Atopic dermatitis, stinging, and effects of chronic stress: A pathocausal study

Background Patients with atopic dermatitis (AD) often have increased skin sensitivity and this symptom often worsens during stress. Objective We sought to find out whether patients with AD had stinging, and to identify the pathocausal neuroimmune mechanisms, including the role of stress. Methods In all, 25 patients with AD with histories of stress worsening were tested using a stinger test. Skin biopsy specimens were processed for immunohistochemistry. Stress inquiries and salivary cortisol tests were performed. Results In all, 16 patients were stinger-positive and 9 were negative. The stinger-positive papillary dermis had an increased number of mast cells, vasoactive intestinal polypeptide–positive fibers, and a tendency to a higher number of substance P–positive nerve fibers, but a decrease of calcitonin gene-related peptide fibers. Patients who were stinger-positive had a tendency to lower salivary cortisol. Conclusions The majority of patients with AD experience stinging. Substance P, calcitonin gene-related peptide, vasoactive intestinal polypeptide, and mast cells may have a pathocausal role, as might chronic stress.