Evers Andrea W M
Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
Exp Dermatol. 2017 Jan;26(1):18-21. doi: 10.1111/exd.13158.
The role of placebo and nocebo effects-that is positive or negative treatment effects that are entirely a consequence of the patient's expectations and beliefs about a treatment outcome in terms of efficacy, safety, usability or side effects-has been shown for almost all types of diseases and physiological response systems. Evidence for the relevance of placebo and nocebo effects in dermatology is also increasing, particularly for symptoms of itch and learned (conditioned) immune function. In addition, increasing knowledge is available about the neurobiological mechanisms of action, such as the role of the dopaminergic system. Studies on this topic offer innovative perspectives to unravel the multifactorial pathways of treatment effects and to use research designs for experimental research that provide full insight into the role of placebo and nocebo effects. Moreover, intervention strategies can be developed for dermatology practice that optimize regular treatments with innovative non-pharmacological treatment strategies (e.g. optimized doctor-patient communication and treatment adherence, or prevention of nocebo reactions with regard to adverse side effects). In addition, evidence on learned immune function offers new pathways to optimize pharmacological treatments (e.g. dosage adjustments and conditioning of physiological responses), the ultimate goal being to prevent individual treatment failures and maximize regular treatment effects.
安慰剂和反安慰剂效应（即完全由患者对治疗效果在疗效、安全性、易用性或副作用方面的期望和信念所导致的正向或负向治疗效果）在几乎所有类型的疾病和生理反应系统中都已得到证实。皮肤科中安慰剂和反安慰剂效应相关性的证据也在不断增加，尤其是在瘙痒症状和习得性（条件性）免疫功能方面。此外，关于神经生物学作用机制（如多巴胺能系统的作用）的知识也日益丰富。关于这一主题的研究为揭示治疗效果的多因素途径以及采用能充分洞察安慰剂和反安慰剂效应作用的实验性研究设计提供了创新视角。此外，可为皮肤科实践制定干预策略，通过创新的非药物治疗策略（如优化医患沟通和治疗依从性，或预防关于不良副作用的反安慰剂反应）来优化常规治疗。此外，关于习得性免疫功能的证据为优化药物治疗（如剂量调整和生理反应调节）提供了新途径，最终目标是防止个体治疗失败并使常规治疗效果最大化。
