PSYCHODERMATOLOGY
Jun
2013
Vol. 32. No. 2
Introduction
In a busy dermatology practice, we frequently encounter
patients whose psychological problems appear just as important
as their dermatological ones. Some examples include
patients with delusion of parasitosis (Morgellons syndrome),
neurotic excoriations, trichotillomania, cutaneous sensory
disorder and any patient whose skin condition is worsened
with emotional stress. Studies have shown that as many as
one-third of dermatology patients have a significant psychological
issue in connection with their skin complaint.
Therefore, it is helpful in clinical practice to know as much
as possible about the management of psychological issues in
dermatology. On the other hand, despite its high relevance to
our practice, psychodermatology is rarely covered in dermatology
residency programs. In this issue of Seminars in Cutaneous
Medicine and Surgery, we provide a rare opportunity to
learn about psychodermatology. You will find the papers
presented herein to be concise and clinically useful.
This issue covers many important topics such as the optimal
approach to the psychodermatology patient, the role of
emotional stress in worsening skin conditions, and the impact
of disfiguring skin disorders on quality of life. We also
review the diagnosis and management of well-known psychodermatological
disorders, such as delusional disorders,
cutaneous sensory disorders, body dysmorphic disorders,
obsessive-compulsive disorders in dermatology, trichotillomania,
onychophagia, and neurotic excoriations. Lastly, both
pharmacologic and nonpharmacologic approaches to the
management of psychodermatology patients are discussed.
We hope that you find this issue easy to comprehend and
practical. Now that you have a compendium of psychodermatology
in your hands, you are about to embark on an
exciting journey. As you flip through the pages of this issue,
you will uncover some fascinating topics in psychodermatology
written by well-known experts in dermatology and psychiatry
from around the world.
Psychodermatology: An Overview
Psychodermatology is an interface between dermatology and psychiatry. The different
disorders within psychodermatology can be categorized in 2 ways: by the type of psychodermatologic
disorder or by the underlying psychiatric disorder. The types of psychodermatologic
disorders include psychophysiological, primary psychiatric, secondary
psychiatric, and cutaneous sensory disorder. The psychiatric disorders include anxiety,
depression, obsessive-compulsive disorder, and psychosis. This manuscript gives an overview
of the different psychodermatologic disorders, underlying psychiatric disorders, and
how to manage psychodermatology cases.
Semin Cutan Med Surg 32:64-67 © 2013 Frontline Medical Communications
MORE
Emotional Stress as a Trigger for Inflammatory Skin Disorders
Dermatologic disorders comprise 15% to 20% of complaints seen in general practice. Skin
disorders result in a negative impact to the patient not only physically but also psychologically,
socially, and occupationally. The most common trigger for several inflammatory skin
disorders, including psoriasis, is emotional stress. Understanding the significance of
emotional triggers to common inflammatory dermatologic disorders is critical to the optimal
management of these conditions. This article will provide an overview of the effects of
emotional stress on skin disorders and psychotherapeutic options.
Semin Cutan Med Surg 32:68-72 © 2013 Frontline Medical Communications
MORE
Delusions of Parasitosis
The most common monosymptomatic hypochondriacal psychosis encountered by a dermatologist
is delusions of parasitosis. In this condition, patients have an “encapsulated”
fixed, false belief that they are infested with parasites or have foreign objects extruding from
their skin. The patient will often experience feelings of biting, crawling and stinging related
to the delusion. Most patients do not have other major psychiatric problems outside of their
encapsulated delusion. The patient usually presents with a long history of symptoms and
multiple visits to physicians in more than one specialty. Without an informed approach to
these patients that focuses on the development of therapeutic alliance, clinical interactions
can become very unpleasant. However, when treated with pimozide, risperidone, or other
antipsychotic medications, patients have a very high response rate. Therefore, it is important
for dermatologists to be able to handle these cases and know that the development of
the therapeutic alliance is the key step to successful management.
Semin Cutan Med Surg 32:73-77 © 2013 Frontline Medical Communications
MORE
Body Dysmorphic Disorder
Body dysmorphic disorder (BDD) is a DSM-IV disorder that is characterized by a distressing
and excessive preoccupation with a slight or imagined defect of a physical feature. BDD
causes significant impairment of psychosocial functioning and a decreased quality of life
for patients. Though the disorder is commonly seen in the dermatology setting, the disease
remains under recognized and under-treated. It is important for dermatologists to be aware
of BDD as patients suffer greatly from the disease. In this review, we provide an update on
the epidemiology, clinical features, and treatment options for BDD.
Semin Cutan Med Surg 32:78-82 © 2013 Frontline Medical Communications
MORE
Obsessive-Compulsive Disorder in Dermatology
Obsessive-compulsive disorder (OCD) is a very common disorder affecting 2% to 3% of
the general population. Up to 25% of patients presenting to physicians with skin disease
suffer from OCD. Only 20% of all patients with OCD are receiving treatment. Unfortunately,
those few receiving treatment remained undiagnosed for many years. Standard
treatment includes behavioral therapy and psychotropic drugs (ie, selective serotonin
re-uptake inhibitors and clomipramine). The highest dosages of these medications must be
used for at least 3 months to see proper effectiveness and maintained for lengthy periods
of time. Not only are there abnormalities in the serotonin pathway of patients with OCD but
also the glutamate pathway is abnormal, leading to possible new treatment strategies.
Semin Cutan Med Surg 32:83-87 © 2013 Frontline Medical Communications
MORE