Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Clinical and Laboratory Investigations Dermatology 2006;212:128–136 DOI: 10.1159/000090653 Low Levels of Emotional Awareness Predict a Better Response to Dermatological Treatment in Patients with Psoriasis Silla M. Consoli a Sophie Rolhion b Caroline Martin c Karine Ruel b Frédéric Cambazard b Jacques Pellet d Laurent Misery b a Department of Psychiatry, Georges Pompidou European Hospital, Paris, and Departments of b Dermatology, c Public Health and d Psychiatry, University Hospital, Saint Etienne, France sessed with the Lane and Schwartz Levels of Emotional Awareness Scale (LEAS). Results: Forty patients present- ed at least one psychiatric diagnosis and 33 were con- sidered alexithymic (TAS 6 73). No psychological score was associated with baseline PASI score, which was higher in men and positively correlated with disease du- ration. Patients who considered their disease to be stress- reactive tended to have lower LEAS scores (p = 0.052). At the 3-month visit, PASI scores had significantly im- proved in the subset of patients (n = 67) presenting se- vere psoriasis at inclusion (PASI 1 2); emotional aware- ness and anxiety scores had also improved in these patients (p ! 0.001), but dermatological and psychologi- cal changes were not statistically related. Dermatologi- cal improvement at 3 months with respect to baseline PASI was predicted by longer disease duration (1 20 years) and lower baseline LEAS score (p = 0.044 and p = 0.021, respectively). Conclusion: This study demon- strates the value of assessing the ability of patients with psoriasis to process emotional information, as defined by emotional awareness. Patients with low LEAS scores appear to be more reactive to stress, but also to be more responsive to treatment, suggesting the activation of a particular stress physiology by negative affective states that are not experienced. Copyright © 2006 S. Karger AG, Basel Key Words Psoriasis  Alexithymia  Emotional awareness  Stress reactivity  Longitudinal study  Response to treatment Abstract Background: Personality and emotional factors are thought to influence the onset of psoriasis, the occur- rence of relapses, and the sensitivity of this condition to dermatological treatments. Objective: To explore the re- lationships between emotional disorders and emotional information processing in the one hand, and psoriasis severity and response to treatment on the other. Meth- ods: We recruited 93 patients through an article in the local press. These patients attended three consultations. We evaluated psoriasis severity by Psoriasis Area and Severity Index (PASI) score and response to treatment by change in PASI score from baseline to the 3-month visit. We screened for comorbid mental disorders, using the Mini International Neuropsychiatric Interview. We used the Hospital Anxiety and Depression Scale to as- sess anxiety and depressive symptoms. Alexithymia (difficulty in identifying and expressing emotions) was evaluated with the 26-item version of the Toronto Alexi- thymia Scale (TAS-26) and the ability to integrate and differentiate emotions (emotional awareness) was as- Received: January 5, 2004 Accepted: August 5, 2005 Prof. Laurent Misery Department of Dermatology, CHU Morvan FR–29609 Brest Cedex (France) Tel. +33 298 223 315, Fax +33 298 223 382 E-Mail laurent.misery@chu-brest.fr © 2006 S. Karger AG, Basel 1018–8665/06/2122–0128$23.50/0 Accessible online at: www.karger.com/drm Downloaded by: Université René Descartes Paris 5 193.51.85.197 - 10/16/2017 1:00:36 PM