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Giornale Italiano di Dermatologia e Venereologia 2000 April;135(2):139-45


language: English

The bifocal approach to psoriasis. A dermatological and psychological combined treatment study of 50 patients

Jonckheere P., Bourlond A., Grazian N.

From the Cliniques Universitaires Saint Luc Dermatological Unit and Liaison Psychiatry Unit Catholic University of Louvain, Brussels, Belgium *Psychiatrist Istituto di Psichiatria “P. Ottonello” Università degli Studi, Bologna


Background. The purpose of this study was to estimate the value of a bifocal approach, dermatological and psychological, for the treatment of psoriasis and to go deeper into the psychogenetic interferences of this illness.
Methods. Fifty patients admitted to the Dermatological Unit with severe psoriasis have been studied. In each case a six stage bifocal approach, both dermatological and psychological, was adopted, including somatic and psychological examination by a dermatologist, referral to a psychiatrist, clinical psychological examination, contract negotiation, and proper bifocal therapy.
Results. Patients’ narratives, memories and fantasies coincided to a large degree. Although other factors (such as a possibly inherited predisposition) are not to be excluded, this would imply that psoriasis often develops through three phases: a period of insecurity throughout childhood; a period of increasing tension and insecurity preceding the onset of psoriasis; factors triggering the initial appearance (as well as relapses): it would seem that there is often at least a chronological association with a compelling need for affection, the need to be protected, or a situation giving rise to anxiety.
Conclusions. The benefits of the combined psychological and somatic approach can be summarized in the following five points: 1. better patient management of the disease: a healthier lifestyle, improved compliance; 2. greater impact of dermatological treatment, less after-care; 3. appreciable improvement of psoriasis in 50% of cases; 4. in some cases the patient entered psychotherapy; 5. considerable social and economic benefits, with fewer hospital admissions and disabling sickness.

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