Behavioral medicine: International perspectives, volume 1: Edited by Don G. Byrne and Glenn R. Caddy. Norwood, New Jersey, Ablex Publishing Corp., 1992 ($65.00), 409 pp

Abstract

In at least one third of dermatology patients, effective management of the skin condition involves consideration of the associated emotional and psychosocial factors.38, 62 In certain dermatologic disorders, the placebo response is greater than 30%,5, 29, 59 which confirms further the important role of psychosomatic factors in dermatology. Psychotropic drugs are an important part of the dermatologists' therapeutic armamentarium.24, 29, 44 This article updates the possible dermatologic uses of the following major classes of psychotropic agents: (1) the antianxiety and hypnotic agents (see Tables 4 and 5), (2) the antidepressants (see Tables 6 and 7), and (3) the antipsychotic agents (see Tables 8 and 9). The specific guidelines, side-effect profile, drug– drug interactions, and most current indications56 always should be obtained for any particular psychotropic agent before it is prescribed.When considering the use of psychotropic agents in dermatology, two major factors should be considered: (1) proper diagnosis of the psychiatric disorder and (2) determination of the existence of proper indications for use of psychotropic agents. When assessing for possible psychiatric comorbidity, the dermatologist should consider the two major classifications in psychodermatology24, 43, 44, 47: (1) cutaneous associations of psychiatric disorders (see Table 1) and (2) the psychiatric aspects of dermatologic disorders (see Table 2). When the presence of psychiatric comorbidity is established, psychotropic agents may not be the primary treatment of choice because other treatment modalities, such as psychotherapy and cognitive-behavioral therapy, may be a more effective or appropriate form of treatment. In some instances, psychotropic agents are used in dermatology because some of their properties are beneficial in primary dermatologic disorders, independent of psychiatric comorbidity, such as the use of the antidepressant doxepin in the treatment of urticaria because of its strongly antihistaminic properties.56 Few studies have examined the use of psychotropic agents in dermatologic disorders in the absence of psychiatric comorbidity,2 and this potentially important area of psychodermatology requires more systematic study. Massage therapy64 may be of benefit in conjunction with psychotropic agents.