Non-Pharmacological Psychosomatic Approaches to Patients With Atopic Dermatitis: A Delphi Consensus of Expert Opinions in Japan.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by persistent itch and a prolonged clinical course and can affect mental health and impair quality of life. Stress and anxiety exacerbate the symptoms of itch, leading to a vicious cycle that influences patient scratching behaviors and worsens disease prognosis. Dermatologists should consider psychosomatic correlations in patients with AD and provide psychosomatic intervention. However, standardized, consensus-based non-pharmacological psychosomatic approaches for patients with AD have not been established in Japan. This study sought to establish a Japanese consensus on non-pharmacological psychosomatic approaches to patients with AD. Japanese experts in psychosomatic dermatology stated their level of agreement with 28 items in round 1 plus one added in round 2 (29 items in total) regarding psychosomatic approaches as non-pharmacological approaches among patients with AD over Delphi rounds. Consensus was defined a priori as agreement from ≥ 75% of participants. The response rate was 17/21 (81.0%) in the first round and 17/17 (100%) in the second round. Twenty-five statements were adopted over both rounds. Performance of medical interviews and physical examinations, recognition of patient efforts, and respect for the interpretive model of the patient categorized to establish a good therapeutic relationship showed agreement. Evaluation of pathology from physical and psychological perspectives (addictive scratching, building a bio-psycho-social [BPS] model and pathophysiological hypothesis) showed high-level agreement. Indirectly promoting patient awareness of aggravating factors of AD and sharing the BPS model and pathophysiological hypothesis with the patient showed consensus. Further, 14 statements about the application of psychosomatic correlations to therapy showed agreement. In the second round, group therapy also gained consensus as a useful intervention. Our Delphi panel provides recommendations about psychosomatic interventions for patients with AD to standardize approaches in clinical practice and research.