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. 2022 Oct;12(10):2383-2395.
doi: 10.1007/s13555-022-00814-x. Epub 2022 Sep 21.

Release of Cervical Muscle Tension Improves Psychological Stress and Symptoms of Moderate-to-Severe Atopic Dermatitis: a Case Series with 20 Patients

Shusaku Hosono  1   2 , Koji Fujita  3 , Akimoto Nimura  4 , Keiichi Akita  1
Affiliations

Release of Cervical Muscle Tension Improves Psychological Stress and Symptoms of Moderate-to-Severe Atopic Dermatitis: a Case Series with 20 Patients

Shusaku Hosono et al. Dermatol Ther (Heidelb). 2022 Oct.

Abstract

Introduction: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease that is triggered by intense pruritus, impaired skin barrier function, and immune responses to allergenic substances. Break-through therapies for AD include molecular-targeted drugs and the effective management of severe symptoms of AD. However, patients with clinical improvements may continue scratching owing to the influence of psychological stress, which might lead to quick relapses of stressors and subsequent intensive scratching. New drugs may be ineffective because of such scratching behavior caused by stressors. Therefore, it may be useful to consider adjunctive treatment options that focus on external stressors as triggers of deterioration of AD. We hypothesized that improvement of psychological stress by relieving cervical muscle tension would reduce pruritus and atopic symptoms.

Methods: Overall, 21 patients with moderate-to-severe AD were treated to relieve cervical muscular tension using Spineliner SA201, which assists in osteopathic manipulative treatment. We assessed the subjective and objective symptoms of AD, cervical muscle tension, which was evaluated using cervical range of motion (ROM), and psychological burden. Only moisturizers were applied topically during the study period, and no topical corticosteroid therapy was used.

Results: Twenty patients who completed the treatment demonstrated improvement in the symptoms of AD: changes on the visual analog scale (VAS) for pruritus were -44.2%, Eczema Area and Severity Index (EASI) was -67.9%, thymus and activation-regulated chemokine (TARC) was -56.2%, Hospital Anxiety and Depression Scale (HADS) was -27.2%, sleep disturbance was -49.7%, and Dermatology Life Quality Index (DLQI) was -46.7%. Additionally, the cervical muscle tension improved significantly: changes in cervical ROM were 14.7%.

Conclusions: Release of cervical muscle tension may improve psychological stress and have an effect on moderate-to-severe AD.

Keywords: Atopic dermatitis; Cervical muscular tension; Itch–scratch cycle; Psychological stress.

Plain language summary

Atopic dermatitis is a chronic relapsing inflammatory skin disease triggered by intense pruritus, impaired skin barrier function, and immune responses. Standard dermatological therapies for patients with atopic dermatitis include topical glucocorticoid treatments. In some cases, scratching and inflammation could not be adequately controlled, a relapse could not be prevented after remission, and their efficacy is limited. Break-through therapies for atopic dermatitis include new molecular biological drugs, which have demonstrated significantly improved and effective management of severe atopic symptoms. However, patients with clinical improvements may continue scratching owing to psychological stress, which might lead to quick relapses of stressors and subsequent intensive scratching. New drugs may be ineffective owing to such scratching behavior caused by stressors. Therefore, it may be useful to consider adjunctive treatment options focusing on external stressors as triggers for worsening atopic dermatitis. We hypothesized that improvement of psychological stress by relieving cervical muscle tension would reduce pruritus and atopic symptoms. Overall, 21 patients with moderate-to-severe atopic dermatitis were treated to relieve cervical muscular tension using Spineliner SA201, which assists in osteopathic manipulative treatment. We assessed the subjective and objective atopic symptoms, cervical muscle tension, and psychological burden. Only moisturizers were applied topically during the study period, and no topical corticosteroid therapy was used. Twenty patients completed the treatment, atopic symptoms improved significantly, cervical muscular tension improved, and the psychological burden decreased with the treatment. Release of cervical muscle tension may improve psychological stress and affect moderate-to-severe atopic dermatitis.

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Figures

Fig. 1
Fig. 1
Effects of Spineliner SA201 (Sigma Inc., Cranberry Township, PA, USA) treatment on patient-reported outcomes and cervical muscle tension. (a) VAS score for pruritus after the treatment. The VAS score for pruritus decreased significantly after the treatment. (b) Cervical ROM after the treatment. The cervical ROM improved significantly after the treatment. (c) VAS for sleep disturbance after the treatment. VAS score for sleep disturbance decreased significantly after the treatment. (d) DLQI after the treatment. DLQI decreased significantly after the treatment. DLQI Dermatological Life Quality Index, ROM range of motion, VAS visual analog scale
Fig. 2
Fig. 2
Effects of Spineliner SA201 (Sigma Inc., Cranberry Township, PA, USA) treatment on different markers of atopic dermatitis. (a) Serum levels of TARC reduced remarkably after the treatment. (b) Peripheral blood eosinophil count reduced after the treatment. (c) Serum levels of LDH reduced after the treatment. (d) Serum levels of total immunoglobulin (Ig)E did not change significantly after the treatment. LDH lactate dehydrogenase, TARC thymus and activation-regulated chemokine
Fig. 3
Fig. 3
Relationship between psychological stress, cervical stiffness, and itch–scratch cycle. Psychological stress can provoke or exacerbate pruritus and increase cervical stiffness. Psychological stress and itching form a vicious cycle, which exacerbates itching, scratching, impaired barrier function, and further stress. The release of cervical stiffness can break the cycle
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