[Body dysmorphic disorder : Diagnostics and treatment in cosmetic dermatology]

Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries

BACKGROUND

Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls.

OBJECTIVES

To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition.

METHODS

This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist.

RESULTS

The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation.

CONCLUSIONS

This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.

['Beauty' - a Topic for Psychiatry? Reflections on the Relation Between Psychopathology and the Body]

'Beauty' - a Topic for Psychiatry? Reflections on the Relation Between Psychopathology and the Body Abstract. Establishing a relation with one's own physicality is an essential element of our anthropological framework (conditio humana). This relation can be disturbed by critical life events as well as by mental disorders, which is here illustrated by clinical examples. Furthermore we discuss the prerequisites for a stable therapeutical relationship with this particular group of patients.

Six-Position, Frontal View Photography in Blepharoplasty: A Simple Method

BACKGROUND

Photography plays a pivotal role in patient education, photo-documentation, preoperative planning and postsurgical evaluation in plastic surgeries. It has long been serving as a bridge that facilitated communication not only between patients and doctors, but also among plastic surgeons from different countries. Although several basic principles and photographic methods have been proposed, there is no internationally accepted photography that could provide both static and dynamic information in blepharoplasty. In this article, we introduced a novel six-position, frontal view photography for thorough assessment in blepharoplasty.

METHODS

From October 2013 to January 2017, 1068 patients who underwent blepharoplasty were enrolled in our clinical research. All patients received six-position, frontal view photography. Pictures were taken of the patients looking up, looking down, squeezing, smiling, looking ahead and with closed eyes. Conventionally, frontal view photography only contained the last two positions. Then, both novel six-position photographs and conventional two-position photographs were used to appraise postsurgical outcomes.

RESULTS

Compared to conventional two-position, frontal view photography, six-position, frontal view photography can provide more detailed, thorough information about the eyes. It is of clinical significance in indicating underlying adhesion of skin/muscle/fat according to individual's features and assessing preoperative and postoperative dynamic changes and aesthetic outcomes.

CONCLUSION

Six-position, frontal view photography is technically uncomplicated while exhibiting static, dynamic and detailed information of the eyes. This innovative method is favorable in eye assessment, especially for revision blepharoplasty. We suggest using six-position, frontal view photography to obtain comprehensive photographs.

LEVEL OF EVIDENCE V

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