1
|
Christensen RE, Jafferany M. Psychiatric and psychologic aspects of chronic skin diseases. Clin Dermatol 2023:S0738-081X(23)00033-0. [PMID: 36878453 DOI: 10.1016/j.clindermatol.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Chronic skin diseases can substantially impact a patient's physical, psychologic, and social well-being. Physicians may play a critical role in identifying and managing the psychologic sequelae of the most common chronic skin conditions. Acne, atopic dermatitis, psoriasis, vitiligo, alopecia areata, and hidradenitis suppurativa are chronic dermatologic diseases that put patients at high risk for symptoms of depression, anxiety, and decreased quality of life. Both general and disease-specific scales exist to assess the quality of life in patients with chronic skin disease, the most common being the Dermatology Life Quality Index. The general management approach to the patient with chronic skin disease should incorporate acknowledgment and validation of the patient's struggles, patient education on the potential impact of disease and prognosis; medical management of the dermatologic lesions; coaching on stress management; psychotherapy. Psychotherapies include talk therapy (i.e., cognitive behavioral therapy), arousal-reducing therapies (i.e., meditation, relaxation), and behavioral therapies (i.e., habit reversal therapy). Improved understanding, identification, and management of the psychiatric and psychologic aspects of the most common chronic skin conditions by dermatologists and other healthcare providers may positively affect patient outcomes.
Collapse
|
2
|
Shah R, Jamgochian M, Haroon A, Pappert A, Miller J. A 14-year-old with dermatitis artefacta secondary to aerosolized spray deodorant: A rare case with an important learning opportunity. JAAD Case Rep 2021; 19:71-73. [PMID: 34917729 PMCID: PMC8669259 DOI: 10.1016/j.jdcr.2021.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rohan Shah
- Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Attiya Haroon
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Amy Pappert
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Jason Miller
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| |
Collapse
|
3
|
Torales J, García O, Barrios I, O'Higgins M, Castaldelli-Maia JM, Ventriglio A, Jafferany M. Delusional infestation: Clinical presentations, diagnosis, and management. J Cosmet Dermatol 2020; 19:3183-3188. [PMID: 33098221 DOI: 10.1111/jocd.13786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delusional infestation is a primary psychiatric disorder characterized by a somatic-type delusional disorder (primary delusional infestation) that may lead to self-induced cutaneous lesions which are often difficult to recognize and treat properly. It may be also secondary to other psychiatric disorders, medical diseases, or substance abuse. AIMS This review will describe prevalence, common clinical features, different clinical presentations, differential diagnoses, and treatment recommendation. Special focus has been put on psychological aspects. METHODS We conducted a literature search on PubMed from January 2001 to June 2020 with the search terms of delusional parasitosis, delusional infestation, psychological, Reference lists of identified articles were examined for further relevant studies. The search was limited to English language articles. No specified quality criteria were used for study inclusion. RESULTS The clinical manifestations of delusional infestation are very important in the differential diagnosis and its psychological implications and management perspectives. CONCLUSION This article presents an update regarding the clinical aspects and treatment options of delusional infestation in order to provide an up-to-date review for dermatologists and general practitioners.
Collapse
Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Mount Pleasant, MI, USA
| |
Collapse
|
4
|
Elsaie ML, Hanafy NS, Zaky MS, Hasan MS, Jafferany M. Psychodermatology knowledge and awareness: A cross-sectional Egyptian perspective. Dermatol Ther 2020; 33:e14239. [PMID: 32856733 DOI: 10.1111/dth.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
The merging of psychiatry and dermatology has resulted in a relatively newer emerging field known as psychodermatology (PD). The aim of this cross sectional study was to assess knowledge, attitudes, and practice patterns of Egyptian dermatologists towards psychodermatology. A cross sectional study was designed and data were collected using structured self-administered online questionnaires. A total of 212 dermatologists completed the full questionnaire. Those with incomplete or partially answered responses were excluded. 171 (81.1%) were females and 40 (18.9%) were males. The majority (n = 109;51.4%) of dermatologists completing the survey were between 30 and 40 years age group while those between 40 and 50 years of age accounted for 48 (22.6%). The vast majority of respondent dermatologists never referred (n = 87; 41%) or very rarely referred (n = 58; 27.5%) any psychocutaneous patients to a psychiatrist. Almost 75% of responding dermatologists were not aware of available community or educational resources for PD and 157 (74.1%) expressed interest in receiving continuing medical education (CME) programs. In conclusion, psychodermatology training among dermatologists shall enhance and improve their approach to psychocutaneous conditions.
Collapse
Affiliation(s)
- Mohamed L Elsaie
- Department of Dermatology, National Research Center, Cairo, Egypt
| | - Noha S Hanafy
- Department of Dermatology, National Research Center, Cairo, Egypt
| | - Mohamed S Zaky
- Department of Dermatology and Venereology, Azhar University Damietta, Cairo, Egypt
| | - Mohamed S Hasan
- Department of Dermatology and Venereology, Azhar University, Cairo, Egypt
| | | |
Collapse
|
5
|
Jafferany M, Ferreira BR, Abdelmaksoud A, Mkhoyan R. Management of psychocutaneous disorders: A practical approach for dermatologists. Dermatol Ther 2020; 33:e13969. [PMID: 32621633 DOI: 10.1111/dth.13969] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/09/2023]
Abstract
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.
Collapse
Affiliation(s)
- Mohammad Jafferany
- Department of Psychodermatology and Psychiatry, Central Michigan University, Saginaw, Michigan, USA
| | | | - Ayman Abdelmaksoud
- Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt
| | - Ruzanna Mkhoyan
- Division of Dermatology, Nairi Medical Clinic, Yerevan, Armenia
| |
Collapse
|
6
|
Sarkar S, Ghosh SK, Sil A. Stereotypical linear purpura of the upper limbs: A report of three cases of a rare psychocutaneous disorder and review of the literature. Indian J Psychiatry 2020; 62:212-216. [PMID: 32382185 PMCID: PMC7197830 DOI: 10.4103/psychiatry.indianjpsychiatry_356_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/02/2019] [Accepted: 12/25/2019] [Indexed: 11/09/2022] Open
Abstract
Mechanically induced purpura with its varied clinical presentations may often pose a great diagnostic challenge to the treating physician. In this report, we seek to familiarize clinicians with a relatively new and rarely diagnosed psychocutaneous disorder, stereotypical linear mechanically induced purpura of the upper limbs, which we had the chance to detect in three teenage girls from Eastern India. A review of the PubMed and Medline database reveals a paucity of information on this subject, especially in the English language literature. Only a handful of reports have been described worldwide till date. However, it is probably hitherto unreported from India.
Collapse
Affiliation(s)
- Sharmila Sarkar
- Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sudip Kumar Ghosh
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| | - Abheek Sil
- Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, Kolkata, West Bengal, India
| |
Collapse
|
7
|
Kuhn H, Mennella C, Magid M, Stamu-O'Brien C, Kroumpouzos G. Psychocutaneous disease: Pharmacotherapy and psychotherapy. J Am Acad Dermatol 2017; 76:795-808. [PMID: 28411772 DOI: 10.1016/j.jaad.2016.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022]
Abstract
Building a strong therapeutic alliance with the patient is of utmost importance in the management of psychocutaneous disease. Optimal management of psychocutaneous disease includes both pharmacotherapy and psychotherapy. This article reviews psychotropic medications currently used for psychocutaneous disease, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics, with a discussion of relevant dosing regimens and adverse effects. Pruritus management is addressed. In addition, basic and complex forms of psychotherapy, such as cognitive-behavioral therapy and habit-reversal training, are described.
Collapse
|
8
|
Kuhn H, Mennella C, Magid M, Stamu-O'Brien C, Kroumpouzos G. Psychocutaneous disease: Clinical perspectives. J Am Acad Dermatol 2017; 76:779-791. [PMID: 28411771 DOI: 10.1016/j.jaad.2016.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/26/2016] [Accepted: 11/03/2016] [Indexed: 01/03/2023]
Abstract
Psychocutaneous disease, defined in this review as primary psychiatric disease with skin manifestations, is commonly encountered in dermatology. Dermatologists can play an important role in the management of psychocutaneous disease because patients visit dermatology for treatment of their skin problems but often refuse psychiatric intervention. This review describes common psychocutaneous syndromes, including delusional, factitious, obsessive-compulsive and related, and eating disorders, as well as psychogenic pruritus, cutaneous sensory (pain) syndromes, posttraumatic stress disorder, and sleep-wake disorders. The updated classification of these disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition is included. Strategies for management are reviewed.
Collapse
Affiliation(s)
- Helena Kuhn
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Constance Mennella
- Division of Child/Adolescent Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michelle Magid
- Department of Psychiatry at Dell Medical School, University of Texas at Austin, Austin, Texas; Department of Psychiatry, University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Psychiatry, Texas A&M Health Science Center, Round Rock, Texas
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts.
| |
Collapse
|
9
|
Abstract
RATIONALE Artifacts or simulated diseases are self-inflicted conditions caused by various means and for different purposes. Disease simulation can be motivated, among other things, by illegal purposes, to escape from civil duties or prison sentences, for example, or to exploit specific situations in order to receive a range of benefits. In such cases, the simulator is fully aware of his or her actions and intentions. DIAGNOSES, INTERVENTIONS AND OUTCOMES We report the case of a 42-year-old woman who, for 3 consecutive years, showed religious stigmata on the forehead and on the dorsal surface of hands and feet immediately before Easter. Lesions showed an acute onset, manifested as erosions and ulcerations, and healed a few days after Easter. Stigmata were immediately made public and every year faithful and curious people went in procession to the house of the patient, offering different kinds of gifts. After intervention of the police authority in the early days of the third episode, the patient and her family repented of their actions. Cutaneous lesions healed in few days and similar events did not occur during the following 2 years. LESSONS Regardless of personal beliefs, the possibility that stigmata could be self-inflicted for illegal or profit purposes should always be considered.
Collapse
Affiliation(s)
- Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology
| | - Michelangelo Vestita
- Unit of Plastic Surgery, Department of Emergencies and Organ Transplantation, University of Bari, Bari, Italy
| | - Angela Filoni
- Section of Dermatology, Department of Biomedical Science and Human Oncology
| | - Giuseppe Giudice
- Unit of Plastic Surgery, Department of Emergencies and Organ Transplantation, University of Bari, Bari, Italy
| | - Gianni Angelini
- Section of Dermatology, Department of Biomedical Science and Human Oncology
| |
Collapse
|
10
|
Abstract
Dermatitis artefacta (DA) is a psychocutaneous disorder where the skin lesions are self self-induced to satisfy an unconscious psychological or emotional need. We report a case of DA where we video recorded the patient self-inducing the lesions.
Collapse
Affiliation(s)
- M Kumaresan
- Department of Dermatology, PSG Hospitals, Coimbatore, Tamil Nadu, India
| | | | | |
Collapse
|
11
|
Abstract
The nervous system and the skin develop next to each other in the embryo and remain intimately interconnected and interactive throughout life. The nervous system can influence skin conditions through psychoneuroimmunoendocrine mechanisms and through behaviors. Understanding the pathophysiology aids in selection of treatment plans for correcting the negative effects of the psyche on specific skin conditions. Medication options include standard psychotropic medications and alternative herbs and supplements. Other options include biofeedback, cognitive-behavioral methods, hypnosis, meditation, progressive relaxation, the placebo effect, and suggestion. When simple measures fail, combining medications with other therapeutic options may produce better results. Skin conditions that have strong psychophysiologic aspects may respond well to techniques such as biofeedback, cognitive-behavioral methods, hypnosis, meditation, or progressive relaxation that help to counteract stress. Treatment of primary psychiatric disorders that negatively influence skin conditions often results in improvement of those skin conditions. Abnormal conditions of the skin, hair, and nails can also influence the psyche negatively. Treatment of secondary psychiatric disorders such as anxiety or depression that are triggered or exacerbated by the appearance of these skin conditions or the associated discomfort may also be required.
Collapse
Affiliation(s)
- Philip D Shenefelt
- Department of Dermatology and Cutaneous Surgery, College of Medicine, University of South Florida, Tampa, Florida, USA
| |
Collapse
|