Psychocutaneous Disorders

5

Psychocutaneous Disorders

Introduction

• Psychodermatology refers to any aspect of dermatology in which psychological factors play a significant role.

• Psychodermatologic disorders can be classified in two ways: (1) by the specific psychodermatologic condition or (2) by the underlying psychopathology (Fig. 5.1).

Fig. 5.1 Classification of the psychodermatologic disorders.

• Treatment is simplified by basing the choice of psychotropic medication or therapy on the underlying psychopathology (Table 5.1).

• The more commonly encountered primary psychiatric disorders in dermatology include body dysmorphic disorder, psychogenic (neurotic) excoriations, acne excoriée, trichotillomania, dermatitis artefacta, and delusions of parasitosis.

• Because many of these patients with primary psychiatric disorders present to the dermatologist and not the psychiatrist, it is important to establish the correct diagnosis and to offer appropriate treatment options.

The More Common Primary Psychiatric Disorders Seen in Dermatology

Body Dysmorphic Disorder

• Characterized by a distressing or impairing preoccupation with a nonexistent or slight defect in appearance.

• On a psychiatric spectrum from obsessional to delusional.

• Mean age of onset is 30–35 years; females = males; present in up to 10–15% of dermatologic patients.

• Patients usually concerned with nose, mouth, hair, breasts, or genitalia.

• Often adopt obsessional (e.g., numerous visits to physician for reassurance), ritualistic (e.g., excessive grooming routines), or delusional (e.g., multiple unnecessary surgeries) behaviors.

• Consider and assess for this diagnosis in patients seeking multiple cosmetic procedures.

• Rx: selective serotonin reuptake inhibitors (SSRIs) for obsessive–compulsive disorder (OCD) variant or antipsychotics for delusional variant.

Psychogenic (Neurotic) Excoriations

• A conscious, repetitive, uncontrollable desire to pick, rub, or scratch skin.

• On a psychiatric spectrum most closely related to OCD but may also be an expression of generalized anxiety disorder or depression.

• Most common in middle-age; females > males.

• Favors scalp, face, upper back, extensor forearms, shins, buttocks.

• Lesions usually in all stages of evolution: erosions (prurigo simplex), deep circular or linear ulcerations with hypertrophic borders, hypo- or hyperpigmented scars (Fig. 5.2); admixed well-healed scars point to chronicity.

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Apr 22, 2016 | Posted by admin in Dermatology | Comments Off

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