ATTENUATED FREE CORTISOL RESPONSE TO PSYCHOSOCIAL STRESS IN CHILDREN WITH ATOPIC-DERMATITIS

Objective: Atopic dermatitis (AD) is an inflammatory skin disease char acterized by a hyperactivity of the humoral immune system with an onse t in infancy or early childhood. Although most of the research has foc used on the pathophysiological role of the immune system in AD, the im pact of endocrine signals in the pathology of AD has received only lit tle attention, However, because the endocrine system may play a regula tory role in immune functioning, it might be of major interest to stud y endocrine reactivity in AD patients. The present two-part study inve stigated the relationship between adrenocortical stress response, hear t rate response, and psychological parameters in children with AD. Met hod and Results: In Study 1, a protocol for induction of psychosocial stress in children aged 8 to 14 years was evaluated. Healthy children (N = 16) were exposed to the Trier Social Stress Test for Children (TS ST-C) that mainly consists of public speaking and mental arithmetic ta sks in front of an audience, Salivary cortisol was measured 35, 15, an d 1 minute before as well as 1, 10, 20, and 30 minutes after the stres s; heart rate was monitored continuously. Results showed that the prot ocol induced a highly significant increase in free cortisol response ( p<.001) and heart rate (p<.001). In Study 2, the TSST-C was applied to AD children (N = 15) and age- and sex-matched healthy controls (N = 1 5), All patients were in remission and medication-free for at least 3 weeks. Again, the stress test induced significant increases in cortiso l and heart rate, However, the AD children showed a significantly blun ted cortisol response to the stressor compared with the control group (p<.05). Heart rate responses were similar in both experimental groups . Neither subjective stress ratings nor personality traits were relate d to the blunted cortisol response. Conclusions: These findings sugges t that the adrenocortical response to stress is attenuated in atopic c hildren. A hyporesponsive hypothalamus-pituitary-adrenal (HPA) axis mi ght explain in part the stress-induced eruptions of AD symptoms.