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Somatization: the under-recognized factor in nonspecific eczema. The Hordaland Health Study (HUSK)

Authors

  • M. Klokk,

    1. Department of Physical Medicine and Rehabilitation, Aalesund Hospital, Helse Sunnmore HF, 6026 Aalesund, Norway
    2. Department of Neuroscience, Norwegian University of Science and Technology, MTFS, 7489 Trondheim, Norway
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  • S. Stansfeld,

    1. Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, London, U.K.
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  • S. Øverland,

    1. Research Centre for Health Promotion, Faculty of Psychology, University of Bergen, 5015 Bergen, Norway
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  • I. Wilhelmsen,

    1. Institute of Medicine, University of Bergen, Haraldsplass Deaconal Hospital, 5009 Bergen, Norway
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  • K.G. Gotestam,

    1. Department of Neuroscience, Norwegian University of Science and Technology, MTFS, 7489 Trondheim, Norway
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  • S. Steinshamn,

    1. Department of Neuroscience, Norwegian University of Science and Technology, MTFS, 7489 Trondheim, Norway
    2. Department of Pulmonary Medicine, St Olav’s University Hospital, 7006 Trondheim, Norway
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  • A. Mykletun

    1. Research Centre for Health Promotion, Faculty of Psychology, University of Bergen, 5015 Bergen, Norway
    2. Division of Mental Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, 0403 Oslo, Norway
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  • Funding sources
    None.

  • Conflicts of interest
    None declared.

Marianne Klokk.
E-mail: ma-klokk@online.no

Summary

Background  Psychodermatology has focused primarily on depression and anxiety in eczema. Skin symptoms are listed among many others for the ICD-10 diagnosis of somatization disorder. Somatization (unexplained somatic symptoms) is highly prevalent in the general population, but its association with eczema is yet to be empirically investigated.

Objectives  We therefore explored the association between somatization and eczema by examining the extent of somatization in eczema compared with allergic rhinitis, and by examining if eczema was more strongly associated with somatization than with anxiety and depression. Finally, we aimed to examine the relationship between the site of eczema and somatization for individual somatic symptoms and for somatic symptoms as a whole.

Methods  For this population-based cross-sectional study we employed data from the Hordaland Health Study (HUSK) with 15 225 participants aged 41–48 years. Information on nonspecific eczema, allergic rhinitis, somatization, anxiety, depression and other covariates was obtained by self-report.

Results  The association between nonspecific eczema and somatization was strong and followed a dose–response pattern, as did all somatic symptoms in our index of somatization when analysed separately. The association between nonspecific eczema and somatization was stronger than that between rhinitis and somatization, and also the association between nonspecific eczema and anxiety and depression. In multivariate models, somatization accounted for most of the association between nonspecific eczema and anxiety/depression. In contrast, the association between nonspecific eczema and somatization was robust for adjustment for anxiety/depression.

Conclusions  Somatization was strongly associated with nonspecific eczema. This applies to a whole range of somatic symptoms constituting the construct of somatization. There is hardly any mention of somatization in leading dermatological journals, in contrast to anxiety and depression which are frequently reported in eczema. We speculate that this under-recognition of somatization in the dermatological literature may correspond to under-recognition of this factor also in clinical practice.

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