half of a thick slice of white bread, but systemic wheal and flare reactions appeared during an exercise tolerance test after ingestion of one thick slice of white bread. A diagnosis of food-dependent exercise-induced anaphylaxis caused by flour was made on the basis of the results.