[Phobic neuroses presenting as "intolerance reaction of the skin"]

Intolerance reaction of the skin refers to multiple reaction patterns, including toxic, allergic, pseudo-allergic and even psychiatric mechanisms. In our case, a patient was diagnosed for years as having "multiple allergies", but except for a documented contact allergy to a local anesthetic, her underlying disease was panic disorder with multiple phobias. Using this case study with one year follow-up, hypotheses are discussed about effective psychotherapy in patients with intolerance reactions of the skin. Differential indications are explored with reference to the latest investigative results in psychoneuroimmunology. In this patient, psychotherapy helped the phobias and eliminated her conviction that she had multiple allergies. In addition, the positive pre-therapy allergy testing was not reproducible. The dermatologist should not expect such patients to present with phobias, because they frequently shift their phobic anxiety into the fear of allergic reactions to escape from the label of having psychiatric disease. Such patients should receive psychotherapy if they begin to generalize their avoidance behavior and limit their social contacts.