[논문]La pelade est-elle une maladie psychosomatique ?

Misery, L; Rousset, H

doi:10.1016/s0248-8663(00)00328-3

[해외논문] La pelade est-elle une maladie psychosomatique ?
Is alopecia areata a psychosomatic disease?.

La Revue de médecine interne, v.22 no.3, 2001년, pp.274 - 279

Misery, L (Service de dermatologie, hô) , Rousset, H (pital Nord, 42055 Saint-É)

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AbstractIntroduction. – Destruction of hair follicles by lymphocytes induces alopecia aerata. Hence, immunological mechanisms are involved in this disease, as for numerous dermatoses. Nonetheless, alopecia aerata appears to be a psychosomatic disease. Is there any contradiction?Current knowledge and key points. – Alopecia aerata often occurs after stress, particularly during mourning. Psychiatric disorders are more frequent in patients with alopecia than in healthy subjects. But these disorders might be secondary to the visible hair disease. Psychopathological mechanisms need to be clarified but alexithymia seems to be the key for understanding how stress could induce hair loss. In the skin (and the scalp) all functions are narrowly controled by nerve fibers. Among these functions are hair growth and immunity. Immune cells and hair follicle cells possess receptors for neurotransmitters, which are synthesized by neuronal endings. When activated, these receptors are able to modulate cell properties. The same phenomena are described with stress-induced hormones. In alopecia aerata, like in numerous other diseases, psychosomatics and immunology are not opposed because immune cells are controlled by the nervous system through neurotransmitters.Future prospects and projects. – Research needs to be thorough in both the fields of psychology and neurobiology. Psychotherapies or psychotropes appear to be useful in the treatment of alopecia aerata.

Abstract

RésuméIntroduction. – Au cours de la pelade, les follicules pileux sont détruits par des lymphocytes. Ainsi, des mécanismes immunologiques interviennent, comme dans de nombreuses dermatoses. La pelade est souvent considérée comme une maladie psychosomatique. Y a-t-il une contradiction ?Actualités et points forts. – La pelade semble survenir souvent après un stress, surtout lorsque celui-ci est suivi dˈun deuil au sens large du terme. Bien que des troubles psychiatriques soient plus fréquents chez les patients atteints de pelade que chez les autres, le lien de cause à effet n’est pas clair. Il semble plutôt que lˈon retrouve chez ces malades une réaction inappropriée aux stress en relation avec lˈalexithymie. Les mécanismes psychopathologiques sont encore mal connus et demandent à être précisés. Dans la peau (et donc le cuir chevelu), les fibres nerveuses contrôlent de manière étroite toutes les fonctions cutanées, parmi lesquelles la croissance pilaire et lˈimmunité cutanée. Les cellules immunitaires (dont les lymphocytes) ou celles des follicules pileux possèdent en effet des récepteurs pour les neuromédiateurs produits par les terminaisons neuronales. Lˈactivation de ces récepteurs permet la modulation de leurs propriétés. On observe les mêmes phénomènes avec les hormones sécrétées en réponse à un stress. Comme dans de nombreuses autres maladies, psychosomatique et intervention de lˈimmunité ne sont pas contradictoires. Au contraire, le système nerveux intervient en modulant les propriétés des cellules immunes par lˈintermédiaire des neuromédiateurs.Perspectives et projets. – Dans le cas de la pelade, la recherche doit être poursuivie dans le champ de la psychologie comme dans celui de la neurobiologie. Sur le plan thérapeutique, les psychothérapies et/ou les psychotropes peuvent avoir un intérêt en association avec dˈautres traitements.

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