Psychodermatology: practical aspects of diagnosing autodestructive dermatoses on the example of our own clinical observations

Abstract

The study of the features of the relationship between the mental state of the patient and skin pathological processes at the present stage is especially relevant. This is due not only to an increase in the prevalence of psycho-dermatological comorbidity, but also to the pathogenetic features of the formation of the clinical picture of this pathology, which make it difficult to diagnose. Skin lesions can either be a consequence of a primary psychiatric illness or induce the development of concomitant psychosocial illnesses. At the same time, mental disorders masked by skin manifestations combine, as a rule, skin lesions due to self-harm. Their clinical picture can mimic the symptoms of a number of nosologies, including not only dermatological pathology, but also systemic diseases with skin manifestations. The artificiality of rashes may not always be obvious, which often leads to the erroneous involvement of doctors of various specialties in the diagnostic search and prolongs the time for making the correct diagnosis. The article presents our own clinical observations of patients with autodestructive dermatosis, in which the verification of the diagnosis was accompanied by diagnostic errors, which caused pronounced destructive changes. In the analysis of the above clinical observations, attention is focused on the features of the skin pathological process, aspects of differential diagnosis, as well as insufficient awareness of primary health care professionals about this problem. Increased awareness of doctors of related specialties can contribute to clinical alertness, reduce the time of diagnosis and timely start of therapy for these patients by a psychiatrist, which will reduce the risk of an increase in the severity of the disease and social exclusion of patients.