Jun
2013
Vol. 32. No. 2
Psychodermatology: An Overview
Psychodermatology is an interface between dermatology and psychiatry. The different
disorders within psychodermatology can be categorized in 2 ways: by the type of psychodermatologic
disorder or by the underlying psychiatric disorder. The types of psychodermatologic
disorders include psychophysiological, primary psychiatric, secondary
psychiatric, and cutaneous sensory disorder. The psychiatric disorders include anxiety,
depression, obsessive-compulsive disorder, and psychosis. This manuscript gives an overview
of the different psychodermatologic disorders, underlying psychiatric disorders, and
how to manage psychodermatology cases.
Semin Cutan Med Surg 32:64-67 © 2013 Frontline Medical Communications
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Jun
2013
Vol. 32. No. 2
Emotional Stress as a Trigger for Inflammatory Skin Disorders
Dermatologic disorders comprise 15% to 20% of complaints seen in general practice. Skin
disorders result in a negative impact to the patient not only physically but also psychologically,
socially, and occupationally. The most common trigger for several inflammatory skin
disorders, including psoriasis, is emotional stress. Understanding the significance of
emotional triggers to common inflammatory dermatologic disorders is critical to the optimal
management of these conditions. This article will provide an overview of the effects of
emotional stress on skin disorders and psychotherapeutic options.
Semin Cutan Med Surg 32:68-72 © 2013 Frontline Medical Communications
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Jun
2013
Vol. 32. No. 2
Delusions of Parasitosis
The most common monosymptomatic hypochondriacal psychosis encountered by a dermatologist
is delusions of parasitosis. In this condition, patients have an “encapsulated”
fixed, false belief that they are infested with parasites or have foreign objects extruding from
their skin. The patient will often experience feelings of biting, crawling and stinging related
to the delusion. Most patients do not have other major psychiatric problems outside of their
encapsulated delusion. The patient usually presents with a long history of symptoms and
multiple visits to physicians in more than one specialty. Without an informed approach to
these patients that focuses on the development of therapeutic alliance, clinical interactions
can become very unpleasant. However, when treated with pimozide, risperidone, or other
antipsychotic medications, patients have a very high response rate. Therefore, it is important
for dermatologists to be able to handle these cases and know that the development of
the therapeutic alliance is the key step to successful management.
Semin Cutan Med Surg 32:73-77 © 2013 Frontline Medical Communications
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Jun
2013
Vol. 32. No. 2
Body Dysmorphic Disorder
Body dysmorphic disorder (BDD) is a DSM-IV disorder that is characterized by a distressing
and excessive preoccupation with a slight or imagined defect of a physical feature. BDD
causes significant impairment of psychosocial functioning and a decreased quality of life
for patients. Though the disorder is commonly seen in the dermatology setting, the disease
remains under recognized and under-treated. It is important for dermatologists to be aware
of BDD as patients suffer greatly from the disease. In this review, we provide an update on
the epidemiology, clinical features, and treatment options for BDD.
Semin Cutan Med Surg 32:78-82 © 2013 Frontline Medical Communications
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Jun
2013
Vol. 32. No. 2
Obsessive-Compulsive Disorder in Dermatology
Obsessive-compulsive disorder (OCD) is a very common disorder affecting 2% to 3% of
the general population. Up to 25% of patients presenting to physicians with skin disease
suffer from OCD. Only 20% of all patients with OCD are receiving treatment. Unfortunately,
those few receiving treatment remained undiagnosed for many years. Standard
treatment includes behavioral therapy and psychotropic drugs (ie, selective serotonin
re-uptake inhibitors and clomipramine). The highest dosages of these medications must be
used for at least 3 months to see proper effectiveness and maintained for lengthy periods
of time. Not only are there abnormalities in the serotonin pathway of patients with OCD but
also the glutamate pathway is abnormal, leading to possible new treatment strategies.
Semin Cutan Med Surg 32:83-87 © 2013 Frontline Medical Communications
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