[Phobic neuroses presenting as "intolerance reaction of the skin"]. / Phobische Neurose unter dem klinischen Bild multipler Unverträglichkeiten der Haut.

Intolerance reaction of the skin refers to multiple reaction patterns, including toxic, allergic, pseudo-allergic and even psychiatric mechanisms. In our case, a patient was diagnosed for years as having "multiple allergies", but except for a documented contact allergy to a local anesthetic, her underlying disease was panic disorder with multiple phobias. Using this case study with one year follow-up, hypotheses are discussed about effective psychotherapy in patients with intolerance reactions of the skin. Differential indications are explored with reference to the latest investigative results in psychoneuroimmunology. In this patient, psychotherapy helped the phobias and eliminated her conviction that she had multiple allergies. In addition, the positive pre-therapy allergy testing was not reproducible. The dermatologist should not expect such patients to present with phobias, because they frequently shift their phobic anxiety into the fear of allergic reactions to escape from the label of having psychiatric disease. Such patients should receive psychotherapy if they begin to generalize their avoidance behavior and limit their social contacts.

"Amalgam disease"--poisoning, allergy, or psychic disorder?

Frequently, patients in environmental health out-patient units relate various complaints to their amalgam fillings. However, an association between the toxic exposure and the reported complaints appears plausible only in few cases. We investigated toxicological, allergological and psychological parameters in patients with amalgam-associated complaints and compared them to controls with similar numbers of amalgam fillings. Forty patients with health disturbances related to amalgam were compared to a control group without amalgam-associated complaints (n = 40), carefully matched for age, sex, and dental status. Mercury concentrations were analyzed in blood, saliva, and 24-h-urine. Atopic predisposition, determination of IgE, patch testing with amalgam and amalgam-associated metals and a psychometric assessment were performed in all participants. Mercury concentrations in blood or urine were similar in patients and controls. Atopic predisposition was markedly enhanced in patients (11/40) as compared to controls (5/40). Only one patient with a lichen ruber of the oral mucosa showed a contact sensitization to amalgam. Patients reported more psychic strain and higher depression scores than controls. Somatization disorders were found in 10 patients (25%) and in one control. Eighteen patients (45%) neither showed an atopic predisposition nor an influence of psychosocial factors. Toxic exposure to mercury does not appear to play a role in "amalgam disease". Since many of these patients are atopic without an "amalgam allergy", but with more psychic strain and notably more depression, the treatment should be focused on allergologic and psychological factors.

Relation between mercury concentrations in saliva, blood, and urine in subjects with amalgam restorations.

The aim was to determine the relationship between mercury content of resting and stimulated saliva, and blood and urine. Eighty subjects participated; 40 of them attributed their self-reported complaints to dental amalgam (patients), the others were matched with respect to age, sex and amalgam restorations (controls). Serum, 24-h urine, resting and chewing stimulated saliva were analyzed for mercury using the ASS-technique. Quality, number, surfaces and total area of amalgam fillings were recorded clinically and using study models. Median (range) mercury levels in serum were 0.67 (0.1-1.52) microgram/l for patients and 0.60 (0.1-1.3) for controls. In urine levels were found to be 0.77 (0.11-5.16) and 0.94 (0.17-3.01) microgram/g creatinine respectively. No significant differences were found between the groups. Resting saliva contained 2.97 (0.10-45.46) micrograms/l in patients and 3.69 (0.34-55.41) in controls (not significant). Chewing mobilized an additional amount of 16.78 (-6.97 to 149.78) micrograms/l in patients and 49.49 (-1.36 to 504.63) in controls (P < or = 0.01). Only a weak correlation was found between mobilized mercury in saliva and serum (r = 0.27; P < or = 0.05) or urine (r = 0.47; P < or = 0.001). For resting saliva the respective values were r = 0.45 (P < or = 0.001) and r = 0.60 (P < or = 0.001). Saliva testing is not an appropriate measure for estimating the mercury burden derived from dental amalgam.

[Integrated brief psychotherapy in skin diseases. Case contribution with 1-year catamnesis]. / Integrative Kurzzeitpsychotherapie bei Hauterkrankungen. Kasuistischer Beitrag mit 1-Jahres-Katamnese.

The effectiveness of concurrent psychotherapeutic treatment for various skin diseases can be regarded as sufficiently validated. Contributions on in-patient treatment concepts are rare, and there are up to now no reports on methods integrating psychotherapeutic treatment approaches. Our concept of a 4-week short-term psychotherapy-starting from a conflict hypothesis in the complaint intensifying, acute situation-includes the bimodal work on both understanding and practice oriented treatment focus. By means of 2 case studies with 1-year-follow-up, insight is given into the treatment approach from which effective factors of psychotherapeutic treatment were tentatively in with patients with skin diseases.

[Treatment of atopic eczema in interdisciplinary cooperation between dermatology and psychosomatic medicine. An individual case report]. / Die Behandlung des atopischen Ekzems in interdisziplinärer Zusammenarbeit zwischen Dermatologie und Psychosomatik. Eine Enzelfalldarstellung.

Atopic eczema is one of the most frequent dermatological diseases, with a still increasing incidence. Although its etiopathogenesis is still not completely understood, a variety of triggering factors are known. The following case report describes the clinical course of atopic dermatitis in a 2-year-old boy in whom both IgE-mediated allergic reactions and psychological factors were involved in triggering and maintenance of skin lesions. This demonstrates how important both dermatological therapy and close cooperation with the field of psychosomatic medicine can be.

Chronic urticaria due to nickel intake.

A case of chronic urticaria is presented. The case of the disease was traced back to nickel intake by food as judged from type I and IV sensitization to nickel, a positive oral challenge test and long-standing, complete healing under a nickel-restrictive diet.