title: Effect of itch, scratching and mental stress on autonomic nervous system function in atopic dermatitis.
abstract: Atopic dermatitis is a stress-responsive disorder that involves the autonomic nervous system. The current study used heart rate variability to examine the effect of itch, scratching and mental stress in atopic patients with moderate to severe disease. Twenty-one patients with active disease and 24 healthy volunteers participated in the study. Heart rate variability measurements were taken at 5 min intervals at rest and after each of 3 acute stress tests, which included histamine-induced itch at the forearm, scratching around the itch site, and the Trier Social Stress Test. Atopic patients displayed a higher heart rate than healthy controls in all 4 experimental settings, which was statistically significant using Cohen's delta analysis. The very low frequency component of the power spectrum, indicative of sympathetic activity, showed a 200% increase after scratching in patients with atopic dermatitis. The high frequency component, reflecting parasympathetic tone, responded swiftly to itch and scratching in healthy controls, but displayed a limited adaptability in atopic dermatitis. This study supports the concept that atopic dermatitis is a stress-responsive disorder and involves autonomic nervous system dysfunction. Atopic subjects exhibited an overactive sympathetic response to itch and scratching, while the parasympathetic tone was persistently and rigidly elevated, showing a lack of adaptability in response to stress.
authors.affiliation: Department of Dermatology, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
authors.forename: Bryant W
authors.initials: BW
authors.lastname: Tran
authors.forename: Alexandru D P
authors.initials: AD
authors.lastname: Papoiu
authors.forename: Carmen V
authors.initials: CV
authors.lastname: Russoniello
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Tejesh S
authors.initials: TS
authors.lastname: Patel
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Gil
authors.initials: G
authors.lastname: Yosipovitch
mesh_terms: D000223:Adaptation, Psychological; D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D016022:Case-Control Studies; D003876:Dermatitis, Atopic / Q000503:physiopathology* / Q000523:psychology; D025802:Electric Capacitance; D005260:Female; D006339:Heart Rate; D006632:Histamine / Q000008:administration & dosage; D006801:Humans; D007478:Iontophoresis; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D011537:Pruritus / Q000503:physiopathology* / Q000523:psychology; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology; D013997:Time Factors; D014870:Water Loss, Insensible; D055815:Young Adult
chemical_list: D006632:Histamine