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Atopische Dermatitis und psychischer Stress

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Zusammenfassung

Die atopische Dermatitis (AD) ist eine chronisch-rezidivierende entzündliche Hauterkrankung. Sie ist charakterisiert durch die typische Morphologie und Lokalisation von Hautveränderungen und einen intensiven, oft quälenden Juckreiz. Verschiedene Provokationsfaktoren wie Hautirritanzien, systemische oder lokale Infektionen, Umweltnoxen und Allergene, aber auch hormonelle Einflüsse werden als relevant in der Pathophysiologie der AD gesehen. Einen wichtigen Einfluss auf die Exazerbation der intrinsischen und extrinsischen AD hat auch emotionaler Stress. Neuere experimentelle Untersuchungen weisen hierbei auf direkte psychoneuroimmunologische und -endokrinologische Mechanismen hin. So führt psychologischer Stress bei AD-Patienten zu einem raschen transienten Anstieg peripherer eosinophiler Granulozyten, CD8+/CD11b+- und CLA+-T-Lymphozyten. Zusätzlich ändert sich unter Stress das Zytokin- und Hormonprofil mit einer gesteigerten Produktion von IFN-γ und IL-5 sowie einer reduzierten Freisetzung von Kortisol im Vergleich zu Gesunden. Diese Daten unterstützen die Annahme, dass die immunologischen Veränderungen genauso wie die mögliche Suppression der hypothalamo-hypophysär-adrenergen Achse (HPA) zur Entzündung der Haut bei der AD beitragen. Damit schließt sich der Regelkreis der stressinduzierten immunologischen Veränderungen mit der Endstrecke der Exazerbation der AD.

Abstract

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Its main features are eczematous skin lesions with a typical distribution and severe pruritus. Allergens, skin irritants, systemic or local infections, environmental pollutants and hormonal changes have a role in the pathophysiology of AD. A further important trigger factor for both intrinsic and extrinsic AD is emotional stress. Recently published observations point to direct psychoneuroimmunological and -endo-crinological mechanisms: Psychological stress causes a transient increase of peripheral blood eosinophil count and an increase in both CD8+/CD11b+ and CLA+ T-cells. In addition, stress changes the cytokine and the hormone profile with increased levels of IFN-γ and IL-5, and decreased levels of cortisol in AD patients in contrast to healthy controls. These findings underline the role of immunological changes and a possible suppressed hypothalamic-pituitary-adrenal (HPA) axis closing the loop for the final aggravation of AD.

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Venerologie, Medizinische Hochschule Hannover

    U. Raap & T. Werfel

  2. Abteilung Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover

    B. Jaeger & G. Schmid-Ott

  3. Klinik und Poliklinik für Dermatologie und Venerologie der Medizinischen Hochschule Hannover, Ricklingerstraße 5, 30449 , Hannover

    U. Raap

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  1. U. Raap
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  2. T. Werfel
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  4. G. Schmid-Ott
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Correspondence to U. Raap.

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Raap, U., Werfel, T., Jaeger, B. et al. Atopische Dermatitis und psychischer Stress. Hautarzt 54, 925–929 (2003). https://doi.org/10.1007/s00105-003-0609-z

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