Cutaneous Manifestations of Psychiatric Disorders and Management

Abstract

The practice of psychodermatology addresses the correlation between dermatologic manifestations and psychiatric disorders. Psychiatric co-morbidity that exacerbates or causes a skin condition is seen in approximately 30–40 % of patients presenting for dermatologic treatment (Yadav et al. Indian J Dermatol Venereol Leprol 79:176–92, 2013; Park and Koo Clin Dermatol 31(1):92–100, 2013). This chapter will focus on those psychiatric conditions that have skin findings, and may present to a dermatologists’ office for diagnosis and treatment.

Delusional infestation (DI) is rare in children, though a parent may have concerns for infestation; management involves recognition of DI and protection of the child. Body awareness disorders such as body dysmorphic disorder (BDD), anorexia nervosa (AN), and bulimia nervosa (BN) may be first recognized in a dermatologic setting. Referral for psychotherapy and medication management is beneficial in these populations. Factitious disorders require early recognition and psychiatric treatment. For pediatric patients with obsessive-compulsive related disorders, including excoriation disorder and trichotillomania, some evidence supports the use of cognitive behavioral therapy, selective serotonin reuptake inhibitors, and tricyclic antidepressants. The diagnosis and treatment of psychogenic purpura is controversial, though therapy may be helpful for underlying psychological stressors.