Picardi A, Abeni D
Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy.
Psychother Psychosom. 2001 May-Jun;70(3):118-36. doi: 10.1159/000056237.
The possibility of a causal influence of emotional stress, especially of stressful life events, on the course of various skin diseases has long been postulated. Clinical wisdom and experience, as well as many anecdotal observations and uncontrolled case series, support this opinion. We reviewed the available evidence on the role of stressful life events in triggering or exacerbating skin diseases. The role of stressful events in vitiligo, lichen planus, acne, pemphigus and seborrhoeic dermatitis was either controversial or insufficiently explored. The role of stressful events in psoriasis, alopecia areata, atopic dermatitis and urticaria was apparently clearer. However, only a few studies met acceptable methodological standards for stress measurement. Also, few studies considered common potential confounding factors (e.g. age, duration of illness, familial factors), and no study controlled adequately for the influence of other crucial factors (e.g. discontinuation of treatment, seasonal effects). Adding that the large majority of studies were retrospective, it seems wise to conclude that only preliminary evidence has been published so far on the role of stressful life events in bringing on or worsening any dermatological disease. Further research is mandatory, either in the form of prospective studies or, more feasibly, of well-designed case-control studies with adequate statistical power. Future studies should also pay more attention to protective as well as vulnerability factors in stressful events. Further, it would be important to investigate other sources of psychological stress, such as chronic stress and everyday stress. Measuring stress appraisal, although difficult, would also be important.
长期以来，人们一直假定情绪应激，尤其是应激性生活事件，可能对各种皮肤病的病程产生因果影响。临床经验以及许多轶事观察和无对照病例系列都支持这一观点。我们回顾了关于应激性生活事件在引发或加重皮肤病方面作用的现有证据。应激事件在白癜风、扁平苔藓、痤疮、天疱疮和脂溢性皮炎中的作用存在争议或研究不足。应激事件在银屑病、斑秃、特应性皮炎和荨麻疹中的作用似乎更明确。然而，只有少数研究符合可接受的应激测量方法标准。此外，很少有研究考虑常见的潜在混杂因素（如年龄、病程、家族因素），也没有研究充分控制其他关键因素的影响（如治疗中断、季节效应）。再加上绝大多数研究是回顾性的，因此可以明智地得出结论，到目前为止，关于应激性生活事件在引发或加重任何皮肤病方面的作用，仅发表了初步证据。必须进行进一步的研究，形式可以是前瞻性研究，或者更可行的是设计良好、具有足够统计效力的病例对照研究。未来的研究还应更多地关注应激事件中的保护因素和脆弱因素。此外，研究其他心理应激源，如慢性应激和日常应激，也很重要。测量应激评估虽然困难，但也很重要。
