title: Psychological factors associated with hand dermatoses: which subgroup needs additional psychological care?
abstract: BACKGROUND
  The aetiology of hand dermatoses (HD) is very heterogeneous. Psychological influences on severity and coping in hand eczema have been only rarely investigated.
  
  
  OBJECTIVE
  To investigate whether psychological factors correlate with somatic factors, in order to be able to estimate the possible need for psychosocial treatment of these patients.
  
  
  METHODS
  In a cross-sectional study 101 hand dermatosis patients (49F, 52M) with psoriasis (n = 26), vesicular hand eczema (n = 33) or contact dermatitis (n = 42) were examined with regard to dermatological [diagnosis, severity, Erlanger Atopy Score (EAS)], allergic (patch test) and psychological aspects [Coping with Chronic Skin Diseases questionnaire (CSD), Allover Depression Scale (ADS), Social Readjustment Rating Scale (SRRS), questionnaire for measuring Factors of Aggression (FAF)],and Visual Analogue Scales (VAS) concerning itching, scratching and impairment. Subgroups of high stress responders (high-SR) vs. low stress responders (low-SR) were also examined.
  
  
  RESULTS
  Of the patients with HD, 47.52% are convinced that 'stress' influences the course of their disease. Analysis of variance shows that the subjective reaction to stress (high-SR) correlates with higher severity scores, more itching, higher depression scores and more life events. High-SRs were younger and the onset of the disease was earlier compared with patients without a subjective reaction to stress (low-SR). In the CSD those with especially high-SR but negative patch-test results stated significantly higher values for itching, helplessness and search for information.
  
  
  CONCLUSIONS
  Psychological factors should be taken into consideration in the treatment of patients with HD. High-SR patients with a negative patch-test seem to require more adjuvant psychological care.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig-University Giessen, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Niemeier
authors.forename: M
authors.initials: M
authors.lastname: Nippesen
authors.forename: J
authors.initials: J
authors.lastname: Kupfer
authors.forename: W-B
authors.initials: WB
authors.lastname: Schill
authors.forename: U
authors.initials: U
authors.lastname: Gieler
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D018592:Cross-Over Studies; D003866:Depressive Disorder / Q000150:complications; D003876:Dermatitis, Atopic / Q000523:psychology; D005260:Female; D006229:Hand Dermatoses / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011537:Pruritus / Q000209:etiology; D011565:Psoriasis / Q000523:psychology; D012917:Social Adjustment; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires