[Development of the psychosomatic concept of perioral dermatitis].

In recent years, ,perioral dermatitis' though practically unknown in the past, has been observed rather frequently in female patients. It has proven remarkably refractory against external dermatotherapy, and numerous attempts to analyse the causality have failed. However, we very often noted certain characteristics of personality structure and social attitude in the patients afflicted with the disease. Both clinical findings and various signs of vegetative dystonia suggested psychoneurotic rather than purely somatic causes. We therefore set about to elucidate the psychic and other clinical symptoms of our patients in co-operation with a psychoanalyst and a clinical psychologist. Throughout a period of several years, this interdisciplinary teamwork helped us develop biographically and psychoanalytically oriented case studies in so-called Balint seminars. We thereby gained a better understanding of the psychodynamics in each of our cases, which enabled us to treat the disease successfully. We consider ,perioral dermatitis' a primarily psychosomatic disorder which, in most cases, responds well to short-term psychotherapy. Other findings reported in dermatological literature are controversial as to their causal interpretation, even when assuming an origin by infecting microbes. We regard bacterial and other findings as sequelae which may give rise to clinical exacerbation, yet not as genuine causes of the disease. Our conception is strongly supported by the success of psychotherapy, through which the symptomatic tetracyclin and/or corticosteroid treatment has been rendered superflous.