Psychocutaneous Disorders Research Articles

Psychocutaneous Disorders in Paediatric Population: A Cross-Sectional Observational Study in a Tertiary Care Centre in Eastern India

Abstract Introduction: Psychocutaneous disorders in children have been a gray zone in dermatology practice. It can be secondary to some primary dermatological disorder or can be a presentation of underlying primary psychiatric illness. There is a paucity of data regarding the occurrence of these disorders in the pediatric population. The present study was carried out to assess the proportion of primary psychiatric dermatoses in the pediatric population seeking dermatological care. Materials and Methods: This was a hospital-based cross-sectional observational study done over 6 months. All consecutive children <14 years old presenting with primary psychiatric disorders (PPDs) to the dermatology outpatient department were recruited in the study. Results: PPDs were found in 0.41% of the pediatric patients attending the outpatient department. Dermatitis artefacta was the most common PPD in our study (47.05%). Other less frequently observed PPDs were trichotillomania, lip-licking dermatitis, and nail-biting. Underlying psychiatric illness was found in 41.17% of affected children. Conclusion: Primary psychiatric dermatoses in children could go undiagnosed because of its rarity but early diagnosis is essential as it can be an early sign or a harbinger of underlying severe psychiatric illness.

Advances in Psychodermatology: Pediatric Trichotillomania

Trichotillomania (TTM) is a complex disease that often presents first to pediatric dermatologists. Despite its high prevalence in childhood, limited recommendations and treatment modalities are available for pediatric TTM. While Habit Reversal Therapy and Cognitive Behavioural Therapy are the most commonly used treatments for children with trichotillomania, pediatric dermatologists are more likely to prescribe medications as a primary treatment modality. Mind-skin disorders, now referred to as psychodermatologic or psychocutaneous disorders, affect the pediatric population in both a visible and psychological manner. The rise of psychodermatology in pediatric dermatology provides the opportunity to not only address any visible skin conditions such as TTM, but also any additional psychological aspects of the disorder. This review focuses on the differences in treatment modalities for children with trichotillomania utilized by pediatric dermatologists and behavioural health specialists, as well as the most recent recommendations for dermatologists and mental health providers working in conjunction with a shared goal of providing the best long-term support for these patients. Objective: Discuss the differences in treatment modalities for children with trichotillomania by pediatric dermatologists and behavioural health specialists, as well as the most recent recommendations for dermatologists and mental health providers working in conjunction with a shared goal of providing the best long-term support for these patients Raise awareness of the discrepancies that exist between pediatric dermatologists and behavioural health specialists (psychologists, mental health counsellors, school counsellors) in the treatment of trichotillomania in children Facilitate further discussion between pediatric dermatologists and behavioural health specialists when treating trichotillomania in the pediatric population.

The skin-brain connection and pleasant touch as supportive care for psychocutaneous disorders.

Psychodermatology is a subdiscipline of dermatology at the intersection of dermatology, psychiatry, and psychology. In dermatology clinical practice, patients may present with skin disease that affects their mental health, or skin disorders induced or worsened by psychological/psychiatric problems so there is a need for specialised education of dermatologists, as well as multidisciplinary teams, to achieve better management of these patients. Understanding the interaction between the central nervous system and the skin underlying psychocutaneous disorders could help identify alternative therapies that may improve patient well-being. The concept of pleasurable touch has received increasing attention following the discovery of C-tactile (CT) fibres. While afferent C-fibre stimulation is usually associated with pain, temperature, or itch, CT-fibres are stimulated optimally by a stimulus not in the nociceptor range but by a gentle, low-force stroking. As this affective touch may counteract unpleasurable sensations, such as pain and itch, and elicit positive feelings, the potential benefits of gentle touch and massage are interesting for dermatological, especially psychocutaneous, disorders. Here we provide an overview of the skin-brain connection to help understand the benefits of touch and massage, as illustrated with studies on atopic dermatitis and burns, as an adjunct to dermatological treatment for improving patient well-being and optimising treatment outcomes.

Updates in the Treatment of Body-Focused Repetitive Disorders.

Body-focused repetitive disorders (BFRBs) are psychocutaneous disorders that are underrecognized and undertreated.

A clinicoepidemiological study of geriatric dermatoses

Skin diseases are a common and inevitable consequence of ageing. Moreover, the clinical presentation is not as classical as they do in the younger population. A lifetime of solar exposure, along with intrinsic changes in the dermal structures, predisposes to a variety of skin diseases.
 The aim: to study the spectrum of various geriatric dermatoses among our patient population at the Department of Dermatology, Venereology, and Leprosy at Kamineni Academy of Medical Sciences and Research Centre.
 Materials and methods: in this study, a total of 200 patients aged 60 years and above attending the DVL OPD of Kamineni Academy of Medical Sciences and Research Centre were included.
 Results: maximum number of patients in this study belonged to 60-65 years (60 %), Male to female ratio was 1.86:1. Most of the males had agriculture work, and most of the females were housewives. Diabetes mellitus was the commonest associated systemic disease seen in 68 cases (34 %), and generalised pruritus was the commonest symptom seen in 64 (32 %) cases, of which 42 cases (65.6 %) were associated with xerosis. Pathological skin disorders and eczematous conditions were seen in 56 out of 200 cases. Of this, asteatotic eczema was the common finding among the eczematous conditions seen in 14 cases (7 %). Psoriasis was seen in 32 (16 %) and lichen planus in 10 cases (5 %). Infectious diseases were seen in 78 cases (39 %). Of these, fungal infections were common, seen in 28 cases (14 %). The benign tumour was seborrheic keratosis in this study, seen in 61 cases (30.5 %); among the malignant tumours, 4 cases (2 %) of basal cell carcinoma and 2 cases (1 %) of squamous cell carcinoma were seen. Among 16 cases of bullous disorders, bullous pemphigoid was seen in 12 (6 %) cases. Among 22 cases of psychocutaneous disorders, delusional parasitosis was seen in 10 cases (5 %), and perforating folliculitis in 15 cases (7.5 %). Loss of luster was the commonest nail change seen in 182 cases (91 %), followed by nail plate thickening in 54 cases (27 %). Greying of the hair was seen in all cases. Out of 70 females, diffuse hair loss was seen in 58 cases (82.9 %), and out of 130 males, androgenetic alopecia was seen in 72 cases (55.4 %).
 Conclusion: skin diseases cause considerable morbidity in the elderly, particularly if associated with other comorbid conditions. Health education on proper skin care, avoidance of irritants and self-medication etc., would help to reduce the incidence of common dermatoses.

Estimation of Hair Cortisol Levels as a Biomarker of Chronic Stress in Psoriasis: A Pilot Study

Background: Psychological stress can exacerbate many inflammatory diseases like psoriasis by dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. One method of establishing this correlation is by measuring cortisol levels. Deposition of cortisol in the hair during its growth allows for retrospective quantification and to analyze the relationship between hair cortisol levels, stress, and psoriasis. Objective: The objective of this study is to evaluate hair cortisol levels as a biomarker of chronic stress in psoriasis patients. Materials and Methods: Detailed clinical and personal history and stress-related events before the onset of the disease or any exacerbations during the disease were taken. Clinical severity was assessed using psoriasis area and severity index (PASI) scoring. Stress levels in individuals, during the previous 6 months were assessed, using Holmes–Rahe Life Stress Inventory. Following this, hair samples were collected from the vertex of the scalp and sent to the laboratory in an envelope. After extraction of the cortisol, their levels were estimated using an enzyme-linked immunosorbent assay. Statistical analyses were done. Results: Mean hair cortisol level per mg of hair sample was 0.92 ± 0.84 ng/mg compared to 0.50 ± 0.60 ng/mg in controls (P = 0.002). There was a significant positive correlation of hair cortisol levels with the duration of disease, PASI score, and stress level. Conclusion: Measurement of cortisol in hair is a novel, noninvasive method that may assess systemic cortisol levels over several weeks to months. It may potentially be used as a biomarker in psychocutaneous disorders like psoriasis.

Psychodermatology in Lithuania. A survey on knowledge, awareness, and practice patterns in Lithuanian dermatovenereologists.

The aim of this study was to evaluate the knowledge, awareness, and practice patterns of Lithuanian dermatovenereologists regarding psychocutaneous medicine. An online survey questionnaire was distributed to the members of the Lithuanian Association of Dermatovenereologists and to dermatovenereologists through public and private healthcare institutions in Lithuania. The questionnaire consisted of questions related to dermatovenereologists' awareness, knowledge, experience, and training needs regarding psychocutaneous disorders. 50% of respondents reported having a good or excellent understanding and knowledge of psychodermatology, and 42% feel prepared to consult psychodermatology patients. 54% of doctors rated their preparedness to prescribe psychopharmacological treatment as poor. The most frequent diagnoses referred to mental health professionals were dermatitis artefacta, acne excoriée, other self-inflicted dermatoses, trichotillomania, and pruritus. The most common course of action with patients at high risk of suicide or other acute psychiatric condition was trying to provide psychological support during dermatovenereology consultation. The most frequent management tactic for patients with chronic psychological problems was a referral to a psychiatrist. 85% of all respondents would participate in educational events about psychodermatology. 70% expressed interest in events about psychopharmacological treatment in dermatology. Lithuanian dermatovenereologists have a good understanding and knowledge of psychodermatology and are willing to further their education in this field. However, some gaps remain. Many doctors reported feeling poorly prepared to administer psychopharmacological treatment to their patients and there seems to be a lack of formal training in psychodermatology in Lithuania.

A Series of Clinical Cases of Psychocutaneous Disorders in a Dermatology Unit in Albania

This study aims to represent our clinical experience with several psychocutaneous disorders, such as trichotillomania, neurotic excoriation, dermatitis artefacta, and parasitic delusion. Lightening the human mind’s way of function has always been a challenge and has attracted medical interest through the years. Psychodermatology has recently received attention because different mechanisms of psychoneuroimmunology are being explored. They can successfully explain different clinical presentations and drug therapy. Awareness, recognizing important risk factors (suicide, serious self-harm, other people harm, child abuse, and neglect), associated psychiatric diagnoses, adequate screening, seeking a specialized referral, and reasonable security measures should be on focus. The proper management needs a multidisciplinary team, including the dermatologist, the psychiatrist, the family physician, and the social support.

Trichotillomania in Children − How can a Dermatologist Deal with it?

Hair loss in children is an important cosmetic concern, especially in adolescents where body image matters. Trichotillomania manifests through patchy hair loss which reflects underlying psychiatric conditions. It is a challenge for the dermatologist, who are first contact physicians, to deal with such cases who are secretly struggling with their inner turmoil. Hence, they must be well versed to deal with such patients. The current review aims to facilitate the dermatologist to handle them effectively. We performed PubMed and Google Scholar searches of English literature using the terms “Trichotillomania”, “Trichotillosis,” “Trichotillomania in Children,” “Trichotillomania in pediatrics,” “Trichotillomania in adolescents,” “Hair pulling disorder,” “Obsessive-Compulsive disorders AND Dermatology,” “Psychodermatology,” and “Psychocutaneous disorders.” The selected publications were reviewed for additional resources. Thorough psychological evaluation of the patient along with the cutaneous examination will help the dermatologists in establishing the diagnosis. Dermatologists should be empowered regarding the need of mental health referral and should be able to convey the same to the patient/family members empathetically. They can offer habit reversal therapy, mainstay treatment, as well as pharmacotherapy as and when needed after adequate training.

Dermatitis Neglecta in a Case of Meningomyelocele

Dermatitis neglecta is a condition secondary to inadequate cleansing of the skin due to underlying causes such as pain, surgical site, neurological deficit, and neglect or psychocutaneous disorders. The result is an accumulation of keratin debris, sweat, sebum, and dirt giving a hyperkeratotic, hyperpigmented, and waxy appearance of the affected area. Soakage of the lesion with alcohol swabs and frictional cleaning of the area leads to the clearing of hyperkeratotic debris. We report a case of a 2-year-old male with dermatitis neglecta over meningomyelocele in the sacral region.

A review of psychocutaneous disorders from a psychotherapeutic perspective-Toolkit for the dermatologist.

The study of psychocutaneous disorders requires a multidisciplinary approach. It is of paramount importance that dermatologists understand the psychiatric premise for these disorders. Mental health professionals can also benefit from a better understanding of the dermatologic manifestations of psychiatric disorders they may encounter in their practice. The aim of this study is to elevate the level of understanding regarding psychotherapeutic treatment of psychocutaneous disorders. We performed a literature review using the major databases. Four researchers reviewed English, full text, peer-reviewed articles that were published after 2000 using our specific search terms and inclusion/exclusion criteria. The majority of psychocutaneous disorders seem to be clustered among three DSM-5 disorders: depressive disorders, anxiety disorders, and obsessive-compulsive related disorders. Better recognition of the underlying psychiatric comorbidities may lead to improved patient outcomes.

Global Awareness, Knowledge, and Practice Patterns of Psychocutaneous Medicine: A Primary Care Perspective.

Objective: To report findings generated from an analysis of available literature on psychodermatology knowledge, awareness, and practice patterns among dermatologists worldwide to better elucidate their educational needs and referral practices. Data Sources: To identify literature from inception to December 23, 2020, the following search strategy was used within PubMed and Google Scholar databases: psychodermatology OR psychocutaneous disorders OR psychodermatology practice patterns OR psychodermatology awareness OR psychodermatology attitudes OR psychodermatology knowledge. Non-English studies were excluded. Studies were included if they were identified as having collected data from a survey instrument assessing psychodermatology awareness, knowledge, and practice patterns of dermatologists and dermatology trainees. Study Selection and Data Extraction: Of 1,347 records screened, a total of 12 cross-sectional studies were identified as having collected data from 2,466 dermatologists in 18 countries worldwide. Individual study and overall response frequencies were extracted for each variable of interest by an independent reviewer. Results: Although most respondents provided weekly psychodermatologic care, only 13% reported feeling very comfortable treating patients with psychocutaneous concerns. Only 19% of respondents had a clear understanding of psychodermatology, and almost two-thirds of participants had no formal training in psychodermatology. Seventy-three percent of dermatologists reported interest in continuing medical education. Conclusions: A considerable number of patients present to their physician with a psychocutaneous concern. As such, dermatologists, psychiatrists, and primary care providers may benefit from an understanding of the presentations and management of the most common psychodermatology complaints. Incorporation of psychodermatology curriculums into training programs and educational activities should be considered.

Psychopathological symptoms in dermatology: A basic approach toward psychocutaneous disorders.

Dermatological conditions impact not only an individual's physical body but also their psychological health. Similar to how cutaneous conditions can affect one's psychological health, worsening psychological conditions can exacerbate or even induce dermatological conditions. There are four common psychiatric pathologies typically found in dermatology practices: depressive symptoms, anxiety symptoms, obsessive-compulsive disorder behaviors, and psychosis. Common cutaneous disorders associated with these psychopathological symptoms include, but are not limited to, psoriasis, acne vulgaris, atopic dermatitis, urticaria, trichotillomania, excoriation disorder, and delusions of parasitosis. The goal of this review is to examine the relationship between these four psychopathological symptoms with common psychodermatological conditions and to help providers better diagnose and implement appropriate psychological support to treat their patients.

Psychocutaneous Medicine in Iraq

Objective: To evaluate the knowledge and attitudes of Iraqi dermatologists regarding understanding, diagnosing, and treating psychocutaneous disorders.Methods: An online survey questionnaire was randomly distributed among Iraqi dermatologists through Google Forms in August 2020. The dermatologists were asked to provide information on their understanding of psychodermatology, referral patterns, level of comfort in managing psychocutaneous disorders, awareness of community resources, and interest in learning more about psychodermatology.Results: Of 200 distributed questionnaires, 61 were returned. The most common psychocutaneous disorder seen was acne, followed by alopecia areata and vitiligo. About half of the participants reported being neutral about their comfort level in treating psychocutaneous disorders, and approximately half had no formal training in psychodermatology. Almost 60% of participants did not know of any community resources, and three-quarters were willing to seek educational activities on psychodermatology.Conclusions: The study results revealed that Iraqi dermatologists have significant gaps in knowledge, training, and treatment of psychocutaneous disorders. The survey findings reveal the importance of addressing the training needs of young physicians, including dermatologists, psychiatrists, and primary care physicians, in relation to the psychological component of skin diseases.

Treatment strategies for dermatillomania. Literature review

Emilija Narvydaitė1, Rima Viliūnienė2 1Faculty of Medicine, Vilnius University, Vilnius, Lithuania 2Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania Abstract Introduction: dermatillomania is one of the psychocutaneous disorders that can have negative consequences for the patient’s health. This condition manifests itself in a difficult-to-control constant need to touch, scratch, […]

Psychocutaneous disorder due to university stress-A case study

Psychocutaneous disorders, or allergies exacerbated by psychological factors in adults, are a group of dermatological diseases, where an underlying condition such as atopic dermatitis is triggered by psychological stressors, and whose diagnosis is made by clinical, questioning, and ruling out others most frequent skin pathologies. It is closely linked to certain triggering psychological factors, which can be stress or anxiety. The present article includes a case study of an undergraduate patient, with the classic symptoms of a skin allergy. However, her case undergoes diagnostic trials without revealing any apparent cause. By means of a more thorough anamnesis, the stress factors that produce the skin affectation are identifiable.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Adverse psychocutaneous effects of prescription stimulant use and abuse: A systematic review.

Although rare, psychocutaneous disorders induced by prescription stimulants have been reported throughout the literature. A systematic review was conducted to identify all case reports and case series of prescription stimulant-induced trichotillomania, tactile hallucinations, and delusional infestation. A total of 22 case reports were identified and relevant information was analyzed. Patients presenting with trichotillomania and tactile hallucinations induced by prescription stimulants were typically pediatric male patients being treated for attention deficit hypersensitivity disorder. Symptoms resolved after discontinuation of the offending medication. Patients presenting with delusional infestation secondary to stimulant use or abuse were typically adults who were misusing or abusing stimulant medication. Although symptoms typically improved or resolved after decreasing or discontinuing medication, several patients required the use of antipsychotic medication. While the observational nature of case reports and small number of patients limits meaningful analysis of trends and comparison, this study demonstrates that physicians, especially dermatologists and psychiatrists, should be aware of the potential for prescription stimulants to precipitate adverse psychocutaneous disorders in a minority of individuals.

Psychodermatology - a case for sensitization of pharmacists in Mumbai, India.

Though studies have looked at the attitudes of dermatologists towards psychodermatology, few have highlighted the attitudes of pharmacists towards these conditions. To study the knowledge, attitudes and practices of pharmacists towards the prescription of psychotropic medications to dermatology patients. This cross-sectional analysis included 80 pharmacists from Mumbai, India. We used an interviewer-administered questionnaire to collect information from pharmacists on their demographics, psychotropic medications in dermatological patients, knowledge about psychocutaneous conditions and comfort about dispensing these medications. In our study, 37 (46%) of pharmacists received prescriptions of psychotropic drugs from dermatologists; however, 24 (30%) were not comfortable dispensing them. Sixty (75%) pharmacists felt that only psychiatrists should prescribe psychotropic drugs and 37 (46%) felt that they had a right to refuse to dispense prescribed medication; of these, 15 (19%) had actually refused to give medications to patients. Pharmacists who disagreed with the statement that 'the state of mind is associated with medical conditions', were more likely to discourage psychotropic prescription from dermatologists (29% vs 11%, P = 0.04). Pharmacists with experience of more than five years were significantly more likely to refuse to dispense medications (odds ratio: 5.14, 95% confidence interval: 1.02, 25.83; P = 0.047). We did not have a list of all pharmacists in Mumbai; thus, no sampling frame could be applied. Pharmacists do comment on doctors' prescriptions, discourage certain medications and even refuse to dispense them based on their personal opinions. Since they are the last stop for patients between the doctor and the medication, their inclusion (in addition to dermatologists, psychiatrists and psychologists) in integrated awareness, training and care programs would improve the quality of care of patients with psychocutaneous disorders.

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.