Abstract
Background: Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety particularly for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions; and to compare each dermatological group versus healthy control subjects. Methods: This prospective cross-sectional study was conducted in dermatology outpatient clinics in Khartoum. Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D). ICD-10 criteria were used for clinical psychiatric diagnosis. Tabulated results were analyzed using Chi-square test. Significance was set at P P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Similarly, HADS-A scores above the cut off points were significantly higher in patients with psoriasis (P P = 0.0001), acne (P = 0.0143) and eczema (P = 0.0281) compared with healthy subjects. No significant difference between the control group and patients with other dermatologic conditions regarding both HADS-D and HADS-A scores. Using ICD-10 criteria for clinical psychiatric diagnoses indicated that 52.3% of dermatology patients had an associated ICD-10 diagnosis; most commonly anxiety disorders (28.6%), and depression (21.9%). ICD-10 diagnoses of anxiety disorders included: OCD (13.3%) generalized anxiety disorder (5.7%), panic disorder (4.8%), phobic anxiety disorder (3.8%) and post-traumatic stress disorder (0.95%). Conclusion: Dermatological conditions are associated with high rates of psychiatric comorbidity. Screening for anxiety and depressive symptoms may be helpful for early diagnosis and management of associated psychiatric symptoms.
Highlights
Dermatological conditions can be associated with high psychiatric comorbidity
The sample included 19 patients presented with psoriasis, 24 patients with vitilligo, 16 patients with eczema and 20 patients with acne in addition to a fifth group composed of 26 patients with miscellaneous dermatological diagnoses such as cutaneous lishmaniasis, drug eruptions, pemphigus, mycosis fungoid, urticaria, alopecia areata, ...etc
No significant differences were found between the control group and patients with other dermatologic conditions regarding both Hospital Anxiety and Depression Scale (HADS)-D and HADS-A scores
Summary
Dermatological conditions can be associated with high psychiatric comorbidity. Several studies reported high rates of depression and anxiety for specific dermatological disorders such as psoriasis and acne. Aim: The aim of this study was to compare the rates of psychiatric symptoms in patients with psoriasis, acne, vitiligo, and eczema versus patients who had other dermatological conditions; and to compare each dermatological group versus healthy control subjects. Results: HADS-D scores above the cut off points were significantly higher in patients with psoriasis (P = 0.0062), vitiligo (P = 0.0054), acne (P = 0.0103) and eczema (P = 0.0359) compared with healthy subjects. Psychiatric and psychological factors are thought to play a role in at least 30% of dermatologic disorders [3] It is well-known that psychological stress leads to activation of the HPA axis which can result in undesirable physiological responses including the exacerbation of dermatological conditions. The activity of mast cells, Natural killer (NK) cells or dendrites in the skin are influenced by neuroendocrine mediators including Corticotrophin Releasing Factor (CRF), adrenocorticotropic hormone (ACTH), substance P, glucocorticoids and catecholamines [5]
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