Functional symptoms in dermatology: Part 2

Abstract

Functional disorders within dermatology present as various constellations of skin symptoms, but without evidence of organic pathology. Examples can include mucocutaneous pain syndromes, functional pruritus, somatoform pain disorder and rarer entities, such as undifferentiated somatoform idiopathic anaphylaxis and multiple chemical sensitivity syndrome. These conditions can have a significant impact on a patient's quality of life, and can present challenges in communication, investigation and management. The aetiology of functional disorders is not fully understood, but with an effective collaborative approach, a psychological explanation for these symptoms is often found. A structured approach to assessment can lead to a confident diagnosis, and understanding a patient's belief system and the impact of symptoms on their functioning can give better grounding for successful management. Treatment is dependent on the level of the patient's engagement with healthcare professionals, and often takes a measured and rehabilitative approach. Psychological therapies have been shown to be effective, often alongside both psychopharmacological and topical medications.

Multiple Chemical Sensitivity Syndrome: A Principal Component Analysis of Symptoms

“…This can indicate that exposure to volatile organic compounds might be related to neurogenic inflammation and concomitant histamine-induced responses [ 52 , 67 ]. On the other hand, this symptom cluster has been viewed as a subtype of functional disorder [ 68 ].…”

Apremilast in benign chronic pemphigus (Hailey–Hailey disease)

“…4 Apremilast induces specific inhibition of phosphodiesterase-4, that inhibits T helper (Th)1and Th17, and decreases the release of inflammatory cytokines such as CXCL10. 5 In the case series by Kieffer et al 1 apremilast produced a sustained improvement in symptoms during the first 6 months of treatment, with a decrease in number and severity of lesions. However, in our study, we observed a lack of response in all of our five patients, four of whom had a follow-up time of > 6 months.…”

“…Recently, the usefulness of apremilast was described in two papers. 1,2 In this study, we sought to assess the use of apremilast for HHD.…”

“…Care must be taken to manage patient expectations of new treatments. 1 The authors suggested that an approach to managing vulvodynia could include starting with topical preparations such as capsaicin. We would like to share our experience of managing vulvodynia in our multidisciplinary vulval clinic, which has highlighted that the reported potential irritation with capsaicin is common.…”

Caution with topical capsaicin

“…It discussed the assessment and management of patients with a suspected functional dermatological disorder. 1 The authors suggested that an approach to managing vulvodynia could include starting with topical preparations such as capsaicin. We would like to share our experience of managing vulvodynia in our multidisciplinary vulval clinic, which has highlighted that the reported potential irritation with capsaicin is common.…”