Vol. 32. No. 2


In a busy dermatology practice, we frequently encounter patients whose psychological problems appear just as important as their dermatological ones. Some examples include patients with delusion of parasitosis (Morgellons syndrome), neurotic excoriations, trichotillomania, cutaneous sensory disorder and any patient whose skin condition is worsened with emotional stress. Studies have shown that as many as one-third of dermatology patients have a significant psychological issue in connection with their skin complaint. Therefore, it is helpful in clinical practice to know as much as possible about the management of psychological issues in dermatology. On the other hand, despite its high relevance to our practice, psychodermatology is rarely covered in dermatology residency programs. In this issue of Seminars in Cutaneous Medicine and Surgery, we provide a rare opportunity to learn about psychodermatology. You will find the papers presented herein to be concise and clinically useful. This issue covers many important topics such as the optimal approach to the psychodermatology patient, the role of emotional stress in worsening skin conditions, and the impact of disfiguring skin disorders on quality of life. We also review the diagnosis and management of well-known psychodermatological disorders, such as delusional disorders, cutaneous sensory disorders, body dysmorphic disorders, obsessive-compulsive disorders in dermatology, trichotillomania, onychophagia, and neurotic excoriations. Lastly, both pharmacologic and nonpharmacologic approaches to the management of psychodermatology patients are discussed. We hope that you find this issue easy to comprehend and practical. Now that you have a compendium of psychodermatology in your hands, you are about to embark on an exciting journey. As you flip through the pages of this issue, you will uncover some fascinating topics in psychodermatology written by well-known experts in dermatology and psychiatry from around the world.

Psychodermatology: An Overview

Argentina Leon, MD | Ethan C Levin, MD | John Y M Koo, MD
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

Emotional Stress as a Trigger for Inflammatory Skin Disorders

John Y M Koo, MD | Monica Huynh, BA | Rishu Gupta, BS
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

Delusions of Parasitosis

Adam Rubin, MD | Ethan C Levin, MD | Uwe Gieler, MD
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

Body Dysmorphic Disorder

Iona H Ginsburg, MD | Monica Huynh, BA | Rishu Gupta, BS
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

Obsessive-Compulsive Disorder in Dermatology

Thelda Kestenbaum, MD
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