Psychocutaneous Disease Research Articles

Psychocutaneous Medicine: Current Global Understanding and Imperatives for Continuing Medical Education and Training Opportunities: A Systematic Review

Abstract The intersection of dermatology and psychiatry has gained significant attention in recent years. Psychocutaneous disease affect patient population, who have undiagnosed and undertreated ailments related to the body and mind. These patients suffer a reduce quality of life due to knowledge gaps and reduce awareness about psycho dermatology. This review aims to assess the integration of psychopharmacology topics in continuing medical education programs (CME) and its relevance in clinical practice, it's impact on healthcare professionals’ quality of care, and existing knowledge gaps among trainees and young dermatologists. To identify data from inception up to December 2023, a systematic literature review and search was conducted following PRISMA guidelines. Pubmed, Cochrane, and Embase databases were searched using predefined terms including “continuing medical education”, “dermatology”, “psychology”, “psychodermatology”, “psychocutaneous”, “awareness” and “practice patterns”. Inclusion criteria comprised studies evaluating CME programs, clinical studies and reviews published in English language. Studies were excluded if they were single case reports. A total of 93 studies were identified and 12 were included in this review following screening, removal of duplicates, and application of inclusion criteria. Studies revealed lower level of confidence among professionals in handling psycho cutaneous conditions, limited awareness of available resources and high interest in CME programs. Initiatives like video mentoring and clinical skills lessons showed promise but are currently scarce. Examined data from selected studies demonstrate that current CME programs in psychodermatology lack depth, leaving practitioners feeling ill equipped and unaware of available resources. There is substantial global interest in enhancing these programs. Given the breadth of conditions covered, educating dermatologists is crucial for enhanced patient outcomes and satisfaction. Addressing resource scarcity and patient stigma is imperative to develop specialized programs. Improvement to education can drive stronger outcomes and holistic patient care. Future efforts should prioritize refining program strategies and conducting thorough assessments to maximize impact.

Evaluation and Approach to Patients with Psychodermatoses

Abstract Psychodermatology is an emerging subspecialty of dermatology. It encompasses the management of patients with primary psychiatric disease presenting to dermatologists (e.g., delusional infestation, body dysmorphic disease, and factitious diseases), together with patients who have primary dermatological disease (e.g., psoriasis, atopic eczema, hair disorders, and others) with a psychiatric or psychological comorbidity. This review presents a practical approach to patients with psychocutaneous disease keeping in mind that the management requires the input of a wide multidisciplinary team including dermatologists, psychiatrists, psychologists, and primary care physicians, among others. The aim is to provide an overview on effectively building a therapeutic alliance with a psychodermatology patient in order to improve therapeutic outcomes. Dermatologists should be able to initiate basic pharmacotherapy, have a basic knowledge of nonpharmacological therapies, and be able to judge which patients need urgent psychiatric referral. Awareness of this group of disorders will enable a holistic management that takes care of body as well as the mind.

Effectiveness of Vamana Karma in Kitibha Kustha with special reference to Psoriasis – A Case Study

Any disease pertaining to skin causes adverse impact on psychological and social well-being results in depression, social isolation, loneliness and reduce quality of life. WHO has classified skin diseases a psycho-cutaneous disease which emphasizes the relation between skin and psyche. Hence skin ailments are given high priority by the patients. Skin diseases are commonly observed thanks to altered lifestyle including improper and altered food habits, mental stress, improper sleeping habits and poor hygiene. In Ayurveda, the majority the skin diseases are incorporated under Kustharoga and are classified as Mahakustha (major skin disorders) and Kshudra kustha (minor skin disorders). Kitibha kustha is explained under Kshudra kustha in Ayurvedic Samhitas. The signs and symptoms of Kitibha kustha are same as that of psoriasis explained in modern science. Aim: The aim was to gauge the importance of Vamana karma (bio-purificatory measures) in Kustha. Materials and Methods: A male patient aged 18 years presented with the signs and symptoms of slightly raised well-defined brownish patches over upper middle back, behind both ears and around both alar nasal sulcus associated with itching diagnosed it as Kitibha kustha and was treated with Vamana karma (emesis) followed by prior Deepan karma and Bahya & Abhyantar snehan (internal & external oiling) followed by Swedan (fomentation). Results: At the conclusion of Vaman, Pittantik vamana was achieved. Patient had significant relief from Kandu (itching), scaling and reduction of erythema after the procedure. Photographic changes were kept for comparison. Conclusion: This present case study revealed the importance of Vamana karma in Kitibha kustha (Psoriasis).

Neurotic excoriation: A case report and literature review

Background: On average, one-third of patients seeking treatment for skin problems have associated psychological stress or psychiatric disease. Most psychodermatologic patients visit a dermatologist instead of a psychiatrist. It is important to recognize the signs and symptoms immediately, make a prompt diagnosis and do a comprehensive treatment that involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Presentation: A 40-year-old female, visited the Dermatology and Venereology (DV) outpatient clinic of Dr. Cipto Mangunkusumo Hospital with a chief complaints of wound on her right ear since 2 weeks ago. The patient was also diagnosed with Chiari malformation type 1 and had undergone surgery twice. The patient confessed of having a habit of intentionally skin picking until they were chafed and bled when she was stressed. The patient was diagnosed as neurotic excoriations, treated with potent topical corticostreroid and consulted to the psychiatric department. Discussion: Neurotic excoriations is classified as primary psychiatric skin disorders. Symptoms usually occurred when the patient was in the depression state. At first the patient only followed the dermatologist treatment and had a poor compliance with psychiatric management. Therefore the patients keep manipulating the lesions and the outcome was not satisfactory because the underlying disease has not been well treated. After the dermatologist convinced her to see the psychiatrist regularly, accompanied by a good compliance in applying the corticosteroid cream, the result was satisfactory. Conclusion: The psychocutaneous disease need a comprehensive and multi-disciplinary approach. Dermato-venereologists should work together with the psychiatrist.

AYURVEDIC MANAGEMENT OF KITIBHA KUSHTA W.S.R TO PSORIASIS – A SUCCESSFUL CASE STUDY

Skin being the largest organ of the body is the reason behind the beauty and cause for confidence. Chronic skin conditions adversely affect one’s physical, functional and emotional wellbeing, thereby causing negative impact on one’s own quality of life. Due to altered lifestyle, lack of physical exercise, unhygienic, mental stress, overeating, nutrition deficiency, skin diseases are commonly observed. WHO has classified skin diseases as a Psycho-cutaneous disease. Materials & Methods 29 year old male was diagnosed with a KitibhaKushta with a clinical feature of flaky reddish white elevated skin lesions over a B/L lower limb associated with severe itching sensation and peeling of the skin since 4 years, has been treated with classical Virechanakarma (Purgation) along with Shamanaushadhis (Oral medicines). Results: After the course of treatment the patient noticed significant relief in signs and symptoms and worth documenting. Conclusion: Kitibha Kushta though it is difficult to manage, but if proper diagnosis is made at proper time many complication can be avoided. In this case study, we found significant results in signs and symptoms with Virechana followed by Shamanoushadhi and Rasayana karma. By this we conclude that various Panchakarma procedures especially Virechana Karma and internal medicines can be the best option in its management. Keywords: Virechana Karma, Kitibha Kushta, Psoriasis

Stimulant use in patients presenting with psychocutaneous disorders

Psychocutaneous disorders are often attributed to stimulant medications, yet this relationship has never been fully elucidated. Literature on psychocutaneous disorders largely focuses on clinical presentation and treatment rather than disease etiology or exacerbation. To determine whether patients presenting with psychocutaneous disorders display high rates of stimulant use and psychiatric comorbidity. We undertook a retrospective cohort study of patients with psychocutaneous disorders presenting to a single center. It was hypothesized that these patients would have high rates of stimulant use and psychiatric comorbidity. Following analysis of baseline demographics, the patients were assigned to 1 of 2 groups: those with a psychotic disorder and those with a neurotic disorder. Sixty percent of the patients (n=317) with psychocutaneous disease had recently used a stimulant and more than 80% (270 of 317) carried an additional psychiatric diagnosis. The neurotic disorder group (n=237) was younger and had higher rates of stimulant use. The psychotic disorder group (n=80) had higher rates of psychosis, medical comorbidity, and illicit stimulant drug use. The predominantly Caucasian population may limit generalizability of findings as may the retrospective nature. Patients with psychocutaneous disease have high rates of stimulant use and most have at least 1 psychiatric comorbidity.

A case study of Ayurvedic management on Kustha (Pittakaphaja Kustha).

Skin being the largest organ of the body which is the reason behind the beauty and the causes for confidence. WHO has classified skin disease a psycho-cutaneous disease. This emphasizes on the relation between skin and psyche. Hence skin aliments are given high priority by any victim .All the skin diseases in Ayurveda have been discussed under the broad heading of Kustha. Kustha is said to be Tridoshatamak(1) and it have various variety found in day to day clinical practice so said to be treated according to dominance of Doshas. Tridoshas and various Dushyas are involved in Kustha. Here dominance of pitta and Kapha is seen so Diagonsed as “Pittakaphaj Kustha” and management was given accordingly.

Case series of primary psychiatric skin disorders with multi-disciplinary approach

  Background: The incidence of psychodermatologic diseases, a group of skin abnormalities associated with psychosomatic factor, are increasing recently. About 20-40% patients with skin symptoms have concurrent psychiatric problems which are often difficult to diagnose and treat. The new classification of primary psychiatric skin disorders are delusional disorders, obsessive-compulsive and related disorders, and factitious disorders. This classification could be used for effective treatment in each patient which involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Illustration: The first case was a 39-year-old unmarried female, with anemia and dermatitis artefacta occurred as wound due to blade cuts. Patient was with schizoaffective depressive type and was not under regular treatment. The second case was a 61-year-old male referred with unresolved prurigo nodularis for the past 30 years. After in-depth assessment, there were delusional parasitosis and neurotic excoriations disorders. The third patient was a 50-year-old female admitted with recurrent ulcer on her face. She was aware that the lesions were intentionally manipulated by her own fingers when she was depressed. Discussion: All patients were classified as primary psychiatric skin disorders with varied skin manifestations. Symptoms usually occurred when the patient was in the depression state or low compliance for the psychotropic drugs. Patients generally had poor insight and refused to be associated with psychiatric factors. Dermato-venereologists are expected to conduct early detection and treat this disease. Conclusion: It is important to approach psychocutaneous disease in multi-disciplinary manner, especially with the psychiatrist. Keywords: psychodermatologic, dermatitis artefacta, neurotic excoriations, delusion of parasitosis  

Psychodermatology in clinical practice: An examination of physician attitudes, beliefs, and interventions toward psychocutaneous disease.

Fifteen days postconception, the embryonic ectoderm simultaneously gives rise to the central nervous system and the epidermis of the integumentary system. The connections between the two organ systems manifests in both the psychiatric and dermatologic setting. To examine the current awareness of psychiatric comorbidity in dermatologic practice and its management in a sample of dermatologists across the United States. A survey was conducted that explored physician perspective on psychiatric comorbidity, clinical practice, and management, that is, use of survey screening measures, employment of psychological interventions, and coordination with mental health services. SPSS v25 was used for descriptive statistical analysis and to calculate Pearson's correlation coefficients between familiarity with dermatologic/psychiatric comorbidity and its management. Ninety-eight percentage of respondents believed a relationship between mental and dermatological health. 61.7% of respondents reported seeing patients with known psychological problems more than once a week. The administration of a psychiatric questionnaires was noted in 23% of practices and only 6.38% administer the questionnaire at every appointment. Management of comorbid disease is best done through the collaboration of dermatology and psychiatry. Implications for streamlining practice include the routine administration of quality of life surveys, utilization of brief psychotherapeutic strategies, and regular interdisciplinary referrals.

Psychodermatology in Balkans: Knowledge, awareness, and practice patterns of dermatologists in Albania.

The aim of this study is to find out the practice patterns, awareness, and knowledge about psychodermatology in Albanian dermatologists. A survey questionnaire was sent to Albanian dermatologists by mail and distributed during a regional dermatology conference. The dermatologists were requested to provide information on demographic variables, level of training, referral patterns, degree of comfort in managing psychocutaneous disorders, awareness of community resources, and interest in continuing medical educational activities. A total of 75 surveys were mailed in and 41 were returned for analysis. Only 13.2% of dermatologists reported clear understanding of psychodermatology and 41.5% reported being somewhat comfortable in diagnosing and treating psychocutaneous disorders, however requiring further help. Psoriasis, prurigo, and acne were the most common diagnoses associated with psychiatric involvement. The most common diagnoses referred by dermatologists to psychiatrists were psoriasis, prurigo, acne, and trichotillomania. Almost all 98% of dermatologists were not aware of any community resources. About 70% of dermatologists expressed interest in attending continuing medical educational activities. Albanian dermatologist have significant gap in the knowledge, training, awareness, and in treating psychocutaneous disease.

Understanding psychocutaneous disease: psychosocial & psychoneuroimmunologic perspectives.

The study of psychocutaneous disease involves a comprehensive understanding of the complex and often neglected psychoneuroimmunologic components and pathways. Patients suffering from the many disorders that blur the interface between the fields of psychiatry and dermatology are often misdiagnosed and mistreated because of the lack of knowledge and awareness of the underlying disease-causing mechanisms. Individuals with psychodermatologic disease also experience a general lower overall quality of life as it has negative implications on psychosocial, emotional, and cognitive well-being. Factors like early life interactions, body image dissatisfaction, and societal stigma play a crucial role in the development of psychosocial stress experienced by individuals with visible skin conditions. This heightened level of stress serves as a trigger in the activation of the hypothalamic-pituitary-axis (HPA), mediating immune responses that influence cutaneous disease severity and exacerbation. In order to improve the quality of life and treatment outcomes of the patient population impacted by psychodermatologic disease, it is essential to better understand the complex interplay between the various psychosocial factors and pathophysiologic pathways involved.

Neurosis and true dermatosis: a case of ossified pilomatricoma developing within a self-inflicted ulcer

Clinicians have a tendency to dismiss patients with psychiatric illness like skin picking disorder without assessing completely for organic disease. Patients with psychocutaneous disease have the potential to develop true dermatopathology and should always be examined thoroughly. We describe a case of skin picking disorder with underlying pilomatricoma. The patient met criteria for skin picking disorder and had been prescribed numerous topical treatments without efficacy by countless physicians over 18 years. In addition, a pilomatricoma was discovered within a self-inflicted ulcer. Pilomatricomas can rarely result from trauma and develop ossification, both of which were true of this lesion. The prevalence of skin picking disorder proves more pervasive than previously realized and it has only recently been recognized by the DSM-5 as an independent diagnosis. Therefore, it is necessary to clarify the diagnosis as well as remind clinicians not to discount underlying dermatologic disease. In addition to the risk of bleeding and infection, these patients are at risk for masking neoplasms, which should be removed. Our case emphasizes the need for thorough examination of patients with psychocutaneous disease and further work-up when necessary to prevent permanent disfigurement.

Ayurvedic management of Kitibha Kushta - A Case Report

Skin being the largest organ of the body is the reason behind the beauty and the cause for confidence. WHO has classified skin diseases a Psycho-cutaneous disease. This emphasizes on the relation between skin and psyche. Hence skin ailments are given high priority by any victim. 10 - 15% of the OPD patients for any practitioner will comprise of cosmetology related patients. Skin diseases are commonly observed due to altered lifestyle; lack of physical exercise, poor hygiene, mental stress and improper food habits. All the skin disorders in Ayurveda have been discussed under the broad heading of Kushta. Kushta is being further divided into Maha Kushta and Kshudra Kushta. Kitibha Kushta is one of the Kshudra Kushta, disorder which is commonly encountered in today’s clinical practice. Here, Tridoshas, Rasa, Rakta and Mamsa Dhatu are affected. Kitibha Kushta is a disease mainly affecting the beauty of the subject, thus its management would be challenging task.

Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines.

Dermatological disease can be devastating for patients, and although dermatologists are focused on remedying the cutaneous manifestations of these conditions, it is easy to miss the psychological suffering lurking below. Studies reveal that psychiatric comorbidity in dermatology is highly prevalent. Undetected psychopathology can greatly decrease a patient’s quality of life and even contribute significantly to the clinical severity of their skin disease. For these reasons, it is vital that practitioners learn to detect psychological distress when it is present, and it is equally essential that they understand the treatment options available for effective intervention. Without training in psychiatric diagnosis and psychopharmacology, dermatologists can easily feel overwhelmed or out of their comfort zone when faced with the need to manage such conditions, but with the negative stigma associated with psychiatric disease in general, a psychiatric referral is often refused by patients, and the dermatologist is thus left with the responsibility. Uncertainty abounds in such situations, but this review seeks to alleviate the discomfort with psychodermatological disease and share practical and impactful recommendations to assist in diagnosis and treatment. In a busy dermatology clinic, the key is effective and efficient screening, combined with a repertoire of pharmacological and non-pharmacological treatment options that can be dispersed through an algorithmic approach according to the specific findings of that screening. By implementing these recommendations into practice, dermatologists may begin to gain comfort with the management of psychocutaneous disease and, as a specialty, may expand to fill a hole in patient care that is truly significant for patients, their families, and our communities as a whole.

Modulation of couples' stress hormones in everyday life through a minimal couple intervention

psychocutaneous diseases) have demonstrated a high distress vulnerability, including also an increased skin perspiration to sad music (as a distressing stimulus). These patients show personality traits characterized by high stress load and increased vulnerability to stress that may influence disease progression and coping strategies. The somatopsychic recoil (revealed by the existence of high levels of anxiety and depression)maymaintain increased reactivity to stress. The similarities between drug allergy patients and psychocutaneous disease patients may be explained by the role of the skin as a shock organ and the low presence of drug anaphylaxis among drug allergy patients.

Psychocutaneous disease: knowledge and clinical attitudes of Chilean dermatologists

Psychocutaneous disease: knowledge and clinical attitudes of <scp>C</scp>hilean dermatologists

460 – The prevalence and severity of obsessive-compulsive disorder and its relationship with dermatological lesion in iranian dermatological clinic

Introduction Obsessive Compulsive Disorder (OCD) is an anxiety disorder which is usually characterized by two types of symptoms, namely.obsessions and compulsions. Objectives Psychosomatic disorders include psycho-cutaneous disease, obsessive-compulsive disorde r(OCD) might be expressed as dermatological lesion and are known as dermo-OCD. Aims The aim of this study were to determine the prevalence and severity of OCD and its relationship with dermatological disease in sari, Iran, 2011. Method The sample consisted of 265 consecutively presenting dermatological patients who agreed to participate in the study, the subjects were assessed with structured clinical interview (SCID-I) by psychiatrist resident and also completed the yalebrown obsessive compulsive scale(Y-BOCS). T-test and chi-square were used to analyze of data. Results Of the 265 dermatological patients, 24(9.1%) met DSM-IV criteria for OCD. Only 9(37.5%) of them had previousely been diagnosed as OCD. The most common obsession were washing 13(54.1) and pathological doubt 7 (25%), contamination7 (25%), checking 7(25%). Conclusion There is a high prevalence of OCD in dermatological patients and with considerating of importance of OCD with comorbitiy of skin disease, dermatologist must be aware about relationship between two disorders and referring OCD patients to psychiatrist.

A survey assessment of the recognition and treatment of psychocutaneous disorders in the outpatient dermatology setting: How prepared are we?

Dermatologists provide the bulk of psychocutaneous care; however, recent studies suggest that dermatologists believe they are largely underprepared to treat most psychocutaneous conditions. We sought to identify gaps in psychodermatologic knowledge among practicing dermatologists in two academic institutions. An online survey was sent to 59 dermatologists at the Massachusetts General Hospital (Boston, MA) and Brigham and Women's Hospital (Boston, MA) from July 2010 through October 2011. The response rate was 40 of 59 (68%). More than 50% of dermatologists were comfortable making diagnoses for 8 of 10 psychocutaneous disorders. In all, 57% were comfortable making a diagnosis of depression. A total of 11% were comfortable starting antidepressants; 3%, antipsychotics; and 66%, medications for neuropathic pain. In all, 72%, 68%, and 21% of dermatologists never prescribe antidepressants, antipsychotics, or medications for neuropathic pain, respectively. Only 38% believed they were successful treating compulsive skin picking; 15%, body dysmorphic disorder; 27%, delusions of parasitosis; and 24%, depression. Limitations include small sample size, data extraction from an academic setting, self-reporting of outcome measures, and response bias. Although the majority of the physicians surveyed believed they were capable of diagnosing psychocutaneous disease, very few were comfortable starting psychotropics or thought they were successful treating such conditions.

Approach to the Patients with Psychocutaneous Disease

Approach to the Patients with Psychocutaneous Disease

Therapeutic management of psychodermatological disorders

Background: The skin and the brain interact through psychoneuroimmunoendocrine mechanisms and through behaviors that can strongly influence the initiation or flaring of skin disorders. Objective: To obtain knowledge of these factors to assist in designing treatment plans for specific skin disorders. Methods: Psychocutaneous disease literature for the past 80 years was reviewed. Results/conclusion: Therapeutic options include standard psychotropic drugs and alternative herbs and supplements, the placebo effect, suggestion, cognitive-behavioral methods, biofeedback, and hypnosis. When simple measures fail to produce the desired results, combinations of drugs or addition of nonpharmacological therapies may produce better results. Psychophysiological skin disorders may respond well to nonpharmacological therapies that counteract stress, supplemented when indicated by anxiolytic or antidepressant drugs. Treatment of primary psychiatric disorders that affect the skin often results in improvement of the associated skin disorders. Psychiatric disorders secondary to skin disorders may also require treatment.