The effect of treatment expectations on pruritus and skin pain

Background Patients' expectations in terms of the benefit of a treatment are key determinants of placebo responses and can affect the development and course of medical conditions as well as the efficacy and tolerability of active medical treatment. The mechanisms mediating these placebo and nocebo effects have been best described in the field of experimental pain and placebo analgesia. However, also in dermatology experimental and clinical studies demonstrate that different skin symptoms such as itch, skin pain and dermatologic diseases can be modulated by patients' expectations. Objectives The aim of this review is to provide a current overview of the empirical evidence for the effects of patients' expectations in the field of dermatology with a focus on different skin symptoms such as itch and pain. Finally, the relevance of this topic for physicians who treat patients with dermatologic symptoms is discussed. Materials and methods The article is a narrative review. Results Steadily growing evidence from experimental and clinical studies in healthy volunteers and dermatologic patients suggests that patients' positive treatment expectations can reduce skin disease symptoms and enhance treatment efficacy, while negative treatment expectations can induce a nocebo effect associated with increased symptomatology. Patients' prior treatment experiences as well as the quality and quantity of doctor-patient communication play a central role in shaping treatment expectations. Conclusions Techniques aimed at maximizing positive expectation effects in patients should be implemented in daily clinical routine.