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La piel, como órgano externo, juega un papel importante en las relaciones interpersonales. El carácter crónico de las dermatosis y la dificultad de establecer su etiología, hacen a quienes las sufren, candidatos y candidatas ad hoc para padecer altos niveles de ansiedad. Para valorar la influencia de la ansiedad en la aparición y mantenimiento de la patología dermatológica aplicamos el Inventario de Situaciones y Respuestas de Ansiedad -ISRA- y un cuestionario relativo a la historia de la enfermedad a 95 pacientes comparándoles con el mismo número de personas sanas. Consideramos factores como género, edad, tiempo de evolución y nivel de afectación del trastorno así como su relación con el estrés. Encontramos diferencias significativas entre los grupos y principalmente entre los géneros. El impacto psicológico que produce la dermopatía, así como su carácter crónico, se relaciona con un alto grado de ansiedad demostrado en este estudio, definiéndose el perfil de reactividad de ansiedad característico de tales pacientes.
Palabras clave: Dermatosis crónicas; estrés; evaluación de la ansiedad; diferencias entre los géneros.
Evaluación de la Ansiedad en Dermatosis Crónica: Diferencias entre Sexos
Skin, as an external organ, plays an important role in interpersonal relationships. The chronic character of some dermatoses and their unknown etiology also makes these patients who experience them, ad hoc candidates for high levels of anxiety. Our objetive was to estimate the influence of this variable on the onset and duration of skin disorders. The Inventory of Situations and Responses to Anxiety--ISRA--and a questionnaire relative to the history of the disease were administered to 95 patients. Results were compared with those of 95 persons without skin diseases. Sex, age, duration of the disease, affectation level of the disturbance and its relation with stress were also considered. We found significant differences between average scores of the two groups and between the sexes. The psychological impact produced by skin disorders and their chronic condition were related to a high level of anxiety in these patients. The anxiety response profile of these patients was also defined.
Keywords: Chronic dermatoses; stress; anxiety assessment; gender differences.
The skin is a major organ of communication, being the primary contact between the organism and the environment. Abnormalities of the skin's appereance due to skin diseases may produce rejection by community members, specially chronic dermatitis is evident in exposed areas. The consequence of this "impaired appearance" will be a depression of self-esteem and selfimage (Gupta, Gupta, & Watteel, 1996). This is the main reason why patients with dermatoses are so often psychologically disturbed (Van Moffaert, 1992). Many studies report the importance of emotions (Chue,1976; Schimidt, Zyzanski, Ellner, Kumar, & Arno, 1985), unconscious conflicts (Engels, 1982; Whitlock, 1976), personality traits (Gupta et al. 1996; Lyketsos, Stratigos, Tawil, & Psaras, 1986; Shanon,1979) and the presence of anxiety (Amorim-Gaudêncio, Cano-Vindel, & Miguel-Tobal, 1996; Ayyar & Bagadia, 1989; Monegro, 1988), or the association with stressful life events (Harvima et al., 1996) of dermatological diseases.
The dermatoses included on this study have the characteristic of being activated by stress or anxiety. The mayority of them have an unknown origin, related to immunomediated mechanisms or genetic factors (See Table1). Their evolution is recidivant in all cases without an aetiological treatment, with recurrences of simptoms clearly related to an external stimuli (stress). It is recommended the use of psychological therapies (biofeedback, relaxation training, operant conditioning and cognitive behavioral therapies) in the management of these skin disorders (Tsushima, 1988).
In a previous report (Amorim-Gaudêncio et al., 1996) we identified several risk variables that impact the natural history of skin inflamatory diseases. These were mainly of two types: 1) psychosocial variables (situations, personality traits, attitudes and behaviors) and 2) biological variables (genetic susceptibility). Moreover, the immunologic system is very important in the development of certain dermatoses (Arnets, Fjellner, Eneroth, & Kalner, 1991; Rechart & Saarinen, 1991) and its functioning may be influenced by psychological factors such as stress and anxiety (Levine, 1994; Prystowsky, 1994).
Psychological stress and anxiety have been clinically recognized by dermatologists as related to worsening of skin conditions (Fortune, Main, O'Sullivan & Griffiths, 1997). Some studies have identified psychological distress as a correlate of the severity of psoriasis symptoms in 32-70% of interviewed patients (Gaston, Crombez, Lanssonde, Bernier-Buzzanga, & Hodgins, 1991). Recent works have tried to identify why this occurs. Turka et al. (1995) have demostrated the presence of interleukin 12 (2) in the skin and in the central and peripheral nervous systems, suggesting that this factor is a mediator of the cutaneous reaction due to stress. Other authors (Glinsking, Brodeka, Glinska-Ferenz, & Kowalski, 1994) have detected increased level of beta-endorphin (3) in the serum of patients diagnosed with psoriasis, atopic dermatitis and systemic sclerosis, compared with controls. The highest levels of the neuropeptide (4) was found in patients with large plaques of psoriasis. All these reports suggest the intervention of emotional factors on cutaneous inflamatory diseases, although their biochemical and physiological basis is not entirely understood.
The aim of the present study was to analyze …