Psoriasis: Schmid-Ott G

Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B, Anonymous00272, Anonymous00273. · Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Germany. · J Dtsch Dermatol Ges. · Pubmed #17615051 No free full text.

Abstract: Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed lack of satisfaction with the efficacy of available treatments and a high rate of non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) initiated a project to develop evidence-based guidelines for the management of psoriasis. These resulting Guidelines focus on induction therapy in cases of mild, moderate, and severe plaquetype psoriasis in adults. The Guidelines include evidence-based evaluation of the efficacy of all currently available therapeutic options in Germany. In addition, they offer detailed information on how best to administer the various treatments and give information on contraindications, adverse drug reactions, and drug interactions as well as estimates of practicability and cost. The Guidelines were developed following the recommendations of the Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF). The therapeutic recommendations were developed by an expert group and finalized during interdisciplinary consensus conferences.

Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. · Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie, Allergologie, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, Berlin, Germany. · Arch Dermatol Res. · Pubmed #17497162 links to  free full text

Abstract: Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).

Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B, Anonymous00487. · Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin. · J Dtsch Dermatol Ges. · Pubmed #17187649 No free full text.

This publication has no abstract.

Schmid-Ott G, Schallmayer S, Calliess IT. · Department of Psychosomatic Medicine, Hanover Medical School, D-30625 Hanover, Germany. · Clin Dermatol. · Pubmed #18021891 No free full text.

Abstract: Negative impact of psoriasis and psoriasis arthritis on quality of life is a central consequence of these diseases. Feelings of stigmatization might, for example, already emerge with only small patches of skin being affected. Empirical data indicate that treating dermatologists should address possible negative effects elicited by problematic encounters with the public and in sexual relationships even if the severity of the disease is low, because lesions on invisible parts of the body can already cause serious adverse impairment. Such psychosocial consequences can be reduced by attending a self-help organization and by taking part in an interdisciplinary patient education program led by dermatologists.

Werfel T, Breitbart E, Kleinheinz A, Gieler U, Schmid-Ott G. · Klinik und Poliklinik für Dermatologie und Venerologie, Medizinische Hochschule Hannover, Ricklinger Strasse 5, 30449 , Hannover, Deutschland. · Hautarzt. · Pubmed #16977440 No free full text.

Abstract: BACKGROUND: Psoriasis vulgaris is a chronic inflammatory skin disease with a substantial impairment of quality of life. Interdisciplinary outpatient educational programs are an innovative supplementary therapy form for the management of this disorder. SUBJECTS AND METHODS: The Task Force on Dermatological Prevention developed a concept for outpatient instruction of psoriasis patients. Five 2-hour classes by dermatologists, psychotherapists/psychologists and dieticians focus on central topics relevant for the patients and the management of the disease. RESULTS: The results presented are based on own experiences with this educational program. The interdisciplinary program is accepted very well and seen as helpful by the concerned. A structure analysis of the effects in a greater number of cases is a current goal. In some areas, health insurance companies are paying for the classes. CONCLUSION: The educational program for the management of psoriasis vulgaris according to the rules of the Task Force on Dermatological Prevention is a supplement of the treatment of patients with this chronic skin disease. Broader implementation in Germany is desirable.

Bonnekoh B, Schmid-Ott G, Herold S, Sayegh-Jodehl S, Dierkes J, Gollnick H. · Klinik und Poliklinik für Dermatologie und Venerologie, Otto-von-Guericke-Universität Magdeburg, Leipziger Strasse 20, 39120 , Magdeburg, Deutschland. · Hautarzt. · Pubmed #16957961 No free full text.

Abstract: BACKGROUND: The aim of our pilot study was to evaluate effects of an interdisciplinary training program for adult psoriasis patients after six months follow-up.SUBJECTS AND METHODS: Eleven patients with psoriasis participated in an interdisciplinary training program over a weekend taught by dermatologists, psychologists/psychiatrists, and dieticians. Six months follow-up was performed with a questionnaire.RESULTS: The knowledge acquired improved the cooperation with the treating dermatologist (7 of 11), the patients' ability to cope with their disease (11 of 11), and their ability to improving their health status (8 of 11). Their general well-being was increased (9 of 11) and they could better care for their skin disease because they better understood the need for care (9 of 11), and could better judge the best approach for various levels of disease activity (8 of 11).CONCLUSION: These data show early benefits and suggest such a longer lasting effect of this type of psoriasis training and prevention program. Further studies with larger samples and control parameters will have to examine if these results can be confirmed.

Schmid-Ott G, Malewski P, Kreiselmaier I, Mrowietz U. · Abteilung Psychosomatik und Psychotherapie, Medizinische Hochschule, Hannover. · Hautarzt. · Pubmed #15711815 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: The aim of this study was to determine the psychosocial consequences of psoriasis in a large sample in Germany.PATIENTS AND METHODS: A questionnaire including the Psoriasis Disability Index (PDI) circulated by the German Psoriasis Alliance was answered by 3753 members representing a return rate of 42.3%. Psoriasis was graded-at the time of the examination-with less than 3% of the body surface affected as "mild", between 3 and 10% as "moderate," and more than 10% as "severe."RESULTS: The general impact of the illness on everyday life was "mild" in about 27%, "problematic" in about 45%, and "severe" in about 25% of the respondents. About 50% of the participants in the study had, concerning the skin, "mild" (PDI=9), about 35% "moderate" (PDI=14), and about 15% "severe" psoriasis (PDI=19). The differences of the PDI values are significant (ANOVA: p<0.001).CONCLUSIONS: This investigation confirms the enormous burden caused by the skin disease in the form of impairment and stigmatization, depending on the somatic severity, even when the current affection is rather mild. In connection with psychosocial consequences, future study should also focus on the disease burden of psoriasis.

Schmid-Ott G, Jaeger B, Boehm T, Langer K, Stephan M, Raap U, Werfel T. · Department of Psychosomatic Medicine, Hannover Medical School, Hannover, Germany. · Br J Dermatol. · Pubmed #19210504 No free full text.

Abstract: BACKGROUND: Psychological stress causes phenotypic changes in circulating lymphocytes and is regarded as an important trigger of the Th1-polarized inflammatory skin disease psoriasis. OBJECTIVE: To study the effects of psychological stress on immunological parameters, i.e. membrane molecules relevant to the pathophysiology of psoriasis, especially cutaneous lymphocyte-associated antigens (CLA) involved in T and natural killer (NK) cells homing in on the skin. METHODS: The severity of psoriasis was assessed in patients using the Psoriasis Area and Severity Index. Patients with psoriasis (n=15) and healthy volunteers (n=15) were exposed to brief psychological stress in the laboratory. In vitro analyses were conducted 1 h before, immediately following and 1 h after stress exposure. Peripheral T- and NK-cell subsets including CD8+ T lymphocytes, CLA+ lymphocytes and lymphocyte function-associated antigen type 1 (LFA-1)+ lymphocytes were analysed by flow cytometry. RESULTS: We found a significant stress-induced increase of CD3+ T lymphocytes in patients with psoriasis only. Analyses of T-cell subsets revealed that this increase was observable for cytotoxic CD8+ T lymphocytes and CLA+ CD3+ lymphocytes. The total number of circulating NK cells (CD16+, CD56+) increased immediately after stress in both groups whereas only patients with psoriasis showed a significant increase in CLA+ NK cells. CONCLUSIONS: A higher stress-induced increase of CLA+ T and CLA+ NK cells in the circulation of patients with psoriasis might point to an increased ability of T and NK cells in the presence of psoriasis to home in on the skin during mental stress. Further studies are needed to verify these relationships in more detail and to investigate the time point at which these cells accumulate within lesional skin, and whether or not psychotherapy improves the quality of life of patients with psoriasis and influences stress-dependent parameters.

Raap U, Werfel T, Goltz C, Deneka N, Langer K, Bruder M, Kapp A, Schmid-Ott G, Wedi B. · Department of Dermatology and Allergology, Hannover Medical University, Hannover, Germany. · Allergy. · Pubmed #17073871 No free full text.

Abstract: BACKGROUND: Recent studies have shed light on the complex regulation of genetic, environmental, immunologic and pharmacologic factors, which contribute to the development of atopic dermatitis (AD). However, it is still unclear to which extent neuroimmune mediators have a role in AD. AIMS OF THE STUDY: To assess peripheral neurotrophin levels and their correlation with scoring atopic dermatitis (SCORAD) scores in both the intrinsic and extrinsic types of AD compared with patients with psoriasis and nonatopic healthy subjects. METHODS: Levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were assessed in peripheral blood with enzyme-linked immunosorbent assay. Based on IgE-mediated sensitization, AD was divided into the extrinsic and intrinsic type. Severity of AD was assessed with SCORAD score and with psoriasis area and severity index (PASI) in patients with psoriasis. RESULTS: Brain-derived neurotrophic factor and NGF were detectable in all the subjects studied. However, the levels of both neurotrophins were significantly higher in patients with extrinsic and intrinsic types of AD compared with patients with psoriasis and nonatopic healthy subjects (NGF: P < 0.001, BDNF: P < 0.001). NGF and BDNF levels were similar in the intrinsic and extrinsic type of AD. There was a significant correlation between BDNF and SCORAD score only in patients with the intrinsic type of AD (r = 0.57, P < 0.05). CONCLUSIONS: This study shows for the first time that NGF and BDNF are increased in both, the extrinsic type and the intrinsic type of AD. This finding points to a similar pathophysiologic background implicating a neuroimmune network in both variants of this chronic inflammatory skin disease. Future studies are needed to show the direct mechanisms of neurotrophin action in chronic inflammatory skin.

Schmid-Ott G, Künsebeck HW, Jäger B, Sittig U, Hofste N, Ott R, Malewski P, Lamprecht F. · Department of Psychosomatic Medicine, Hannover Medical School, Hannover, Germany. · Acta Derm Venereol. · Pubmed #15848987 No free full text.

Abstract: Feelings of stigmatization are an important somatopsychic consequence of psoriasis, affecting the quality of life. It is thus relevant to supplement reliable statements about the detailed changes of stigmatization experience and psoriasis over time. In this study we compared the Psoriasis Area and Severity Index (PASI), the 'self-administered PASI' (SPASI) and the 'Questionnaire on Experience with Skin Complaints' of 166 psoriasis patients (64 women, 102 men) in a 1-year follow-up to assess the relation between these factors over time. The results suggest a more pronounced feeling of discrimination in women with no significant somatic differences between gender at the first measurement. In a prospective evaluation we found a clear proportion of 'discordant' courses of these parameters, mainly in women, indicating a contradictory relation of somatic improvement or deterioration vs subjective experience with skin complaints. All in all, these results show a moderate but significant relevance of skin state for feeling of stigmatization over time only in men, thus suggesting a considerable influence of other psychic variables, probably coping skills, especially in women.

Schmid-Ott G, Burchard R, Niederauer HH, Lamprecht F, Künsebeck HW. · Abteilung Psychosomatik und Psychotherapie der Medizinischen Hochschule Hannover. · Hautarzt. · Pubmed #12955263 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Psoriasis and atopic dermatitis patients are often influenced by the psychosocial consequences of their skin diseases. In order to assess these experiences reliably, the stigmatization feeling and the quality of life of these patient groups were studied. PATIENTS/METHODS: The short form of the "Questionnaire on Experience with Skin Complaints" (QES) was validated in a sample of 463 in-patients with psoriasis and atopic dermatitis. In addition, the Dermatology Life Quality Index (DLQI) was ascertained. RESULTS: The dimensions "impairment of self-esteem and withdrawal", "rejection experienced", "concealment", and "composure" of the QES could be confirmed by factor analysis. As expected, middle high correlations between the QES and the DLQI were found in both patient groups. However, the stigmatization experience and the quality of life were not significantly different in a subgroup of psoriasis and atopic dermatitis patients with comparable sociodemographic characteristics. CONCLUSIONS: The short form of the QES with 23 items is a valid instrument for the examination of social and psychic burdens of psoriasis and atopic dermatitis patients. The recording of the stigmatization feeling and of the quality of life determines different, supplementary aspects of the illness-related stress of patients with chronic skin diseases.

Schmid-Ott G, Jaeger B, Adamek C, Koch H, Lamprecht F, Kapp A, Werfel T. · Department of Psychosomatic Medicine, Hannover Medical School, Germany. · J Allergy Clin Immunol. · Pubmed #11150008 No free full text.

Abstract: BACKGROUND: Different exogenous and endogenous provocation factors such as mental stress are hypothesized as being relevant in the pathophysiology of atopic dermatitis (AD). OBJECTIVE: The purpose of this study was to examine the effects of acute psychological stress on illness-specific immunologic parameters in AD. Patients with psoriasis and healthy volunteers were investigated in parallel. METHODS: Patients with AD (n = 15), patients with psoriasis (n = 15), and control subjects (n = 15) were exposed to mental stress lasting 10 minutes (public speaking, mental arithmetic). In vitro analyses were done 1 hour before, immediately after, and 1 hour after stress exposure. Vital parameters (blood pressure, heart rate) and plasma noradrenaline concentrations were determined to prove the effects of mental stress on the individuals. Lymphocytes were phenotypically analyzed by flow cytometry. RESULTS: The results indicate a higher ability of CD8(+) T lymphocytes to react to stress, including the subpopulations of CD8(+)/CD11b(+) T lymphocytes and eosinophils in patients with AD compared with healthy volunteers. The increases in the subpopulation of CD8(+)/CD11b(+) T lymphocytes on psychological stress were higher in the patients with AD and psoriasis than in healthy control subjects. Significant stress-induced changes of natural killer cells were revealed for all 3 groups. CONCLUSION: The results suggest that psychological stress has different immunologic effects in patients with AD than in patients with psoriasis and healthy men.

Schmid-Ott G, Malewski P, Künsebeck HW, Ott R, Lamprecht F, Jäger B. · Abteilung Psychosomatik und Psychotherapie, Medizinischen Hochschule Hannover. · Hautarzt. · Pubmed #10969404 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: Illness specific stress plays an important part in the daily life of psoriatic patients. Until now for the measurement of relevant aspects of daily stress only the "Psoriasis Life Stress Inventory" (PLSI) of Gupta & Gupta exists; with the "Psoriasis-Alltagsstress-Inventar" (PAI), a German version of the PLSI is presented and its psychometric properties are discussed. PATIENTS/METHODS: 385 in-patients completed the PAI. The internal validity was examined by factor analysis. Moreover, the correlations between the PAI total score and sociodemographic parameters (ANOVA) and extent of skin involvement (multiple regression) were determined. RESULTS: The PLSI score proves to be sufficiently independent of age, sex, age at onset, and general extent of skin involvement. However, affections of the hands, the lower abdomen and the genitals show a strong influence on the total score. We found marked interrelations with the stigmatization feeling ("Questionnaire on Experience with Skin Complaints" QES, Schmid-Ott et al. 1998). CONCLUSIONS: The results suggest that the PAI is a useful and psychologically relevant questionnaire for psoriatic patients.

Schmid-Ott G, Kuensebeck HW, Jaeger B, Werfel T, Frahm K, Ruitman J, Kapp A, Lamprecht F. · Department of Psychosomatic Medicine, Hannover Medical School, Germany. · Acta Derm Venereol. · Pubmed #10598757 No free full text.

Abstract: A central experience of patients with atopic dermatitis and psoriasis is the feeling of stigmatization. This can be estimated by the "Questionnaire on Experience with Skin Complaints" (QES), based on the "Feelings of Stigmatization Questionnaire" by Ginsburg & Link. This study was designed to evaluate the psychometric properties of the QES, especially the validity of this questionnaire, and to supply more information about the stigmatization experiences of patients with atopic dermatitis and psoriasis. Three groups of patients were analysed: 76 with atopic dermatitis, 81 and 217 with psoriasis, respectively. The comparison of subgroups with different affected regions revealed that the genital region is especially relevant for the stigmatization experience in these patients. In addition, the feeling of stigmatization (estimated by the QES) is relatively independent of the different dimensions of the "Trier Scales of Coping with Diseases", except for the depressive coping style "Rumination" measuring a high amount of inner concern with the afflicting disease. It can be concluded that the QES is a valid and reliable instrument for examining the stigmatization experience of patients with atopic dermatitis and psoriasis.