Nocebo effect in dermatology.
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Date
2015-05
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Abstract
Nocebo effect, originally denoting the negative counterpart of the placebo phenomenon,
is now better defined as the occurrence of adverse effects to a therapeutic intervention
because the patient expects them to develop. More commonly encountered in patients with
a past negative experience, this effect stems from highly active processes in the central
nervous system, mediated by specifi c neurotransmitters and modulated by psychological
mechanisms such as expectation and conditioning. The magnitude of nocebo effect in
clinical medicine is being increasingly appreciated and its relevance encompasses clinical
trials as well as clinical practice. Although there is hardly any reference to the term nocebo
in dermatology articles, the phenomenon is encountered routinely by dermatologists.
Dermatology patients are more susceptible to nocebo responses owing to the psychological
concern from visibility of skin lesions and the chronicity, unpredictable course, lack of
‘permanent cure’ and frequent relapses of skin disorders. While fi nasteride remains the
prototypical drug that displays a prominent nocebo effect in dermatologic therapeutics, other
drugs such as isotretinoin are also likely inducers. This peculiar phenomenon has recently
been appreciated in the modulation of itch perception and in controlled drug provocation
tests in patients with a history of adverse drug reactions. Considering the confl ict between
patients’ right to information about treatment related adverse effects and the likelihood of
nocebo effect stemming from information disclosure, the prospect of ethically minimizing
nocebo effect remains daunting. In this article, we review the concept of nocebo effect,
its postulated mechanism, relevance in clinical dermatology and techniques to prevent it
from becoming a barrier to effective patient management.
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Keywords
Dermatology, drug rechallenge, finasteride, nocebo, placebo
Citation
Sonthalia Sidharth, Sahaya Kinshuk , Arora Rahul , Singal Archana , Srivastava Ankur, Wadhawan Ritu, Zartab Hamed, Gupta Kripa Shankar. Indian Journal of Dermatology, Venereology and Leprology. 2015 May-Jun; 81(3): 242-250.