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MENTAL HEALTH MENTAL HEALTH

A BRIDGE BETWEEN ders or other organisms. The cause of this condition is unknown and 2. Korabel H, Dudek D, Jaworek A, Wojas-Pelc A. Psychoderma-
most commonly occurs in middle-aged white women; however, all in-
tologia: psychologiczne i psychiatryczne aspekty w dermatologii
THE MIND AND THE SKIN dividuals can still be affected. Characteristic symptoms of delusions of [Psychodermatology: psychological and psychiatrical aspects of
dermatology]. Przegl Lek. 2008;65(5):244-248.
parasitosis include sensations of itching, burning, crawling and biting
that may lead to extensive excoriation of the skin. Additional signs in-
clude a patient history of frequently visiting different physicians with 3. Cotterill JA. Psychophysiological aspects of eczema. Semin Der-
matol. 1990;9(3):216-219.
By Tue “Felix” Nguyen, Marie Vu and Caroline Zhu
no resolution of symptoms, as well as keeping specimens in a small con- 4. Jafferany M. Psychodermatology: a guide to understanding com-
tainer or bag with clinic visits. Such specimens typically include frag- mon psychocutaneous disorders. Prim Care Companion J Clin
Introduction In conjunction with treating the skin condition, counseling patients ments of hair or skin with no clear evidence of the inciting organisms. Psychiatry. 2007;9(3):203-213.
Like many medical disciplines, dermatology intersects with other to adopt various stress-relieving and relaxation techniques may be ben- A diagnosis is made through exclusion of other true infestations or con- 5. Magin P, Sibbritt D, Bailey K. The relationship between psychi-
specialties to coordinate patient care optimally. An overlap that has eficial to reduce the number of acute flares. If conservative manage- ditions that may induce the sensation of itchiness, such as drug abuse. atric illnesses and skin disease: a longitudinal analysis of young
been emerging for years is the relationship between the skin and the ment is insufficient, psychological pharmacotherapy such as Treatment of patients with delusions of parasitosis should involve der- Australian women. Arch Dermatol. 2009;145(8):896-902.
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mind. Since both systems are inherently complex, medical profession- benzodiazepines, SSRIs or other psychotherapies may be needed. matologists, psychiatrists and entomologists, as patients are often con- 6. Dalgard F, Svensson A, Holm JO, Sundby J. Self-reported skin
als are continuing to investigate this association to better understand vinced of the existence of their infestation. It is important to gain morbidity among adults: associations with quality of life and gen-
how it impacts our patients. Psychological Problems Caused by Skin Disorders patient trust before initiating any pharmacotherapy, which may occur eral health in a Norwegian survey. J Investig Dermatol Symp Proc.
Psychodermatology, a multidisciplinary subspecialty, focuses on in- Skin diseases are often associated with secondary psychological co- over repeated visits. Antipsychotics have been used to treat delusions 2004;9(2):120-5.
tegrating the principles of dermatology, psychiatry and psychology to morbidities such as depression and anxiety, as well as what some have of parasitosis, but not as solo therapy. Patients should receive additional 7. Bingefors K. Lindberg M, Isacson D. Self-reported dermatologi-
approach patients holistically. termed “subsyndromal morbidities”: embarrassment, shame and low support and attention in order to properly manage their condition. cal problems and use of prescribed topical drugs correlate with
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The origins of psychodermatology can be traced throughout his- self-esteem. This association has also been demonstrated through sev- Trichotillomania is an obsessive-compulsive related disorder char- decreased quality of life: an epidemiological survey. Br J Derma-
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tory. Hippocrates (460 - 370 BC), the father of modern medicine, eral well-designed studies. acterized by urges to repeatedly pull one’s hair, resulting in subsequent tol. 2002;147(2):285-90.
recorded how stress affects the skin and described a hair-pulling dis- In 2004, a group of investigators conducted a life-quality study on hair loss especially in areas such as the scalp. An associated phenomena 8. Sampogna F, Tabolli S, Abeni D. The impact of changes in clinical
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order later to be known as trichotillomania. The book, Diseases of the a population of over 18,000 Norwegian adults with a self-reported includes trichophagia, in which affected individuals ingest their own severity on psychiatric morbidity in patients with psoriasis: a fol-
Skin, written by English dermatologist and surgeon William James skin morbidity. The group found significant impacts on social prob- hair. The cause of trichotillomania is not well-understood; however, low-up study. Br J Dermatol. 2007;157(3):508-13.
Erasmus Wilson in 1846, highlights various skin conditions such as lems and a strong association with depression in patients with skin dis- individuals with this condition experience significant emotional dis- 9. Kilkenny M, Stathakis V, Hibbert ME, Patton G, Caust J, Bowes
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alopecia areata, pruritus and hyperhidrosis which are strongly influ- ease. Similar findings were reported in a survey study of 8,000 adults, tress, often impairing social and occupational functioning. In many G. Acne in Victorian adolescents: associations with age, gender,
enced by the human psyche. which identified a sustained association between skin problems and cases, it usually occurs in adolescence and symptoms may occur in a puberty and psychiatric symptoms. J Paediatr Child Health.
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In modern medicine, dermatologic patients continue to have addi- poor emotional health, despite adjusting for psychiatric diseases. Ad- cyclic manner. The two main forms of treatment for trichotillomania 1997;33(5):430-3.
tional mental burdens. The incidence of psychiatric disorders in der- ditionally, an analysis on patients with psoriasis discovered a correla- include pharmacotherapy and psychotherapy. While there are cur- 10. Xu S, Zhu Y, Hu H, Liu X, Li L, Yang B, Wu W, Liang Z, Deng
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matologic patients is about 30-60%. Recognizing the psychosocial tion between psychiatric disturbances and severity of skin findings. rently no FDA-approved drugs for trichotillomania, there is prelimi- D. The analysis of acne increasing suicide risk. Medicine (Balti-
implications in skin disease is important; patients with refractory skin The authors noted that even with clinical improvement, psychological nary evidence that shows beneficial treatment effects with more). 2021;100(24):e26035.
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disease may have an underlying psychiatric disorder that needs to be suffering could persist. clomipramine, n-acetyl cysteine and olanzapine. Of these different 11. Chamberlain SR. Trichotillomania. NORD (National Organi-
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addressed in order to improve therapeutic outcomes. The pediatric population is also greatly affected by this relationship medications, n-acetyl cysteine is the most well tolerated with fewer zation for Rare Disorders). 2021. https://rarediseases.org/rare-
In this article, we will explore the following three categories encom- between skin disorders and secondary psychological problems. For in- significant side effects. Psychotherapy in the form of cognitive behav- diseases/trichotillomania/. Accessed on August 27, 2021.
passed by psychodermatology: stance, acne severity in adolescents has been correlated with depression ioral therapy aims to treat individuals through habit reversal, awareness 12. Ngan V. Delusions of parasitosis. DermNet NZ. 2005.
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1. Psychophysiologic disorders and anxiety, and has even been suggested to increase suicide risk. training and stimulus control. https://dermnetnz.org/topics/delusions-of-parasitosis/. Accessed
2. Psychological problems caused by skin disorders Through the demonstration of the relationship between skin diseases on August 27, 2021.
3. Primary psychiatric disorders with dermatologic symptoms and secondary psychiatric disorders, these studies highlight the impor- Conclusion 13. Baczynski C, Sharma V. Pharmacotherapy for trichotillomania in
tance for clinicians to consider evaluation for and concomitant man- Dermatologic diseases and psychiatric disorders work synergistically adults. Expert Opin Pharmacother. 2020;21(12):1455-66.
Psychophysiologic Disorders agement of psychological comorbidities in patients with skin disease. to impair our patients’ quality of life. Although it is easy to overlook
Psychophysiologic disorders are dermatologic diseases that are wors- any present mental disorders when interacting with dermatologic pa-
ened by stress or other emotional states. Examples of these conditions Primary Psychiatric Disorders with Dermatologic Symptoms tients, physicians are encouraged to anticipate psychiatric comorbidi-
include eczema, acne, alopecia areata and hyperhidrosis. When inter- Patients with primary psychiatric disorders can also present with ties. For the future of dermatology, psychodermatology may play a
viewing patients about their chief complaints, patients may be unaware skin manifestations. However, any observable skin lesions are not of more prevalent role in patient care as it acknowledges the bridge be-
of how stress and anxiety can impact the skin. Thus, physicians should dermatologic etiology and are usually self-induced. Two disorders that tween the mind and the skin. Tue “Felix” Nguyen, Marie Vu and Caroline Zhu are medical students
investigate any recent stressors for exacerbating factors. The percentage fall under this category are discussed: delusions of parasitosis and tri- at UT Health San Antonio who are interested in dermatology. They all
of patients reporting emotional disturbances accompanying their skin chotillomania. References serve as officers for the medical school’s Dermatology Interest Group.
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condition varies, but the range is estimated to be around 50% to Delusions of parasitosis is a condition in which an individual has 1. França K, Chacon A, Ledon J, Savas J, Nouri K. Pyschodermatol-
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greater than 90%. delusions of parasitic infestation on the skin from mites, lice, fleas, spi- ogy: a trip through history. An Bras Dermatol. 2013;88(5):842-843.
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