Psychiatry

There can be no doubt that emo­tional disturbances are of great im­portance in aggravating atopic derma­titis. That they are ever a primary cause, I do not believe, and I cannot agree with those who think that psy­chiatric treatment is the most im­portant thing in dealing with these patients. Like all good things, the psychiatric aspects of atopic dermatitis have been overemphasized. The older the patient, the more important psychiatry is; I am very doubtful that it has much to do with atopic dermatitis in babies, in spite of what some enthusiasts have said, except that when they are overtired or over­excited they scratch more. There can be no doubt, however, that in older children mental tension of any sort can aggravate the eczema. This is particularly true of girls and boys in high school or college who are con­scientious about their studies and are having difficulty with them-atopic dermatitis is always worse before an examination. I think a good deal of the necessary psychotherapy can be done by the pediatrician, but if it is obvious that there are deep-seated and long-standing psychiatric diffi­culties, he will do better to send the patient to a psychiatrist, for tech­niques which we do not have are necessary in dealing with such pa­tients.