Successful treatment of a chronic and disabling dermatosis by psychotherapy. A case report and discussion

Behavioral dermatology

The practice of behavioral dermatology encompasses the management of any dermatologic condition for which there is a substantial behavioral or emotional component. Commonly recognized behavioral dermatoses such as acral lick dermatitis, psychogenic alopecia, and hyperesthesia are syndromes rather than discrete diagnoses. Successful patient management is dependent upon integrating physiological, social, and environmental factors which contribute to the clinical manifestation of behavioral dermatoses.

Psychotherapy for intractable inflammatory dermatoses

BACKGROUND

Most patients with inflammatory dermatoses respond to conventional treatment. Recalcitrance may indicate underlying emotional factors after infection, contact allergy, and noncompliance have been ruled out. Psychiatric treatment has been reported to be effective.

OBJECTIVE

The purpose was to determine whether insight-oriented psychotherapy, by effecting last change, would provide long-term cutaneous and psychiatric improvement.

METHODS

On the basis of emotional distress attributed to a recalcitrant inflammatory dermatosis, four patients were referred for psychiatric evaluation. The effect of adding insight-oriented psychotherapy as the only change in the treatment regimen of each patient was studied. Each patient served as his or her own control.

RESULTS

In each patient clearing of the previously recalcitrant dermatosis accompanied psychiatric improvement.

CONCLUSION

In selected cases of recalcitrant inflammatory dermatoses, insight-oriented psychotherapy may provide lasting cutaneous improvement and improved life adjustment and psychologic well-being.

Evaluation and treatment of "psychogenic" pruritus and self-excoriation

Psychogenic pruritus and self-excoriation are diagnoses of exclusion. Elimination of traditional organic causes often leads the clinician to label a symptom as psychogenic in origin and limits treatment options. This article examines the organic and psychologic causes and concomitants of dermatologic conditions associated with pruritus and self-excoriation. An organized cognitive framework is presented to guide the clinician in the evaluation and treatment of these patients. Specific treatment options are offered and relevant psychopharmacologic agents are reviewed.

Cutaneous manifestations of psychiatric disease that commonly present to the dermatologist--diagnosis and treatment

Patients whose psychopathology is expressed in cutaneous lesions often consult a dermatologist rather than a psychiatrist. Dermatologists may not be interested in working with these difficult patients. The need for liaison dermatology is becoming more widely recognized. This article discusses the place of psychiatric consultation in the dermatology setting, and describes the common dermatologic presentations of psychopathology: cutaneous delusions, obsessive-compulsive symptoms, expressions of depression, and dermatitis-artefacta. Diagnostic criteria for these conditions are outlined and a treatment approach, within the competence of the interested dermatologist, is offered.