Psychodermatology and psychocutaneous medicine are unfamiliar terms to many physicians. It is reported that up to 18% of dermatologists routinely prescribe psychotropic drugs. These terms describe a field of medicine that focuses on the interface between psychiatry and dermatology. In a surprisingly large proportion of dermatologic disorders, the understanding of the psychosocial and, sometimes, the occupational context is critical for optimal patient management. Examples range from common skin rashes, such as eczema or psoriasis, to flare-ups during emotional stress, to cases in which there is no real skin disorder, but the patient targets his or her skin to express an underlying psychopathologic condition. Neurotic excoriations, trichotillomania, and delusions of parasitosis are examples. Moreover, because skin disease is visible, patients commonly experience a significant negative impact on their psychological stability resulting from the disfigurement caused by their skin disorder. Patients with disfiguring skin disorders, such as alopecia areata, vitiligo, and psoriasis, frequently report problems with self-esteem, depression, and social anxiety.

The management of psychodermatologic disorders requires special skills. First, to understand what is going on and what the actual diagnosis is, a clinician must not only evaluate the skin manifestation based on the usual dermatologic differential diagnosis, but also evaluate the underlying psychopathology and the relevant social, familial, and occupational issues.

Once the diagnosis is made, optimal management often requires a dual approach to address both the dermatologic and the psychological aspects. Even in cases where the main problem is psychopathologic and the skin manifestations are entirely self-induced, the authors cannot overemphasize the importance of maintaining supportive dermatologic care to avoid secondary complications such as infection and to ensure that the patient does not feel “abandoned” by the nonpsychiatric physician. Such demonstrated support by the nonpsychiatric physician can enhance acceptance of a psychiatric consultation or referral by the patient, should there be a need for one. At the same time, it is important for the clinician to try to understand the nature of the underlying psychopathology so that the appropriate psychiatric management can be initiated. This ranges from providing appropriate psychotropic medication and encouraging the patient to attend stress management courses to making a formal referral to a psychiatrist (depending on the severity of the underlying psychopathology). Psychodermatology cases, just like those in any other field of medical practice, can range from mild to severe. In fact, when a clinician becomes aware of the mind-skin interaction and looks for psychological elements in patients, he or she finds that the large majority of these patients have easily treatable psychopathologies impacting their skin disease, such as situational stress or mild depression. Clinicians who are not fully aware of this field may only be reminded of the skin-mind interaction when they encounter the most difficult and most florid cases, such as delusions of parasitosis. It is the recommendation of the authors that clinicians become familiar with the entire range of psychodermatologic disorders so that their perception of this field is not warped by only being forced to deal with the most difficult and frustrating cases.