Review of the diagnosis and management of pediatric psychodermatologic conditions: Part I

Abstract

Pediatric psychodermatologic conditions encompass both primary dermatologic conditions with psychiatric comorbidities and primary psychiatric conditions with self‐induced dermatologic manifestations. Detection, diagnosis, and management of primary psychiatric conditions with dermatologic manifestations are challenging due to patient‐perceived stigma and lack of educational opportunities for dermatology providers. This two‐part series highlights the most up‐to‐date evidence‐based data and management techniques of some of the more common dermatoses of primary psychiatric conditions in children. Part I includes trichotillomania, skin‐picking disorder, and onychophagia, and part II covers dermatitis artefacta, body dysmorphic disorder, and delusions of parasitosis by proxy, with special considerations for family dynamics.

Delusions of parasitosis and delusions of parasitosis by proxy in a mother and her children

“…In some cases, an affected individual may be recalcitrant to all attempted treatments. In situations where delusions are projected onto vulnerable populations such as children (as in our case), child maltreatment by the parent or caregiver is of great concern 9,10 . Children may be continually subjected to physical, emotional, or other forms of harm and knowing when to involve outside intervention in the form of child protective services is vital 9,10 .…”

“…With delusions of parasitosis by proxy, a multidisciplinary management is imperative including involvement of primary care, dermatology, psychiatry, and social work. It may also necessitate the involvement of Child Protective Services (CPS) if there is concern for child safety 9 . Psychiatry involvement should occur as early as possible without jeopardizing the therapeutic alliance.…”

“…It may also necessitate the involvement of Child Protective Services (CPS) if there is concern for child safety. 9 Psychiatry involvement should occur as early as possible without jeopardizing the therapeutic alliance. Individuals afflicted with such disorders often feel isolated in the health care system and seek a multitude of providers which creates a significant health care system burden.…”

“…In situations where delusions are projected onto vulnerable populations such as children (as in our case), child maltreatment by the parent or caregiver is of great concern. 9,10 Children may be continually subjected to physical, emotional, or other forms of harm and knowing when to involve outside intervention in the form of child protective services is vital. 9,10 One should involve these specialists any time the safety of the child is felt to be compromised, with the primary goal of protecting the child and preventing adverse effects on his or her physical and mental health.…”

Noninfectious causes of alopecia in the pediatric population

“…Other medications, such as Selective Serotonin reuptake inhibitors (SSRIs) and Tricyclic antidepressants (TCAs), have demonstrated only modest effects. Behavioral therapy remains the most effective treatment for trichotillomania, underscoring the need for nonpharmacological interventions in managing this condition [13].…”