Current Psychiatry Reports

, Volume 11, Issue 3, pp 211–218

Current concepts in psychodermatology

Article

Abstract

Dermatology is a discipline in which psychosomatic issues serve a key purpose in helping us understand the etiology and progression of skin diseases and determining appropriate treatment protocols. Emotional factors appear to significantly influence most skin diseases, and the correlation between stressful life events and disease flares is well recognized in dermatology. In this article, recent research is highlighted for major cutaneous disease states, as well as psychiatric disorders with symptoms that present as skin disorders. The role of the expanding field of psychoneuroimmunology as it pertains to dermatologic disorders is discussed. The author also presents recommendations for optimal evaluation and management of psychosocial concerns in the dermatology patient population.

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References and Recommended Reading

  1. 1.
    O’sullivan RL, Lipper G, Lerner EA: The neuro-immunocutaneous-endocrine network: relationship of mind and skin. Arch Dermatol 1998, 134:1431–1435.PubMedCrossRefGoogle Scholar
  2. 2.
    Tausk F, Elenkov I, Moynihan J: Psychoneuroimmunology. Dermatol Ther 2008, 21:22–31.PubMedCrossRefGoogle Scholar
  3. 3.
    Kronfol Z, Remick D: Cytokines and the brain: implications for clinical psychiatry. Am J Psychiatry 2000, 158:683–694.CrossRefGoogle Scholar
  4. 4.
    Maes M, Meltzer H, Bosmans E, et al.: Increased plasma concentrations of interleukin-6, soluble interleukin-6 receptor soluble interleukin-2 receptor and transferrin receptor in major depression. J Affect Disord 1995, 34:301–309.PubMedCrossRefGoogle Scholar
  5. 5.
    Fortune DG, Main CJ, O’sullivan TM, et al.: Assessing illness-related stress in psoriasis: the psychometric properties of the psoriasis life stress inventory. J Psychosom Res 1997, 42:467–475.PubMedCrossRefGoogle Scholar
  6. 6.
    Finzi A, Colombo D, Andeassi L, et al.: Psychological distress and coping strategies in patients with psoriasis: the PSYCHAE Study. J Eur Acad Dermatol Venereol 2007, 21:1161–1169.PubMedGoogle Scholar
  7. 7.
    Pietrzak AT, Zalewska A, Chodrowska G, et al.: Cytokines and anticytokines in psoriasis. Clin Chim Acta 2008, 394:7–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Filakovic P, Biljan D, Petek A: Depression in dermatology: an integrative perspective. Psychiatria Danubina 2008, 20:419–425.PubMedGoogle Scholar
  9. 9.
    Karanikas E, Harsoulis F, Giouzepas I, et al.: Neuroendocrine stimulatory tests of hypothalamus-pituitary-adrenal axis in psoriasis and correlative implications with psychopathological and immune parameters. J Dermatol 2009, 36:35–44.PubMedCrossRefGoogle Scholar
  10. 10.
    Hashiro M, Okumura M: Anxiety, depression and psychosomatic symptoms in patients with atopic dermatitis: comparison with normal controls and among groups of different degrees of severity. J Dermatol Sci 1997, 14:63–67.PubMedCrossRefGoogle Scholar
  11. 11.
    Lonne-Rahm SB, Rickberg H, El Nour H, et al.: Neuroimmune mechanism in patients with atopic dermatitis during chronic stress. J Eur Acad Dermatol Venereol 2008, 22:11–18.PubMedGoogle Scholar
  12. 12.
    Hull PR, D’Arcy CD: Acne, depression and suicide. Dermatol Clin 2005, 23:665–674.PubMedCrossRefGoogle Scholar
  13. 13.
    Gupta MA, Gupta AK: Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis, and psoriasis. Br J Dermatol 1998, 139:846–850.PubMedCrossRefGoogle Scholar
  14. 14.
    Rehn LM, Meririnne E, Hook-Nikanne J, et al.: Depressive symptoms, suicidal ideation and acne: a study of male Finnish conscripts. J Eur Acad Dermatol Venereol 2008, 22:561–567.PubMedCrossRefGoogle Scholar
  15. 15.
    Engin B, Uguz F, Yilmaz E, et al.: The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria. J Eur Acad Dermatol Venereol 2007, 22:36–40.Google Scholar
  16. 16.
    Uguz F, Engin B, Yilmaz E: Quality of life in patients with chronic idiopathic urticaria: the impact of Axis I and Axis II psychiatric disorders. Gen Hosp Psychiatry 2008, 30:453–457PubMedCrossRefGoogle Scholar
  17. 17.
    Kretzmer GE, Gelkopf M, Kretzmer G, et al.: Idiopathic pruritus in psychiatric inpatients: an explorative study. Gen Hosp Psychiatry 2008, 30:344–348.PubMedCrossRefGoogle Scholar
  18. 18.
    Murase JE, Wu JJ, Koo J: Morgellons disease: a rapport-enhancing term for delusions of parasitosis. J Am Acad Dermatol 2006, 55:913–914.PubMedCrossRefGoogle Scholar
  19. 19.
    Savely VR, Leitao MM, Stricker RB: The mystery of Morgellons disease: infection or delusion? Am J Clin Dermatol 2006, 7:1–5.PubMedCrossRefGoogle Scholar
  20. 20.
    US Centers for Disease Control and Prevention: Unexplained dermopathy (aka “Morgellons”). Available at http://www.cdc.gov/unexplaineddermopathy/investigation.html. Accessed March 2009.
  21. 21.
    Sandoz A, LoPiccolo M, Kusnir D, et al.: A clinical paradigm of delusions of parasitosis. J Am Acad Dermatol 2008, 59:698–764.PubMedCrossRefGoogle Scholar
  22. 22.
    Thomas I, Patterson WM, Szepietowski JC, et al.: Body dysmorphic disorder: more than meets the eye. Acta Dermatovenerol Croat 2005, 13:50–53.PubMedGoogle Scholar
  23. 23.
    Malick F, Howard J, Koo J: Understanding the psychology of the cosmetic patients. Dermatol Ther 2008, 21:47–53.PubMedCrossRefGoogle Scholar
  24. 24.
    Orringer JS, Helfrich YR, Hamilton T, et al.: Prevalence of psychotropic medication use among cosmetic and medical dermatology patients a comparative study. J Am Acad Dermatol 2006, 54:416–419.PubMedCrossRefGoogle Scholar
  25. 25.
    Szepietowski JC, Salomon J, Pacan P, et al.: Body dysmorphic disorder and dermatologists. J Eur Acad Dermatol Venereol 2007, 22:795–799.CrossRefGoogle Scholar
  26. 26.
    Robinson JK, Kim J, Rosenbaum S, et al.: Indoor tanning knowledge, attitudes and behavior among young adults from 1988 to 2007. Arch Dermatol 2008, 144:484–488.PubMedCrossRefGoogle Scholar
  27. 27.
    Heckman CJ, Coups EJ, Manne SL: Prevalence and correlates of indoor tanning among US adults. J Am Acad Dermatol 2008, 58:769–780.PubMedCrossRefGoogle Scholar
  28. 28.
    Feldman SR, Liguori A, Kucenic M, et al.: Ultraviolet exposure is a reinforcing stimulus in frequent indoor tanners. J Am Acad Dermatol 2004, 51:45–51.PubMedCrossRefGoogle Scholar
  29. 29.
    Nolan BV, Feldman SR: Ultraviolet tanning addiction. Dermatol Clin 2009, 27:109–112.PubMedCrossRefGoogle Scholar
  30. 30.
    Picardi A, Abeni D, Melchi CF, et al.: Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol 2000, 143:983–991.PubMedCrossRefGoogle Scholar
  31. 31.
    Willemsen R, Roseeuw D, Vanderkinden J: Alexithymia and dermatology: the state of the art. Int J Dermatol 2008, 47:903–910.PubMedCrossRefGoogle Scholar
  32. 32.
    Richards HL, Fortune DG, Griffiths CE, et al.: Alexithymia in patients with psoriasis. Clinical correlates and psychometric properties of the Toronto Alexithymia Scale 20. J Psychosom Res 2005, 58:89–96.PubMedCrossRefGoogle Scholar
  33. 33.
    Asri F, Akhdari R, Chagh R, et al.: Alexithymia and depression in chronic dermatosis. Eur Psychiatry 2008, 23:S242.CrossRefGoogle Scholar
  34. 34.
    Gupta MA, Lanius RA, Van der Kol BA: Psychologic trauma, posttraumatic stress disorder and dermatology. Dermatol Clin 2005, 23:649–656.PubMedGoogle Scholar
  35. 35.
    Vythilingum B, Stein D: Obsessive-compulsive disorders and dermatologic disease. Dermatol Clin 2005, 23:675–680.PubMedCrossRefGoogle Scholar
  36. 36.
    Demet MM, Devecci A, Taskin O, et al.: Obsessive compulsive disorder in a dermatology outpatient clinic. Gen Hosp Psychiatry 2005, 27:426–430.PubMedCrossRefGoogle Scholar
  37. 37.
    Warnock JK, Morris D: Adverse cutaneous reactions to mood stabilizers. Am J Clin Dermatol 2003, 4:21–30.PubMedCrossRefGoogle Scholar
  38. 38.
    Krahn LE, Goldberg RL: Psychotropic medications and the skin. In Psychotropic Drug Use in the Medically Ill. Edited by Silver PA. Basel, Switzerland: Karger; 1994:90–106.Google Scholar
  39. 39.
    Wachter T, Murach WM, Brocker EB, et al.: Recalcitrant lithium-induced psoriasis in a suicidal patient alleviated by tumour necrosis factor-alpha inhibition. Br J Dermatol 2007, 157:627–629.PubMedCrossRefGoogle Scholar
  40. 40.
    Lee CS, Accordino R, Howard J, et al.: Psychopharmacology in dermatology. Dermatol Ther 2008, 21:69–82.PubMedCrossRefGoogle Scholar
  41. 41.
    Koo JY, Ng TC: Psychotropic and neurotropic agents in dermatology: unapproved uses, dosages or indications. Clin Dermatol 2002, 20:582–594.PubMedCrossRefGoogle Scholar
  42. 42.
    Gupta MA, Gupta AK, Ellis CN, Koblenzer CS: Psychiatric evaluation of the dermatology patient. Dermatol Clin 2005, 23:591–599.PubMedCrossRefGoogle Scholar
  43. 43.
    Woodruff PWR, Higgins EM, du Vivier AW, et al.: Psychiatric illness inpatients referred to a dermatology-psychiatry clinic. Gen Hosp Psychiatry 1997, 19:29–35.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Department of Psychiatry, Case Western Reserve University School of MedicineUniversity Hospitals Case Medical CenterClevelandUSA

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