Somatization in dermatology

Abstract

Medically unexplained dermatologic symptoms, such as pruritus, numbness and burning are known as somatization. These cutaneous symptoms can be very difficult to treat because of an absence of an objective explanation and they may not fit neatly into any known dermatological or psychiatric condition. These disorders are more commonly encountered in primary care and in dermatology, rather than in psychiatry. Certain skin disorders, for example, pruritus, could be a manifestation of somatization and others may predispose to somatic symptoms, for example, atopic dermatitis and psoriasis. Although there has been increasing research in the interconnection between psychiatry and dermatology, psychodermatology is a relatively new crossover discipline in clinical practice and recognition of psychodermatological conditions, such as cutaneous somatic disorders, can be difficult. Somatization may occur with or without the existence of a dermatological disease. When a dermatological disorder is present, somatization should be considered when the patient is worrying too much about their skin, spending too much time and energy on it and especially if the patient also complains of many non‐cutaneous symptoms. Purely cutaneous somatic conditions include for example, the genital pain syndromes or Gardner–Diamond syndrome, characterized by unexplained bruising, which usually affects women. Effective management tools may include mindfulness therapies, pharmacotherapy with selective serotonin reuptake inhibitors, tricyclic antidepressants and cognitive conduct therapy. Electroconvulsive therapy can also be considered in extremely rare cases for treatment of severe somatization on a background of mood disorders. This paper discusses somatization, its relationship to immunodermatoses and its relevance to clinical practice.

Proopiomelanocortin (POMC) and psychodermatology

“…These results suggest POMC circuits, originating in arcuate nucleus of the hypothalamus, regulate feeding and mood in response to chronic stress, via inhibition of dopaminergic transmission 43 . This could be a model linking POMC with neurological and psychiatric disease, some of which may be linked to skin disease 43,44 …”

“…43 This could be a model linking POMC with neurological and psychiatric disease, some of which may be linked to skin disease. 43,44 Diseases associated with increased cellular immunity, however, seem to show exacerbation with acute stress (for example, psoriasis). 42 From now on, this review will reflect predominantly on the effects of stress on 5 common dermatoses, namely psoriasis, atopic eczema (AE) (atopic dermatitis), acne, alopecia, vitiligo and melasma, as well as skin pigmentation and interaction with stress, pregnancy and the menstrual cycle on the skin.…”

“…Obsessive tanning or skin‐lightening behaviour could be said to represent dysmorphophobia, a non‐acceptance with one's appearance, which often correlates with a history of depression and anxiety 90 . Depression may be triggered by chronic stress, via activation of CNS POMC pathways 44 . Another factor in the POMC pathway, MC1R is mutated in individuals with red hair and freckles, the most likely to use sunbeds 4,10,11,13–18,20–22,28,29,31,80,81,85,86 .…”

Psychodermatology—A special edition of Skin Health and Disease

“…In this special edition of Skin Health and Disease we aim to showcase the breadth and depth of psychodermatology research, covering genetic and acquired skin diseases, involving patients across the entire age spectrum suffering from primary skin or psychiatric diagnoses. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Furthermore, we report the potential of medications to trigger autoimmune blistering disease in patients with neuropsychological disorders. 6 The issue also includes robust prospective epidemiological data from national registries examining associations between mental health and psoriatic arthritis in patients with psoriasis as well as charting the development of psychodermatology clinics and liaison services 7 and the establishment of patient reported outcomes measures for body image in dermatology is detailed.…”

“…In this special edition of Skin Health and Disease we aim to showcase the breadth and depth of psychodermatology research, covering genetic and acquired skin diseases, involving patients across the entire age spectrum suffering from primary skin or psychiatric diagnoses 6–19 . Furthermore, we report the potential of medications to trigger autoimmune blistering disease in patients with neuropsychological disorders 6 .…”