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A Journal on Forensic Medicine
Minerva Medicolegale 2003 March;123(1):65-9
Onset of psoriasis in the workplace: psychosomatic or reactive isomorphism conversion?
Pedana M. A., Iurassich S.
Background. We describe the diagnostic criteria making it possible to differentiate in cases of psoriasis arising in the workplace that of psychosomatic origin (PPO) and that originating in a traumatic reaction (PTO).
Methods. Sixty patients aged 19-45 suffering from psoriasis were studied. The PASI (psoriasis area severity index) was used to assess the clinical gravity of the condition. Emotivity was assessed using Berger's questionnaire and psysician-patient conversation were used to evaluate the emotional dynamics that induced the pathology.
Results. We defined PPO as patients who at the beginning of the study showed high affectivity and the presence of emotional conflicts and PTO patients with low affectivity and the absence of emotional conflicts. The 32 POPs had a PASI of 25-55 and the 28 PTOs a PASI of 30-60. At the end of therapy 28 POPs and 28 PTOs showed low affectivity, 4 POPs a high affectivity, while the PASI was 2-6 in the POPs and 3-12 in the PTOs. After a follow-up of 3 months 24 PPOs and 27 PTOs showed low affectivity, 8 PPOs and 1 PTO high affectivity, while the PASI was 3-7 in the POPs and 18-44 in the PTOs.
Conclusions. The individual who fails to get over the emotional conflict feels maladjusted and produces a defence reaction. PPO represents the conversion into an organic symptom of the defence reaction. The PTOs evidence the onset of lesions in the cutaneous regions that are affected by working activity. In these workers the psychological defence mechanism is produced by a sociocultural attitude. The questionnaire and conversations enable us to distinguish PPOs from PTOs.