Psychiatric Treatment of Eczema: A Controlled Trial
The big idea:
Many factors may contribute to the onset and course of eczema, one amongst them potentially being psychological factors.
What the study asked:
The study sought to explore the following hypotheses:
Psychiatric treatment improves the outcome in cases of eczema independent of the degree of overt psychological disturbance.
It improves the outcome only when there is overt psychological disturbance.
It improves the outcomes particularly when emotional disturbance is “highly relevant” to the eczema — for example, the onset of new psychological or psycho physiological symptoms precedes the rash by up to one year.
It is more beneficial when patients have a high motivation for it and may be harmful when motivation is low. Conversely, withholding psychiatric treatment when motivation is high worsens the outcome.
What the study did:
72 patients with eczema were randomly allotted to one of two treatment groups:
A: those receiving dermatological treatment only
B: those receiving the same dermatologist treatment + psychiatric treatment, limited where possible to 4 months.
Cases were followed up at 6 monthly dermatological assessments, 57 total assessments for 18 months.
What the study found:
Short-term psychiatric treatment given unselectively does not significantly improve the outcome of eczema.
However, it approximately doubles the rate of clearance in patients with more overt emotional disturbance and motivation for treatment, and such patients do consistently badly without psychiatric treatment.
This supports the idea that severe emotional disturbance is a bad prognostic sign in eczema; but with psychiatric treatment, even short term, this is not so.
On the other hand, such psychiatric treatment as given here seems to worsen the outcome in patients with little overt emotional disturbance and low motivation.
The adverse effect on the eczema seems maximal in the first six months — using the time which patients are asked to face the unwelcome fact of psychiatric referral, their problems and conflicts.
What this means for eczema:
From the point of the patients’ eczema, patients should not be pressed too hard for psychiatric treatment.
The others should be readily picked out by the sympathetic general practitioner or dermatologist, who could perhaps provide the short-term psychiatric treatment themselves, at least initially, and the psychiatrist should reserve his diagnostic and therapeutic skills for the problematic cases.
In many cases it is likely that if longer-term psychotherapy is indicated, a therapeutic alliance can be established.
Especially for those who experience psychological factors as an eczema trigger, and are motivated to receive psychiatric treatment, it could potentially be beneficial for improving their eczema condition.
Link to study:
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