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DOI: 10.1055/s-2004-834553
Stress und Psoriasis - eine psychoneuroimmunologische Studie
Stress and Psoriasis - A Psychoneuroimmunological StudyPublication History
Eingegangen: 28. Oktober 2003
Angenommen: 22. Oktober 2004
Publication Date:
13 January 2005 (online)
![](https://www.thieme-connect.de/media/ppmp/200501/lookinside/thumbnails/10.1055-s-2004-834553-1.jpg)
Zusammenfassung
Bei der Psoriasis handelt es sich um eine polygenetisch vererbbare multifaktoriell bedingte Erkrankung, die durch zahlreiche Umwelteinflüsse beeinflussbar ist. Es gibt bisher kaum Studien, die den Einfluss von Stress auf die Psoriasis experimentell untersuchten. Ein Problem der vorhandenen Studien ist, dass unklar bleibt, ob die experimentellen Befunde für die Gesamtgruppe der Patienten relevant ist oder ob es Untergruppen gibt, die besonders stressanfällig sind. Hauptziel dieser Studie ist es daher, zu untersuchen, ob sich mit einem experimentellen Stressor Untergruppen von Patienten finden, die besonders stressanfällig sind und dies auch durch Veränderungen immunologischer Parameter sichtbar wird. Methode: Als Stressor wurde der TSST (Trierer-Social-Stress-Test) eingesetzt. Der Schweregrad wurde sowohl objektiv anhand des PASI (Psoriasis Area Severity Index) sowie subjektiv durch den Patienten erfasst. Als somatische Parameter, die innerhalb dieser Studie explorativ untersucht wurden, wurden Parameter gewählt, von denen die Stressreagibilität bekannt ist, aber kein direkter Bezug zur Psoriasis angenommen werden kann (Speichelkortisol). Als zweite Gruppe von Parametern wurden Variablen gewählt, bei denen ein Zusammenhang mit der Pathophysiologie der Psoriasis und/oder dem Schweregrad bekannt war, bei denen die Stressreagibilität aber unklar war. Neben Speichelkortisol wurden aus dem Serum Eosinophile, ICAM-3 und sIL-2R bestimmt. Es wurden 38 Psoriatiker und 38 Kontrollpersonen untersucht. Es nahmen je 21 Männer und 17 Frauen an der Studie teil. Ergebnisse: Der PASI korrelierte dabei sehr unterschiedlich mit den subjektiven Schweregradparametern. Die Zusammenhänge zwischen Schweregrad und den von uns untersuchten Blutparametern ergab nur für die Eosinophilen eine systematische Beziehung. Der TSST ist geeignet, auch bei Psoriatikern Stress auszulösen. Bei einer Untergruppe kommt es zu einem Anstieg des Hautbefalls, während bei der zweiten Untergruppe der Hautbefall infolge des Experimentes abnimmt oder konstant bleibt. Mit den untersuchten immunologischen Parametern lässt sich die Klassifizierung in stressreagible und nonreagible Patienten allerdings nicht stützen.
Abstract
Psoriasis is a polygenetic hereditary multifactorial disease which may be influenced by a number of environmental factors. To date only a few studies experimentally investigated the influence of stress on psoriasis. One problem of these studies is that it remains unclear whether the experimental findings are relevant for the entire group of patients, or whether there are subgroups who are particularly susceptible to stress. Therefore our main objective is to examine whether experimental stressors can identify subgroups of patients who are particularly susceptible to stress and if these differ in immunological parameters. Method: The Trier Social Stress Test (TSST) was used as stressor. The severity was recorded both objectively using the PASI (Psoriasis Area and Severity Index) as well as subjectively by the patient. Somatic parameters for which stress reactivity is known but no direct relationship to psoriasis is assumed were selected and exploratively examined within the present study (salivary cortisol). The second set of parameters for which the stress reactivity was unclear included variables which are linked to the pathophysiology and/or the severity of psoriasis. In addition to salivary cortisol, eosinophils, ICAM-3, and sIL-2R were determined in serum. 38 psoriasis patients and 38 control subjects were examined (21 male and 17 female participants within each group). Results: The PASI correlated very inconsistently with the subjective severity parameters. The relationships between severity and blood parameters tested showed a systematic relationship for eosinophils only. The TSST is suitable for eliciting stress in psoriasis patients. In one subgroup, there was an increase in skin affliction, while skin affliction in the second group remained constant or decreased. A classification into stress-reactive or non-reactive patients cannot, however, be supported by the immunological parameters tested.
Key words
Skin - psoriasis - stress - pruritus - psycho-social
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Priv.-Doz. Dr. Jörg Kupfer
Abteilung für Medizinische Psychologie
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35385 Gießen
Email: joerg.p.kupfer@psycho.med.uni-giessen.de