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Derksen J.j.l. - One of the best experts on this subject based on the ideXlab platform.
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Van psychosomatosen via somatoforme klachten nu maar weer eens naar medisch onverklaarde klachten
'Springer Science and Business Media LLC', 2010Co-Authors: Derksen J.j.l.Abstract:Item does not contain fulltextDit artikel is een reactie op het artikel 'Stressreacties in het lichaam spelen een geringe rol bij medisch onverklaarde klachten' van Jan Houtveen en Lorenz van Dooren, GZ-psychologie 1, 2010. In de jaren zestig, zeventig en tachtig kwam de buitenlandse invloed op de klinisch psychologie niet alleen met de westenwind mee maar ook nog wel eens met een briesje uit het oosten: de 'psychosomatische Medizin' is hiervan een voorbeeld. Medisch onverklaarde klachten heetten toen nog psychosomatosen en in deze aanduiding tref je een besef aan van de belangrijke bijdrage van psychologische determinanten bij in het lichaam uitgedrukte stoornissen.De psychosomatische benaderingswijze sloot geen enkele ziekte uit, maar historisch gezien waren de symptoomgroepen onder studie vooral: ulcus ventriculi/duodeni, colitis ulcerosa, asthma bronchiale, essentiële hypertensie, ziekte van Graves (hyperthyreoidie), rheumatoïde arthritis en Neurodermatitis. Bij elk van deze stoornissen werd gedacht aan een specifiek psychisch conflict en hieromtrent bestonden theorieën vooral vormgegeven door de Hongaar Franz Alexander en in Nederland door de internist en psychobioloog (zo noemde hij zichzelf), Juda Groen. Hun theorieën leidden tot wat in die tijd de specificiteithypothese werd genoemd. Deze wacht nog op toetsing.3 p
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Van psychosomatosen via somatoforme klachten nu maar weer eens naar medisch onverklaarde klachten
'Springer Science and Business Media LLC', 2010Co-Authors: Derksen J.j.l.Abstract:Dit artikel is een reactie op het artikel 'Stressreacties in het lichaam spelen een geringe rol bij medisch onverklaarde klachten' van Jan Houtveen en Lorenz van Dooren, GZ-psychologie 1, 2010. In de jaren zestig, zeventig en tachtig kwam de buitenlandse invloed op de klinisch psychologie niet alleen met de westenwind mee maar ook nog wel eens met een briesje uit het oosten: de 'psychosomatische Medizin' is hiervan een voorbeeld. Medisch onverklaarde klachten heetten toen nog psychosomatosen en in deze aanduiding tref je een besef aan van de belangrijke bijdrage van psychologische determinanten bij in het lichaam uitgedrukte stoornissen.De psychosomatische benaderingswijze sloot geen enkele ziekte uit, maar historisch gezien waren de symptoomgroepen onder studie vooral: ulcus ventriculi/duodeni, colitis ulcerosa, asthma bronchiale, essentiële hypertensie, ziekte van Graves (hyperthyreoidie), rheumatoïde arthritis en Neurodermatitis. Bij elk van deze stoornissen werd gedacht aan een specifiek psychisch conflict en hieromtrent bestonden theorieën vooral vormgegeven door de Hongaar Franz Alexander en in Nederland door de internist en psychobioloog (zo noemde hij zichzelf), Juda Groen. Hun theorieën leidden tot wat in die tijd de specificiteithypothese werd genoemd. Deze wacht nog op toetsing
Joachim Saloga - One of the best experts on this subject based on the ideXlab platform.
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approach to suspected food allergy in atopic dermatitis guideline of the task force on food allergy of the german society of allergology and clinical immunology dgaki and the medical association of german allergologists ada and the german society of
Journal Der Deutschen Dermatologischen Gesellschaft, 2009Co-Authors: Thomas Werfel, Imke Reese, Thomas Fuchs, Ute Lepp, Bodo Niggemann, Stephan Erdmann, Margot Henzgen, Ja Rg Kleinetebbe, M Raithel, Joachim SalogaAbstract:Summary The following guideline of the “Arbeitsgruppe Nahrungsmittelallergie der DGAKI” (Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology) and the ADA (“Arzteverband Deutscher Allergologen”, Medical Association of German Allergologists) and the GPA (German Society of Pediatric Allergology) summarizes the approach to be taken when food allergy is suspected in patients with atopic dermatitis (Neurodermatitis, atopic eczema). The problem is clinically relevant because many patients assume that allergic reactions against foods are responsible for triggering or worsening their eczema. It is important to identify those patients who will benefit from an elimination diet but also to avoid unnecessary diets. Elimination diets (especially in early childhood) are associated with the risk of malnutrition and additional emotional stress for the patients. The gold standard for the diagnosis of food-dependent reactions is to perform placebo-controlled, double-blind oral food challenges because specific IgE, prick tests and history often do not correlate with clinical reactivity. This is particularly true in the case of delayed eczematous skin reactions. Diagnostic elimination diets should be used before an oral provocation test. If multiple sensitizations against foods are discovered in a patient, an oligoallergenic diet and a subsequent stepwise supplementation of the nutrition should be performed. If a specific food is suspected of triggering food allergy, oral provocation should be performed after a diagnostic elimination diet. As eczema-tous skin reactions may develop slowly (i. e. within one or two day), the skin be inspected the day after the provocation test and that a repetitive test be performed if the patient has not reacted to a given food on the first day of oral provocation. The guideline discusses various clinical situations for patients with atopic dermatitis to facilitate differentiated diagnostic procedures.
Varol Lutfu Aksungur - One of the best experts on this subject based on the ideXlab platform.
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clinical and histopathological findings of psoriatic Neurodermatitis and of typical lichen simplex chronicus
Journal of The European Academy of Dermatology and Venereology, 2007Co-Authors: Suhan Gunasti, Selma Sonmezoglu Marakli, Ilhan Tuncer, Nurgul Ozpoyraz, Varol Lutfu AksungurAbstract:Background We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or knees and have named this condition ‘psoriatic Neurodermatitis’ (PN). Objective The purpose of this study was to compare clinical and histopathological characteristics of these patients to those of patients with typical lichen simplex chronicus (LSC). Methods Nineteen patients with PN and 34 patients with typical LSC were included. Besides clinical dermatological evaluation, the prick test was carried out on 49 patients; the Phadiatop test on 40 patients; the patch test with European standard series on 47 patients; histopathological evaluation on 39 patients; and clinical psychiatric examination on 38 patients. Results Almost exclusively, PN was seen in females and was located on the extremities. It caused more plaques than typical LSC did. In PN, the plaques were smaller, sharper, more keratotic and less excoriated, and had fewer lichenoid papules around them. Itching was usually more severe in the evening, while resting and in a hot environment in typical LSC, but not in PN. In plaques of PN, microabscesses in the horny layer, hypogranulosis, regular acanthosis and thinning of the suprapapillary plates were more frequent, and hyperpigmentation in the basal layer was less. In patients with PN, depressive disorder was found more frequently; and generalized anxiety disorder or psychosomatic characteristics, less. There were no significant differences in the results of prick, Phadiatop and patch tests between patients with PN and those with typical LSC. Conclusion In our opinion, it is most likely that the so-called PN is itchy psoriasis superimposed by LSC.
Thomas Werfel - One of the best experts on this subject based on the ideXlab platform.
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approach to suspected food allergy in atopic dermatitis guideline of the task force on food allergy of the german society of allergology and clinical immunology dgaki and the medical association of german allergologists ada and the german society of
Journal Der Deutschen Dermatologischen Gesellschaft, 2009Co-Authors: Thomas Werfel, Imke Reese, Thomas Fuchs, Ute Lepp, Bodo Niggemann, Stephan Erdmann, Margot Henzgen, Ja Rg Kleinetebbe, M Raithel, Joachim SalogaAbstract:Summary The following guideline of the “Arbeitsgruppe Nahrungsmittelallergie der DGAKI” (Task Force on Food Allergy of the German Society of Allergology and Clinical Immunology) and the ADA (“Arzteverband Deutscher Allergologen”, Medical Association of German Allergologists) and the GPA (German Society of Pediatric Allergology) summarizes the approach to be taken when food allergy is suspected in patients with atopic dermatitis (Neurodermatitis, atopic eczema). The problem is clinically relevant because many patients assume that allergic reactions against foods are responsible for triggering or worsening their eczema. It is important to identify those patients who will benefit from an elimination diet but also to avoid unnecessary diets. Elimination diets (especially in early childhood) are associated with the risk of malnutrition and additional emotional stress for the patients. The gold standard for the diagnosis of food-dependent reactions is to perform placebo-controlled, double-blind oral food challenges because specific IgE, prick tests and history often do not correlate with clinical reactivity. This is particularly true in the case of delayed eczematous skin reactions. Diagnostic elimination diets should be used before an oral provocation test. If multiple sensitizations against foods are discovered in a patient, an oligoallergenic diet and a subsequent stepwise supplementation of the nutrition should be performed. If a specific food is suspected of triggering food allergy, oral provocation should be performed after a diagnostic elimination diet. As eczema-tous skin reactions may develop slowly (i. e. within one or two day), the skin be inspected the day after the provocation test and that a repetitive test be performed if the patient has not reacted to a given food on the first day of oral provocation. The guideline discusses various clinical situations for patients with atopic dermatitis to facilitate differentiated diagnostic procedures.
Suhan Gunasti - One of the best experts on this subject based on the ideXlab platform.
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clinical and histopathological findings of psoriatic Neurodermatitis and of typical lichen simplex chronicus
Journal of The European Academy of Dermatology and Venereology, 2007Co-Authors: Suhan Gunasti, Selma Sonmezoglu Marakli, Ilhan Tuncer, Nurgul Ozpoyraz, Varol Lutfu AksungurAbstract:Background We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or knees and have named this condition ‘psoriatic Neurodermatitis’ (PN). Objective The purpose of this study was to compare clinical and histopathological characteristics of these patients to those of patients with typical lichen simplex chronicus (LSC). Methods Nineteen patients with PN and 34 patients with typical LSC were included. Besides clinical dermatological evaluation, the prick test was carried out on 49 patients; the Phadiatop test on 40 patients; the patch test with European standard series on 47 patients; histopathological evaluation on 39 patients; and clinical psychiatric examination on 38 patients. Results Almost exclusively, PN was seen in females and was located on the extremities. It caused more plaques than typical LSC did. In PN, the plaques were smaller, sharper, more keratotic and less excoriated, and had fewer lichenoid papules around them. Itching was usually more severe in the evening, while resting and in a hot environment in typical LSC, but not in PN. In plaques of PN, microabscesses in the horny layer, hypogranulosis, regular acanthosis and thinning of the suprapapillary plates were more frequent, and hyperpigmentation in the basal layer was less. In patients with PN, depressive disorder was found more frequently; and generalized anxiety disorder or psychosomatic characteristics, less. There were no significant differences in the results of prick, Phadiatop and patch tests between patients with PN and those with typical LSC. Conclusion In our opinion, it is most likely that the so-called PN is itchy psoriasis superimposed by LSC.