Serum Levels of IL-6 and TNF-α, Salivary Morning Cortisol and Intensity of Psychological Stress in Patients with Allergic Contact Hand Dermatitis and Healthy Subjects

Abstract

Introduction: Allergic contact dermatitis (ACD) is a form of late hypersensitivity reaction of skin contact with allergens. As an inflammatory skin disease, ACD has a negative impact on the quality of life and there is a need to elucidate the etiopathogenetic factors of the disease, whereby using the psychoneuroimmunological (PNI) approach can be helpful. Psychological stress (PS), as a component of PNI, leads to aggravation of the contact hypersensitivity reaction. In response to the perception of PS, cortisol secretion is enhanced by activation of the hypothalamic–pituitary–adrenal (HPA) axis. Furthermore, the pro-inflammatory cytokines interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) play a role in activating the HPA axis as well as initiating and maintaining inflammatory responses. Recent studies show that IL-6, IL-1, and TNF-α values are increased in the serum of patients with contact dermatitis, as well as in keratinocyte cell culture. Methods: The study examined the association of PNI factors (serum IL-6 and TNF-α, stress intensity with a Perceived Stress Scale (PSS) questionnaire, quality of life of dermatology patients with a Dermatology Life Quality Index (DLQI)) with the disease severity evaluated using the Hand Eczema Extent Score (HEES) and the duration of disease in hand ACD patients. Results: Patients with hand ACD had higher PSS (p = 0.001) than healthy people, with no difference in IL-6 and TNF-α. Higher DLQI was associated with higher HEES and PSS (p = 0.002 and p < 0.001) and these were the only predictors of DLQI. The duration of the disease was not related to the investigated factors. Conclusion: This study is the first so far, to our knowledge, in which a detailed analysis of PNI factors in patients with hand ACD was conducted. The results show that patients with ACD have higher PS intensity, which can chronically indicate changes in the balance of the HPA axis and indirectly affect the quality of life and disease severity of this disease. The results of the research provide more knowledge about hand ACD and contribute to and emphasize the importance of a multidisciplinary approach to treatment, thus improving the quality of life of these patients.