Psychocutaneous Disorders Research Articles

Psychodermatology knowledge and awareness in Chinese dermatologists: Results of a survey study.

To assess the knowledge, awareness, practice patterns, and attitudes of Chinese dermatologists toward psychocutaneous disorders and explore their interest in continuing medical education (CME) of psychodermatology. An online survey study was conducted from October to November 2019. The survey questionnaire link was sent to the members of the national and local association of dermatology through a social media App. After confirming the informed consent to enrol in the study, the participants filled out the online questionnaire anonymously. About 1047 dermatologists completed the survey. The most common diagnoses referred to the psychiatrist from Chinese dermatologists were venereal phobia (51.77%), delusion of parasitosis (44.03%), and trichotillomania (32.28%). Compared with dermatologists, Traditional Chinese Medicine (TCM) dermatologists had less training experience on psychodermatologic CME (4.21% vs 8.34% who had attending more than twice CME, P < .05). Although TCM dermatologist experience more frequency with psychodermatology (24.21% TCM vs 15.71% dermatologists), they had lower comfort level in treating psychodermatologic patients (51.58% TCM vs 58.89% dermatologist) (P > .05). While 818 (78.13%) dermatologists never received any training course, 84.53% of the dermatologists expressed interest in attending CME events on psychodermatology. The most popular CME themes of psychodermatology were emotional disorders related to skin diseases, delusion of parasitosis, and trichotillomania. Chinese dermatologists have insufficient knowledge and awareness toward psychodermatology. TCM dermatologists have higher awareness on psychocutaneous diseases compared with dermatologists. Psychodermatology continuing medical education programs should be carried out as soon as possible.

Psychiatric morbidity in children and adolescents with dermatological disorders

Background:Understanding the existence of a cycle, where psychological disturbances cause skin diseases and in turn, skin diseases cause psychological disorders, provides the basis for good dermatological practice.Objective:The aim of this case-control study is to examine the psychiatric morbidity of dermatological disorders in children and adolescents with no history of psychiatric disorders.Method:In this study, 502 participants (251 patients and 251 healthy individuals) were evaluated according to DSM-IV criteria. All participants were interviewed and evaluated using the Turkish version of the Kiddie Schedule for Affective Disorders and Schizophrenia – Present and Lifetime Version (K-SADS-PL) and the State-Trait Anxiety Inventory for Children (STAI-1 and STAI-2), the Childhood Depression Inventory (CDI), adolescent and parent forms of the Strengths and Difficulties Questionnaire (SDQ-A and SDQ-P) and a questionnaire evaluating child’s level of school success.Results:Our results indicated that the rates of general psychiatric comorbidity, mood disorders, anxiety disorders, and adjustment disorders were significantly higher in the study group compared to the control group. The CDI, STAI-1, STAI-2, and SDQ (and subscales) scores were significantly higher in the study group. Moreover, psychiatric comorbidity was higher in inflammatory and allergic dermatoses compared to other dermatological subgroups. Having a dermatological disease restricts physical activity thus increasing the risk of psychiatric comorbidity.Conclusions:Investigating the education, attitudes, and awareness of dermatologists about psychocutaneous disorders might contribute to the development of new educational strategies and elicit appropriate biopsychosocial approaches.

A Cross Sectional Survey for Dermatoses in Children and Adolescents Residing in Orphanages in Urban Tirunelveli, Tamil Nadu, India.

Context:Skin diseases are a major cause of public concern among underprivileged people residing in orphanages. There is a need for community-based study for dermatoses in orphanages as the literature is scarce at the national and international levels.Aims:For profiling of various dermatoses to generate information on general health, nutritional status, and sanitation, and to educate about personal skin hygiene and care to inmates in urban child orphanages.Settings and Design:A cross-sectional study was conducted at 18 urban child orphanages in Tirunelveli city for 1 month.Methods and Material:A predesigned proforma was prepared and the demographic details regarding the inmates were obtained and they were screened under natural light for skin, hair, nail, and oral disorders as well as their built, nourishment, height, and weight were measured and recorded in tabulations.Statistical Analysis Used:Descriptive statistical analysis was followed for describing the prevalence of dermatoses and the age group affected which are explained in percentages and ratios.Results:Out of a total of 850 inmates, 93 (11%) were of 5–9 years and 757 (89%) were of 10–19 years. Among them, 330 (39%) were males and 520 (61%) were females. Overall, the inmates affected with dermatoses were 360 (42.4%) and infectious dermatoses were seen in 218 inmates (60.5%) and non-infectious dermatoses were seen in 142 inmates (39.5%). Adolescent females were more commonly affected and the commonest dermatoses observed were pediculosis capitis (13.6%) followed by acne vulgaris (8.1%) and in adolescent males, scabies (7.1%) was the commonest. No psychocutaneous disorders were encountered.Conclusions:Infections and infestations are common in orphanages due to a lack of awareness of personal hygiene and self-care practices. They should be given health education in order to reduce the disease burden in children living in orphanages which in turn decreases the disease burden at the community level.

Awareness of psychodermatology in Indian dermatologists: A South Indian perspective.

This study was aimed to survey the awareness, knowledge, practicing patterns, and attitudes of dermatologists toward psychocutaneous disorders in a South Indian State. The questionnaire-based study was performed from August 1 to October 31, 2019. Study participants included 123 dermatologists. The questionnaire consisted of nine multiple-choice questions and two open-ended questions regarding knowledge, practicing patterns, and attitude to psychodermatology. Forty five (36.6%) dermatologists completed this online survey. Out of them 73% were women and 40% were trainees. Nine respondents (20%) had frequent experience with psychodermatology, but only 6 (13.3%) were very comfortable in diagnosing and treating psychodermatology patients. Vitiligo was the disease with maximum respondents reported encountering >10 patients monthly with psychologic co morbidities (30, 66.7%). The most common diagnoses which required psychiatric referral were delusion of parasitosis (22.2%), trichotillomania (20%) and neurodermatitis (8.9%). Thirty six respondents (80%) were unaware of any patient or family resources on psychodermatology. Thirty-nine respondents (86.7%) expressed interest in attending educational events on psychodermatology. Survey results showed high need of liaison clinics of dermatology and psychiatry. Many dermatologists lack proper training in treating psychodermatology cases while they may be the sole service provider to the patients. We propose incorporation of psychodermatology curriculum in residency training programs.

Psychodermatology in Iran: A survey on knowledge, awareness, and practice patterns in Iranian dermatologists

Psychodermatology is an interdisciplinary field in dermatology which involves the interaction between mind and skin. Studies from various parts of the world demonstrate generalized lack of knowledge regarding psychocutaneous disorders among dermatologists. We provide this survey to evaluate the knowledge, awareness, and practice patterns of Iranian dermatologists about psychodermatology. A survey questionnaire on the topic of this study was randomly distributed among Iranian dermatologists in a national dermatology conference and also by mail. All collected data were entered into SPSS software version 20.0 and were analyzed using descriptive statistics. The questionnaires were filled out by 65 dermatologists aged 30 to 60 years. From this group, 60% (39) were male and 40% (26) were female. About 86% of the dermatologists saw more than 30 psychodermatology patients weekly and about 43% mentioned they felt somewhat comfortable managing psychodermatology patients. Alopecia, vitiligo, and acne were the most common primary dermatology diseases with secondary psychiatric problems. More than half of our responders mentioned that they did not take any psychodermatology courses during their training program. However, about 66% of the dermatologists expressed interest in participating in psychodermatology continuing medical education programs. Further collaboration between dermatologists and psychiatrists can shape a brilliant future in psychodermatology and improve the quality of life of patients. We highly recommend educational courses in psychodermatology for both dermatologists and psychiatrists.

Management of psychocutaneous disorders: A practical approach for dermatologists.

Psychodermatology is a growing specialty which is gaining momentum in different parts of the world. It focuses on the connection between skin and psyche. Psychocutaneous conditions are characterized by those disorders where stress is the key element in exacerbating skin conditions or flare ups of dermatoses like psoriasis and atopic dermatitis. There is a direct relationship of stress with the course, and prognosis of the skin disease. In some situations, there is no skin condition but the lesions are self-inflicted and such disorders are always associated with underlying psychopathology or psychological conflicts. Sometimes emotional problems are more prominent as a result of having skin disease, and the psychological consequences may be more severe than the physical symptoms. Management of these conditions require a combination of psychpharmacology, psychotherapy, and liaison clinics of psychiatry and dermatology. This review focuses on the common management approach which can be adopted by dermatologists in treating patients with psychodermatological disorders, improving doctor-patient relationship and therapeutic bond.

Basic psychopharmacological treatment model in psychocutaneous disorders

Psychodermatology addresses the connection between mind and skin. Psychodermatological disorders are mainly classified in to three major groups. First group is called Psychophysiologic disorders which are characterized by exacerbation or flare ups in skin lesion secondary to stress; primary psychiatric disorders is another group where no recognizable skin conditions present but all skin lesions are either self-inflicted, delusional, or obsessive in nature. Secondary psychiatric disorders are characterized by psychological factors associated with skin lesions. Here, skin lesions are not much destructive but psychological percussion are significantly affecting patient's self-esteem. Treatment of psychocutaneous disorders is always a challenge for dermatologist secondary to gaps in knowledge and awareness among dermatologists in general and lack of knowledge about psychotropic medications. This brief review will focus on four main psychopathologies which occur in the majority of psychocutaneous disorders.

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.

"Psychodermatology" knowledge, attitudes, and practice among health care professionals.

Psychiatric disorders are prevalent in dermatology patients. Psychodermatology is the body of knowledge at the intersection of psychiatry and dermatology practice. The purpose of this literature review was to assess the knowledge, attitudes, and practices of health care professionals regarding psychodermatology. A search of relevant articles was conducted in PubMed, CINAHL, ERIC, and PsychInfo databases using a comprehensive set of search terms. Studies were included if (1) study participants were health care professionals, (2) studies contained data that could be extracted, and (3) studies were published in peer-reviewed journals. A review of study findings was conducted. A total of nine studies were included in the review. Studies were conducted in several countries. Findings from the review confirmed that providers frequently reported psychocutaneous disorders in their practice. There were, however, gaps and variations in providers' knowledge base and level of comfort treating these patients. Further, providers acknowledged a lack of training in the practice of psychodermatology. The findings from this review suggest that health care professionals from multiple areas of the world may lack a full understanding, level of comfort, and proper training in psychodermatology. Improving the knowledge base and increasing level of comfort in treating psychodermatological disorders can improve the practice of psychodermatology amongst providers. Further, addressing knowledge and comfort level among providers through training and continuing education may improve outcomes for patients with psychocutaneous disorders.

Use of psychiatric drugs in Dermatology

Patients with psychocutaneous disorders often refuse psychiatric intervention in their first consultations, leaving initial management to the dermatologist. The use of psychotropic agents in dermatological practice, represented by antidepressants, antipsychotics, anxiolytics, and mood stabilizers, should be indicated so that patients receive the most suitable treatment rapidly. It is important for dermatologists to be familiar with the most commonly used drugs for the best management of psychiatric symptoms associated with dermatoses, as well as to manage dermatologic symptoms triggered by psychiatric disorders.

Health providers induced iatrogenic delusions of infestation.

Patients that suffer from factitial dermatosis mutilate their skin, often lacking any consciousness of self-injury, attributing the resulting lesions to spontaneous development. The case hereby described shows how the health providers’ interventions led a patient from a baseline undiagnosed factitious disorder to frank delusions of infestation with Mycobacterium Kansasii, and a relentless search for antibiotic treatments. We highlight the need for educating health practitioners on the characteristics of psycho-cutaneous disorders.

A new somatic-type delusional disorder subtype: delusion inversus

The interplay between psychiatric and dermatologic conditions has been recognized for decades as evidenced by the widely accepted classification system of psychocutaneous disorders: (1) primary dermatologic disorder with psychiatric sequelae, (2) primary dermatologic disorder exacerbated by stress, (3) primary psychiatric disorder with dermatologic sequelae, and (4) miscellaneous. However, there is minimal literature regarding dermatologic patients who demonstrate a preoccupation with a more severe cutaneous disorder despite evidence confirming a diagnosis of a minor, treatable skin condition. These patients are a hybrid of the first and fourth categories and should be classified under a new entity known as delusion inversus. These patients have a primary dermatologic condition; however, they believe their condition to be more severe and malignant than it is, despite evidence to the contrary. Their beliefs are pathological and analogous to delusion disorder somatic type. Given the scarcity of data concerning delusion inversus, the epidemiology, diagnosis, and management of the disorder as described in this review is extrapolated from reported cases of delusion disorder and delusion disorder somatic-type. Often these patients will present to a non-psychiatric, outpatient clinic for medical care. Thus, it is imperative that dermatologists are able to identify the condition and manage the patient appropriately.

Psychocutaneous disorders in childhood and adolescence

Abstract The adverse impact of skin diseases on an individual's physical and emotional well-being is well recognised, particularly in children as it is reflected in their growth and development. Conversely, the psychological and psychosocial issues that a child or young person may face, can manifest as a skin problem. Cutaneous manifestations of an underlying primary psychiatric problem are a poorly recognised entity amongst paediatricians. Limited knowledge and experience in this realm increases diagnostic and management challenges. The discipline of Psychodermatology attempts to address these problems by relating skin disease to intrinsic and extrinsic mental health factors. This review summarises the current literature on Psychocutaneous conditions with expert opinion from the authors own experience. The importance of a holistic approach in a multidisciplinary setting to manage this vulnerable group of children and young people cannot be over-emphasised.

Prevalence of Infectious Skin Diseases in Psychiatric Patients

Psychodermatology is an underappreciated field that studies psychocutaneous disorders, which are conditions that have both dermatologic and psychiatric characteristics. Underlying psychiatric comorbidity is estimated to occur in up to one-third of dermatologic patients, and psychiatric illness may either be the cause or the consequence of dermatologic disease. The present work aims to identify the type and frequency rate of infectious skin diseases among patients with psychiatric diseases. 500 patients with primary psychiatric disorders and 199 healthy controls from the Benha City, Qalyubia Governorate, Egypt were included in the study and were diagnosed according to The Diagnostic and Statistical Manual of Mental Disorders (DMS V) Criteria. A specially designed questionnaire including socio-demographic data , dermatological and general medical examination was applied. The data were statistically analyzed. There was a significant statistical increase in the prevalence of infectious skin diseases in psychiatric patients compared with non-psychiatric patients. Health education of psychiatric patients and/or of their caregiver and periodic monthly inspection of psychiatric patients are highly indicated for the prevention and control of infectious skin diseases in these patients.

Psychodermatology: Knowledge, Awareness, Practicing Patterns, and Attitudes of Dermatologists in Turkey.

Approximately, 1 in 3 patients in dermatology settings has psychiatric comorbidity. Thus, we conducted a survey in Turkey to explore the awareness, knowledge, practicing patterns, and attitudes of dermatologists toward psychocutaneous disorders. The questionnaire-based study was performed from March 1, 2013, to May 20, 2013. Study participants included 115 dermatologists. The questionnaire consisted of 9 multiple-choice questions and 2 open-ended questions. Of the 115 dermatologists in the study, 38 were men and 77 were women. More than 85% of dermatologists indicated that they examine > 30 patients per week in their practice, while only 2% saw < 10 patients per week. The most frequent dermatologic condition associated with psychiatric involvement seen by dermatologists was acne (49.1%). The top 3 diagnoses referred by dermatologists to psychiatrists were psoriasis (42.6%), alopecia areata (38.2%), and pruritus (27.8%). A need for collaboration between primary care, psychiatry, and dermatology disciplines in handling patients with psychocutaneous conditions is widely accepted. Investigating the knowledge, attitudes, and awareness of dermatologists about psychocutaneous disorders might contribute to the development of new educational strategies and elicit qualified biopsychosocial approaches.

Common psychocutaneous disorders in children.

The prevalence of psychosomatic disorders among dermatological patients is high but frequently unreported because of difficulties in diagnosing and treating this patient group. Psychiatric and psychological factors may play different roles in the pathogenic mechanism of some skin diseases. The mainstay of diagnosis and treatment is the differentiation between skin disorders associated with psychiatric illness and those of a purely psychiatric nature. Dermatologists and psychiatrists should be aware of this pathology and work together as a team to resolve difficult cases, especially in children. The present paper highlights the psychocutaneous diseases most frequently seen by dermatologists in pediatric population.

The Major Psychocutaneous Disorders in Iraqi Patients

Background: Many skin diseases can be evoked by psychological problems. Dermatological conditions could also lead to psychological disorders; hence psychodermatology is an emerging subspecialty that focuses on the interface of psychiatry and dermatology. Objective: To assess the frequency of the major disorders of so-called psychocutaneous disorders which are commonly seen among Iraqi population. Patients and Methods: This case descriptive study had been done in Department of Dermatology-Baghdad Teaching Hospital, Medical City, Baghdad, Iraq during the period from March 2011 to October 2013. All cases were collected and categorized according to the disease problem. Patients were interviewed to search for the main triggering and precipitating factors involved in pathogenesis of these disorders. The clinical picture was well described in order to reach a final diagnosis. Psychological interview and analysis were performed for all patients to reach the specific emotional and psychiatric disease by consultant psychiatrist. Results: A total of 100 patients with major psychocutaneous disorders were seen and evaluated. Nineteen were males and 81 were females with female to male ratio: 4.26:1. Their ages ranged from 7 - 73 (26.5 ± 5.217) years. The frequency of these diseases was as follows: trichotillomania 53%, dermatitis artifacta 37%, delusion of parasitosis 6% and neurotic excoriation 4%. Conclusions: The major psychocutaneous diseases in Iraqi population were: trichotillomania, dermatitis artifacta and these are problems of mainly young females while delusion of parasitosis and neurotic excoriations were diseases of middle age females.

Psychodermatology.

Psychodermatology is an underappreciated field that studies psychocutaneous disorders, which are conditions that have both dermatologic and psychiatric characteristics. Underlying psychiatric comorbidity is estimated to occur in up to one-third of dermatologic patients, and psychiatric illness may either be the cause or the consequence of dermatologic disease. Psychodermatologic patients lack insight and often do not recognize a psychiatric etiology for their symptoms and therefore comprise some of the most challenging cases to treat. Herein, we discuss the background and clinical presentation of the most commonly encountered psychodermatologic conditions, including delusional infestation, neurotic excoriations, factitial dermatitis, trichotillomania and body dysmorphic disorder, followed by practical diagnostic and therapeutic recommendations.

Psychodermatology: Basics Concepts.

Psychodermatology is a relatively new field of medicine. It encompasses the interaction of mind and skin. The role of psychoneuroimmunology in the causation of psychocutaneous disorders and psychosocial aspects of skin disease have gained momentum lately. The treatment of psychodermatological disorders focus on improving function, reducing physical distress, diagnosing and treating depression and anxiety associated with skin disease, managing social isolation and improving self esteem of the patient. Both pharmacological and psychological interventions are used in treating psychocutaneous disorders. The interest in Psychodermatology around the world is increasing and there are several organizations holding their regular meetings.

Psychosomatic paradigms in psoriasis: Psoriasis, stress and mental health

Byline: T. Sathyanarayana Rao, K. Basavaraj, Keya. Das The human race is exposed to vagaries of life in terms of various hazards; or as the Greek would have it, we are all but a heartbeat away from disaster. Major cause for psychopathology has been attributed to stress. A catalyst or precipitator of psychiatric illness and a stimulant to substantial mental agony. The term was coined by Hans Selye (1907-1982) who laid the concept of the adrenocortical system being the vital responder to stress. [sup][1] The more rudimentary term psychosomatic mirrors those illnesses whose evolutions are channeled by psychological (thoughts, emotions and behavior) issues; in contrast somatopsychic diseases echoes those where the biologic aspect of the affects the psyche. [sup][2] Psychocutaneous medicine impacts on the interaction between the mind, the brain and the skin. The brain and the skin originate from same germ layer i.e., the embryonic ectoderm and are under the influence of the same hormones and neurotransmitters. Psychiatric expertise focuses on the internal indiscernible disease conversely dermatological expertise focuses on external discernible disease. Factors of a psychopathological nature tend to play an etiological role in the development of skin disorders, can exacerbate pre-existing skin disorder as well as patients suffering from dermatological disorders may bear the brunt of disfigurement. [sup][3] Psoriasis being a key in the cluster of psychocutaneous disorders, it has become a focus for exploration. Due to the intimate interplay between psychosocial factors and psoriasis, this confirms the said definitions. [sup][2] Psoriasis is a common, chronic, recurrent inflammatory of the skin, characterized by circumscribed, erythematous, dry, scaly plaques of varying sizes. [sup][2] The incidence of is 1-2% of the general population. [sup][4],[5] Stress acts as a catalyst for the onset as well as exacerbation of psoriasis. [sup][6],[7],[8] The neurogenic inflammation hypothesis of psoriasis put forth by Farber et al . states that neuropeptides like substance P (SP) and nerve growth factor (NGF) act as a crux in its pathogenesis. Unmyelinated terminals of sensory fibers in skin release SP and other NP's thereby resulting in generation of local neurogenic inflammation in those who are genetically primed. [sup][1] SP is synthesized in the dorsal root ganglion of nociceptor C fibers and transmitted peripherally in granules. Colocalization with other NP's including calcitonin gene related peptide and vasoactive intestinal peptide (VIP) in cutaneous sensory nerve endings are found via histochemical staining methods. [sup][9] Stressful life events are associated with higher levels of SP in the central and the peripheral nervous system of animal models. [sup][1] SP expressing neurons are in close and functional proximity of mast cells, which when activated release VIP. [sup][10] Autonomic pathways of the descending type via dorsal root ganglia in the spinal cord through SP containing neurons stimulate release of NP's, the neurons extend onto having connections to opioid interneurons in the dorsal horn. Increased release of adrenocorticotropic hormone, glucocorticoids and adrenalin during stress may be attributed to the stimulation of hypothalamic-pituitary-adrenal axis. Significantly increased expression of NGF in keratinocytes regulates skin innervations and up regulates NP's, this has found to be an early event in the pathogenesis of Psoriasis. NGF causes the proliferation of T lymphocytes and brings about mass cell degranulation resulting in production of a chemokine resulting in production of a chemokine RANTES,which is chemotactic for resting Cd4+ memory t cells and memory t cells. [sup][1] The severity of psoriasis is found to be ever fluctuating. Individuals are likely to cycle between differing levels of severity throughout their life time. …