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Our pilot study deals with the systematic investigation of the clinical experience that, in correlation with psychosocial events, atopic dermatitis may take an unexpected course (deterioration or improvement) during hospitalization. We describe our procedures regarding the proposal of hypotheses, the operationalization of the variables "deterioration of eczema" and "psychosocial factor", and our methods in gaining the data required. In the evaluation of 19 courses of treatment, we first checked the possible correlations between individual deterioration of eczema and various psychosocial events. We had to rule out, however, that a positive reaction like this was purely coincidental. In this respect, the event "confrontation with every day life" has significantly been confirmed. We discuss possible further studies which may ensue from our psychosomatic research concept.

Patients with self-inflicted skin disorders form a rather heterogeneous group. Our paper is intended to provide the practitioner with some orientation concerning interaction and therapeutic procedure in patients with artefactual skin diseases. Basically, these patients should be differentiated according to what extent they are aware of their manipulations. This degree of awareness should then be the guideline for a well-dosed and sensitive confrontation with their manipulative behavior. In any case, a positive result of the confrontation largely depends on the confidential relationship between physician and patient.

70 patients suffering from atopic dermatitis and receiving in-patient care were discharged for one or two days upon achieving an improved and stable dermatological state. Back in hospital after their short-term demission, two thirds of these patients showed a deterioration of their cutaneous condition. The majority of them were able to perceive a connection between their worsened skin condition and the acute psychosocial constellation during their brief stay at home. A second short-term demission brought about more acceptable and steady skin conditions, especially in patients treated psychosomatically. Some of the patients declared definite changes in their own modes of behavior to be responsible for this stabilized improvement.

We studied both the frequency of changes in the therapeutic management regarding in-patients with skin diseases and the estimation of these changes by dermatologists, nurses, and the patients concerned. Changing the procedures of topical treatment have been found a special source of conflict between doctors, nurses, and patients.

We report on psychosomatic aspects regarding out-patient and hospital treatment of atopic dermatitis, including information concerning the disease, motivation for psychotherapeutic forms of treatment (relaxation, diagnostic and therapeutic conversation), as well as psychosomatic indicators for the discharge from hospital.

Our psychodiagnostic studies were concerned with two female patients considering themselves disfigured although their residual somatic findings were only minimal. Two main factors could be derived from analysis: "feelings of anxiety and insecurity" and "obsessive-compulsiveness". The compulsive and sometimes paranoid ideas of the patients suffering from dysmorphophobia require differentiated conclusions by the doctor.