Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease

Abstract

Approximately half of all patients presenting to dermatologists exhibit signs and symptoms of psychiatric conditions that are either primary or secondary to cutaneous disease. Because patients typically resist psychiatric consult, dermatologists often are on the front line in evaluating and treating these patients. Accordingly, distinguishing the specific underlying or resulting psychiatric condition is essential for effective treatment. The etiology, epidemiology, clinical presentation, diagnosis, and first-line treatment of specific primary psychiatric causes of dermatologic conditions, including delusional infestation, Morgellons syndrome, olfactory reference syndrome, body dysmorphic disorder, excoriation disorder, trichotillomania, and dermatitis artefacta are discussed here, followed by a discussion of the recommended treatment approach with an overview of the different first-line therapies discussed in this review, specifically cognitive behavioral therapy, atypical antipsychotics, selective serotonin reuptake inhibitors, and tricyclic antidepressants. Included is a guide for dermatologists to use while prescribing these medications.

SnapshotDx Quiz: May 2022

“…The pathophysiology of TTM is that of an OCD. TTM is primarily a clinical diagnosis; however, this can be confirmed by a punch biopsy of the scalp (Krooks et al, 2018). Histopathologic features of TTM (from punch biopsy) include noninflammatory nonscarring alopecia with follicular damage (evidence of traumatic removal of hair follicles), loss of hair shafts, and noticeable trichomalacia (Stefanato, 2010).…”

Differences in dermatologic patient complexity based on practice setting

“…2 This may be particularly true in the South, which demonstrated the greatest underuse due to the higher regional prevalence of ultraviolet radiationeinduced cancers, which disproportionately affect white patients. 3 However, minorities likely face a degree of unmet clinical need because they are diagnosed with several skin conditions at later stages, with poorer outcomes. 1,4 Interestingly, states with the greatest minority under-representation also had a higher minority beneficiary prevalence.…”

“…2 Poorly controlled schizophrenia can affect treatment adherence and also increase the risk for primary psychiatric causes of dermatologic conditions. 3 Depression and reduced access (eg, Medicaid insurance) have been established as significant barriers to dermatologic treatment compliance and influence disease outcomes. Importantly, patients with multiple comorbidities (eg, diabetes, chronic heart failure) may have several risk factors for dermatologic complications, including ulcer formation.…”

Клинические И Психологические Модели Патологических Кожных Ощущений

“…В диагностических критериях описывается разнообразие патологических кожных ощущений, включающих зуд, ползнание, пощипывание и покалывание [30,38]. У пациентов имеются значительные повреждения кожных покровов как результат их борьбы с мнимыми паразитами [32,34]. В аспекте патогенеза обсуждаются нарушения интероцепции, неправильные обработка и интерпретация воспринимаемых ощущений как способствующие формированию галлюцинаций [35].…”

“…При синдромах импульсивных и компульсивных экскориаций пациенты сообщают о навязчивых и непреодолимых импульсах к расчесыванию [29] с ощущениями зуда по типу интрадермальной или эпидермальной дизестезии [11]. Расстройства характеризуются различными манипуляциями (расчесыванием, сдиранием, сдавливанием), производимыми с кожей [34]. Физические следы экскориаций располагаются в легкодоступных для пациентов местах -лицо, руки, верхняя часть спины [60].…”