THE ASSOCIATION BETWEEN ATOPIC DERMATITIS AND THE STRESS DEFINED BY SALIVARY CORTISOL AND PSYCHOLOGICAL TESTING OF THE QUALITY OF LIFE

Među brojnim čimbenicima u etiopatogenezi atopijskog dermatitisa (AD) navodi se psihički stres, čiji utjecaj na bolest nije do kraja poznat i istražen. Prema dosadašnjim spoznajama, kod oboljelih od AD-a postoji poremećaj regulacije hipotalamičko-hipofizno-adrenalne (HPA, engl. hypothalamic-pituitary-adrenal) osi s promijenjenim odgovorom kortizola na stres, povezanim s pogoršanjem bolesti. Istraživanje je obuhvatilo 84 ispitanika s AD-om: 42 s manifestacijama AD-a (simptomatski) i 42 u fazi remisije (asimptomatski), kojima je uzet uzorak sline za procjenu razine kortizola. Također, ispunili su psihološke upitnike za procjenu percepcije stresa, kvalitete života i obilježja osobnosti. Ispitanicima sa simptomatskim oblikom bolesti određena je težina AD-a indeksom SCORAD (engl. SCORing atopic dermatitis) te provedena druga procjena parametara nakon dva mjeseca prospektivnog praćenja. Niži je salivarni kortizol uočen kod simptomatskog AD-a nego kod asimptomatskog oblika [niska snaga efekta (p=0,011; r=0,276)], a vrijednosti nisu bile ovisne o SCORAD-u i percipiranoj razini stresa (PSS). Zabilježeni SCORAD najjače je korelirao s dermatološkim indeksom kvalitete života (DLQI) (r=0,551; p 50) utvrđen je znatno niži salivarni kortizol nego kod onih s umjerenim i blagim AD-om [umjerena snaga efekta (p=0,042; r=0,313)]. Percipirana razina stresa (PSS) nije ovisila o SCORAD-u, ali je korelirala s percipiranim utjecajem bolesti na emocionalno stanje (IPQ 8) (r=0,397; p<0,001), dimenzijama kvalitete života WHOQOL BREF [fizičkim i psihičkim zdravljem, socijalnim odnosima i okolinom (r=-0,398 - (-0,483); p<0,001)] te obilježjima osobnosti [osobito s anksioznosti i depresijom (r=0,633 i 0,605; p<0,001), s čijim se porastom povećavao i stupanj PSS-a]. Potrebno je dalje istraživati način utjecaja psihičkog stresa na AD radi poboljšanja kvalitete života bolesnika i osmišljavanja novih terapijskih mogućnosti.One of the numerous factors in the etiopathogenesis of atopic dermatitis (AD) is psychological stress, the influence of which is unknown and under-researched. According to current knowledge, AD patients have a disturbance in the hypothalamic-pituitary-adrenal (HPA) axis with a changed cortisol response to stress associated with the worsening of the disease. The study included 84 subjects with AD: 42 subjects with symptoms of AD (symptomatic) and 42 subjects in remission (asymptomatic). A sample of saliva was taken from each subject to estimate the cortisol level, and each subject filled out a psychological questionnaire to assess their perception of stress, quality of life and personality traits. Symptomatic subjects were assigned an AD severity scoring (SCORAD index), and a second parameter evaluation was performed after two months of prospective monitoring. Lower salivary cortisol was observed more frequently in symptomatic AD than in the asymptomatic form [low power effect (p = 0.011; r = 0.276)], and these values were not dependent on SCORAD and perceived stress level (PSS). Recorded SCORAD values strongly correlated with the dermatological quality of life index (DLQI) (r = 0.551, p 50), significantly lower salivary cortisol was found than in those with moderate and mild AD [moderate effect power (p = 0.042; r = 0.313)]. The Perceived Stress Level (PSS) was not dependent on SCORAD but correlated with the following: perceived effect of the disease on emotional states (IPQ 8) (r = 0.397; p <0.001); the quality of life dimensions WHOQOL BREF [physical and psychological health, interpersonal interactions and the social environment (R = -0.398 - (- 0.483), p <0.001)]; and personality traits, especially connected with anxiety and depression (r = 0.633 and 0.605, p