Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,
Department of Dermatology, Venereology, and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Dermatology. 2021;237(6):857-871. doi: 10.1159/000513445. Epub 2021 Jan 26.
Patients' expectations towards the benefit of a treatment are key determinants of placebo responses and can affect the development and course of medical conditions and 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 various skin diseases such as inflammatory dermatoses and allergic reactions can be modulated by patients' expectations. Dermatologists should consider the important modulatory role of patients' expectations on the efficacy and tolerability of specific treatments and the key role of verbal information, patients' prior treatment experiences (associative learning), and the quality and quantity of doctor-patient communication in shaping treatment expectation. As a consequence, techniques aiming at maximizing patients' expectation effects should be implemented into daily clinical routine. By contrast, in clinical studies expectation effects should be maximally controlled and harmonized to improve the "assay sensitivity" to detect new compounds. Further translational studies, also in dermatoses that have not been investigated yet, are needed to better characterize the mechanisms underlying patients' expectation and to gain further insights into potential clinical implications of these effects in dermatologic conditions. Therefore, in this review, we provide a brief overview on the concept of expectation effects on treatment outcome in general, summarize what is already known about this topic for dermatologic diseases, and finally present the relevance of this topic in clinical dermatology.
患者对治疗益处的期望是安慰剂反应的关键决定因素，可能会影响医疗状况的发展和进程，以及积极治疗的疗效和耐受性。在实验性疼痛和安慰剂镇痛领域，这些安慰剂和反安慰剂效应的机制得到了最好的描述。然而，在皮肤病学中，实验和临床研究也表明，各种皮肤病，如炎症性皮肤病和过敏反应，可以通过患者的期望来调节。皮肤科医生应考虑患者对特定治疗效果和耐受性的期望的重要调节作用，以及口头信息、患者先前的治疗经验（联想学习）以及医患沟通的质量和数量在塑造治疗期望中的关键作用。因此，旨在最大化患者期望效果的技术应被纳入日常临床实践中。相比之下，在临床研究中，应最大限度地控制和协调期望效应，以提高检测新化合物的“测定灵敏度”。还需要进行进一步的转化研究，包括尚未研究过的皮肤病，以更好地描述患者期望的潜在机制，并进一步了解这些效应在皮肤病学中的潜在临床意义。因此，在这篇综述中，我们简要概述了治疗效果的期望效应的概念，总结了目前已知的关于皮肤病的这一主题，并最终介绍了这一主题在临床皮肤科中的相关性。
