|LETTER TO EDITOR
|Ahead of print publication
Allergic-dermatological symptoms and psychological variables in fibromyalgia: A preliminary study of their relationship
Juan Antonio Becerra-García
Psychology Area, Faculty of Health Sciences, Universidad Internacional De La Rioja, Logroño, La Rioja, Spain
Juan Antonio Becerra-García,
Faculty of Health Sciences, Universidad Internacional De La Rioja, Avenida De La Paz, 137, 26006 Logroño, La Rioja
Source of Support: None, Conflict of Interest: None
Fibromyalgia (FM) is a rheumatic disease with wide heterogeneity in symptomatology that includes conditions such as musculoskeletal pain, fatigue, cognitive impairment, anxiety and mood disorders, and insomnia, among others. In FM, the presence of dermatological and allergic manifestations (such as hyperhidrosis, allergic rhinitis, pruritus, burning, and tingling), is common, and psychological factors (such as negative emotions, alexithymia, and neuroticism) play a relevant role in the pain experience, illness behavior, complaint level, and the quality of life of these patients., The aim of this pilot study was to assess the association between different psychological variables and self-reported allergic-dermatological symptomatology in a sample of FM patients.
The sample was composed of 16 women with FM diagnosed by a rheumatologist according to the American College of Rheumatology criteria. The mean age of the women was 51.94 ± 4.47 years, with a median of 52.50 years (age range: 44–61 years). The participants had a mean of 10.06 ± 3.04 years of education (median of 10 years, ranging 5–14 years) and a mean of 4.01 ± 1.41 years from FM diagnosis (median of 4 years, ranging 2–7 years). These participants were recruited from an FM association in southern region of Spain. Inclusion criteria were: (1) voluntary and anonymous participation, (2) providing signed informed consent form (according to the Declaration of Helsinki prior to their participation), and (3) not suffering from other severe somatic (cancer, neurological disorders, and cardiovascular diseases) or psychiatric diseases (such as bipolar or psychotic disorders).
The psychometric instruments used were the Skin/Allergy-Related Subscale of the Somatic Symptom Scale-Revised (SSS-R), which comprises 10 items (of 90 included in the full SSS-R) rated on a 5-point Likert scale (from 0 to 4), to assess incidences in the last year of self-reported allergic-dermatological symptoms (such as skin rashes, allergic sneezes, and eczema) and provide a quantitative measure of these manifestations (range: 0–40; the higher the score, the greater the symptomatology); the Life Orientation Test-Revised to measure dispositional optimism; and the Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale (TAS-20) to assess the anxious-depressive symptomatology and alexithymia levels, respectively. The study was conducted in one session. In the first step, sociodemographic data were recorded and inclusion criteria were confirmed. In the second step, the psychometric instruments were administered in an individual interview. The statistical analysis of the relationship between allergic-dermatological symptoms and the psychological factors was performed using Pearson's correlations, followed by linear regression analysis with all psychological, clinical, and sociodemographic variables examined as predictors and allergic-dermatological manifestations as a dependent variable. Previously, the following assumptions necessary to apply linear regression analysis were examined [Table 1]: normality (Kolmogorov–Smirnov's test), homoscedasticity (scatterplot of standardized predicted values and standardized residuals without pattern in the spread, points in the middle of the plot, and residual values between 2 and − 2), multicollinearity (variance inflation factor), and independence (Durbin–Watson's test).
|Table 1: Summary of different statistical analyses conducted (correlations and linear regression) between psychological factors and allergic-dermatological manifestations in fibromyalgia patients|
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In the analyses conducted, significant correlations were found between allergic-dermatological manifestations and optimism level and also between these somatic symptoms and depression score [Table 1]. Later, in the linear regression analysis conducted, the optimism score was the only and most relevant predictor (negative association) of allergic-dermatological symptomatology level [Table 1]. The FM participants' group showed relations between emotional and personality variables with somatic symptoms, findings which are in accordance with a previous scientific literature., The variables examined were differentially associated with these somatic symptoms in the sample studied. In this research, the results indicate that dispositional optimism level (versus emotional state and alexithymia score) is the psychological variable with the best explanatory capacity for self-reported allergic-dermatological manifestations. The dispositional optimism is a personality construct defined as positive generalized expectations about events, which is related to motivation and effort. These findings may be explained considering the relationship reported by different studies between optimism level, biological responses (as immune function), and subjective health outcomes (as self-reported somatic symptoms).
The relevance of stress and psychosocial variables in dermatological symptoms, skin pathologies, and allergic reactions is widely accepted., The results obtained may be useful for identifying the underlying psychological factors potentially relevant in the association between stressful events and allergic-dermatological symptomatology in these patients. Thus, on a psychological level, specifically, a lower dispositional optimism may facilitate the translation of perceived stress to these somatic responses in FM. From a clinical perspective, if optimism level is independently related with allergic-dermatological manifestations in FM, a psychosocial intervention based on positive psychology (as training in cognitive skills to promote optimism, increase of positive emotions, and engagement) may be useful as psychotherapeutic approach in patients with high levels of these somatic manifestations. The study characteristics warrant cautious interpretation of these findings. For this reason, future studies with more statistical power including other clinical variables and control groups (e.g., medications consumed and participants with other rheumatic and dermatological diseases) would be useful to verify these preliminary results.
The author wishes to thank psychologist Mr. M. J. Robles for his help in data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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