Meštrović-Štefekov Jelena, Novak-Bilić Gaby, Kuna Matea, Pap Nives, Lugović-Mihić Liborija
Prof. Liborija Lugović-Mihić, MD, PhD, Department of Dermatovenereology Sestre milosrdnice University Hospital Center, Vinogradska c. 29, 10000 Zagreb, Croatia;
Acta Dermatovenerol Croat. 2018 Dec;26(4):297-303.
Atopic dermatitis (AD) is a frequent dermatosis with a growing incidence and multifactorial and complex pathogenic mechanisms that are still being investigated. Although the connection between AD and psychological stress has been known for a long time, there is a lack of reliable and objective indicators for the characterization of this association. Psychological stress triggers complex immune pathways. Therefore, acute stress quickly triggers a high release of cortisol and adrenalin or noradrenalin which then stimulates the immune system, primarily T-helper type 1 (Th1 cells) to produce pro-inflammatory cytokines, resulting in a cellular immune response and inflammation. On the other hand, chronic stress increases basal cortisol levels and decreases the capacity to mount an acute stress response, with the immune system shifting from a cellular response (which is active in acute stress) to a humoral response. Furthermore, skin keratinocytes contain receptors for neurotransmitters and hormones (muscarinic, adrenergic, glucocorticosteroid, androgenic, estrogenic), thus actively participating in psychoneuroimmunological pathways. The measurement of plasmatic cortisol has been used routinely, but in recent years, particularly in research, preference has been given to measurement of salivary cortisol. Reliable psychological tests are an important additional parameter for assessment of a patient's psychological state. We hope that future studies will supplement our current knowledge on the influence of psychological stress in AD.
特应性皮炎（AD）是一种常见的皮肤病，发病率不断上升，其发病机制多因素且复杂，仍在研究中。尽管AD与心理压力之间的联系早已为人所知，但缺乏可靠且客观的指标来表征这种关联。心理压力会触发复杂的免疫途径。因此，急性应激会迅速引发皮质醇和肾上腺素或去甲肾上腺素的大量释放，进而刺激免疫系统，主要是1型辅助性T细胞（Th1细胞）产生促炎细胞因子，导致细胞免疫反应和炎症。另一方面，慢性应激会增加基础皮质醇水平，并降低产生急性应激反应的能力，免疫系统会从细胞反应（在急性应激中活跃）转变为体液反应。此外，皮肤角质形成细胞含有神经递质和激素的受体（毒蕈碱能、肾上腺素能、糖皮质激素、雄激素、雌激素），从而积极参与心理神经免疫途径。血浆皮质醇的测量一直是常规使用的方法，但近年来，特别是在研究中，更倾向于测量唾液皮质醇。可靠的心理测试是评估患者心理状态的一个重要附加参数。我们希望未来的研究能补充我们目前关于心理压力对AD影响的知识。
