Effect of stress on atopic dermatitis: Investigation in patients after the Great Hanshin Earthquake,☆☆,

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Abstract

Background: Although a variety of factors are responsible for atopic dermatitis (AD), very little is known about the effect of stress caused by a natural disaster on AD symptoms. Objective: This study was conducted to assess the effect of stress or trauma on the symptoms of AD. Methods: One thousand four hundred fifty-seven patients with AD (745 males and 712 females), diagnosed by using the criteria of the Japanese Dermatology Association, were enrolled in the study. The data were obtained from a self-administered questionnaire given to patients with AD after experiencing the Great Hanshin Earthquake. The data were analyzed by multivariate logistic regression analysis. Patients were divided into 3 groups: area A, severe damage to buildings and houses; area B, mild damage; and control area, no damage. Results: Exacerbation of skin symptoms was found in 38% and 34% of patients in areas A and B, respectively, whereas similar exacerbation was seen in 7% of control patients. Nine percent and 5% of the patients in areas A and B, respectively, showed improvement in their symptoms compared with 1% in the control group. The earthquake caused stress in 63% and 48% of the patients in areas A and B, respectively, but fewer patients felt stress in undamaged areas (19%). Multiple logistic regression analysis revealed that of the factors examined here, subjective distress is the factor that is most responsible for the exacerbation of skin symptoms (odds ratio, 2.98; 95% confidence interval, 2.25-3.96). Conclusion: The results presented here strongly suggest that stress caused by a natural disaster influences AD symptoms. (J Allergy Clin Immunol 1999;104:173-6.)

Section snippets

METHODS

One thousand five hundred eighty-nine outpatients with diagnoses of AD before the earthquake, according to the Japanese Dermatology Association Criteria, 16 were asked to fill out self-administered questionnaires. They were asked to provide the following: initial of name; age; sex; and a yes or no response with regard to questions concerning staying in a temporary shelter, bathing, cleaning up one’s living environment, taking treatment, feeling stress, and skin symptoms (the degree of itching

RESULTS

As shown in Table II , the number of patients with exacerbated symptoms significantly increased 1 month after the earthquake in the earthquake-damaged areas: 38.4% and 29.1% in area A and area B, respectively, compared with the control area (6.8%).

. Exacerbation and improvement of AD skin symptoms

AreaSubjects (n)Exacerbated symptomsImproved symptoms
n%n%
A *539207 38.449 9.1
B 757220 §29.134 §4.5
Control161116.821.2
* Severely damaged area. Mildly damaged area. Significant versus area B ( P <

DISCUSSION

A natural disaster such as the Great Hanshin Earthquake causes a great deal of mental and physical distress, even though the level of stress is not be uniformly distributed among all people. In this study we did not ask the patients questions related to fear of the earthquake, injury from the earthquake, death or injury of their relations, and so on. We therefore cannot quantify how stressful those specific events were. The results of this study, however, suggest strongly that stress

Acknowledgements

We thank Dr Tomoyuki Nishizaki for critical reading of the manuscript.

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    Supported in part by a Grant for Synthetic Research on the Great Hanshin Earthquake in the Southern District of Hyogo Prefecture by Kobe University Specific Research Project Team and by the Japanese Ministry of Education, Science, and Culture.

    ☆☆

    Reprint requests: Tatsuya Horikawa, MD, Department of Dermatology, Kobe University School of Medicine, 7-5-1 Kusunokicho, Chuoku, Kobe 650-0017, Japan.

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