A significant proportion of patients seen in an average dermatologic practice have psychosocial issues associated with their skin disease. There are at least two ways to classify psychodermatologic cases: by the category of psychodermatologic disorder and by the nature of the underlying psychopathologic condition. The categories of psychodermatologic disorders are psychophysiologic disorders, primary psychiatric disorders, secondary psychiatric disorders, cutaneous sensory disorders, and the use of psychopharmacologic agents for purely dermatologic (i.e., non-psychiatric) cases. There are four major underlying psychopathologic conditions seen in dermatology: anxiety disorder, depression, psychosis, and obsessive-compulsive disorder (OCD). For the treatment of chronic anxiety, we recommend as first-line therapy Buspar®. Our next best choices then fall to low-dose doxepin or paroxetine, and lastly benzodiazepines. In the pharmacotherapy of depression, selective serotonin reuptake inhibitors (SSRI) or non-selective serotonin reuptake inhibitors and non-tricyclic antidepressants are to be tried first and if those are unsuccessful, tricyclic antidepressants, for which doxepin would be an excellent choice, can be used. For patients with both anxiety/agitation and depression, doxepin and nefazadone (Serzone®) would be excellent first choices with venlafaxine as second-line therapy. For the treatment of dermatologic psychotic disorders, pimozide is still the first choice of the authors, but risperidone may be equally beneficial for treating these patients with fewer side effects. For OCD, SSRIs are the treatments of choice. This paper presents an overview of psychopharmacology for the practicing dermatologist. A short discussion is made of psychodermatologic disorders and the nature of underlying psychopathologic conditions. Pharmacologic recommendations and updates are provided to create a framework for dealing with these challenging patients.

No abstract