Psychodermatology. Practical guidelines on pharmacotherapy.

Abstract

The importance of emotional factors in dermatologic disorders has been recognized for several decades. However, there have been few reports on the management of psychodermatologic disorders. Meanwhile, there has been tremendous progress in the pharmacologic treatment of these conditions. This article describes major categories of psychodermatologic disorders and provides practical management guidelines, emphasizing the use of selected psychopharmacologic agents. Psychodermatologic conditions can be divided into three broad subgroups: psychophysiologic disorders in which the severity of primary cutaneous disease is influenced by the patients' emotions; primary psychiatric disorders in which the skin conditions are self-induced and reflect underlying psychopathologic conditions; and secondary psychiatric disorders in which the patients experience psychologic problems as a result of disfigurement associated with the skin conditions. There are many ways to manage these psychodermatologic conditions, including psychotherapy, behavioral therapy, and psychopharmacotherapy. To determine which pharmacologic agent is most appropriate, the nature of the underlying psychopathologic condition such as anxiety, depression, psychosis, and obsession/compulsion should be identified. Furthermore, there are nonpsychiatric disorders encountered by dermatologists in which psychopharmacologic agents may be more efficacious than conventional therapeutics. We conclude that psychopharmacologic agents provide a useful option to the management of psychodermatologic disorders.