Official websites use. Share sensitive information only on official, secure websites. Corresponding author. Pruritus and psyche are intricately and reciprocally related, with psychophysiological evidence and psychopathological explanations helping us to understand their complex association. Their interaction may be conceptualized and classified into 3 groups: pruritic diseases with psychiatric sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus.
Management of chronic pruritus is directed at treating the underlying causes and adopting a multidisciplinary approach to address the dermatologic, somatosensory, cognitive, and emotional aspects. Antipsychotics are required for treating itch and formication associated with schizophrenia and delusion of parasitosis including Morgellons disease.
Just as the eyes are the windows to our soul, the skin is a surface reflection of the inner depths of our mind. The skin and the brain are polar terminal differentiations from the same embryonic neuroectoderm, and pruritus is a symptom that demonstrates the complex yet intricate link between these 2 organs. To illustrate this point, itch can be induced simply by thinking about it.
Evidence of the effect of psyche on itch was provided in a number of studies. Dark et al 5 showed that release of histamine can be achieved by classic conditioning methods in guinea pigs and this effect can be enhanced by administration of stress. In humans, psychosomatic status and psychosocial factors were observed to be good predictors of histamine-induced itch and flare. We have also recently found that patients with atopic dermatitis experienced more intense itch when they were shown video recordings of other people scratching.
It has been shown that the reactivity of the hypothalamus-pituitary-adrenal HPA axis in response to stress, which could be essential in avoiding immune overreactivity, 11 is impaired in patients with atopic dermatitis and may be linked to the severity of allergic inflammation. In recent years, the areas of the brain activated by itch have been elucidated.
