Somatization in the dermatology patient: Some sociocultural perspectives

Somatization in dermatology

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.

Psychological Responses According to Gender during the Early Stage of COVID-19 in Spain

BACKGROUND

Current research has pointed out an increased risk of mental health problems during the COVID-19 pandemic in women compared to men, however the reason for this difference remains unclear. The aim of this research is to study early psychological responses to the pandemic in the Spanish general population, focusing on gender differences.

METHODS

Nine to 14 days after the declaration of a state of emergency an online survey was conducted assessing sociodemographic, health, behavioral and COVID-19-related variables. Mental health status was evaluated by the Depression, Anxiety and Stress Scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the Self-Care Scale (SCS).

RESULTS

The study included 3520 respondents: 2611 women and 909 men. Women scored significantly higher in DASS-21 and IES-R (p < 0.05) and were more likely to somatize, suffer from hypochondriasis, sleeping disturbances and claustrophobia (p < 0.05). Being a woman can be considered a risk factor for intrusive thoughts, avoidance mechanisms, stress and anxiety (Odd Ratio = 2.7/2.3/2.3/1.6). The risk of presenting posttraumatic symptoms and emotional distress was greater in women (Odd Ratio = 6.77/4.59). General linear models to predict IES-R and DASS-21 scores clarified which variables were gender specific, such as main concerns.

CONCLUSIONS

This study provides evidence that at early stages of the pandemic, women mental health was more impacted and that both genders show different concerns. Gender perspective in secondary and tertiary prevention strategies must be taken into account when facing the distress associated with the pandemic.

Psychological disturbances in patients with pigmentary disorders: a cross-sectional study

BACKGROUND

Data on prevalence and factors influencing psychological burden in pigmentary disorders are scarce.

OBJECTIVE

To determine the point prevalence of anxiety disorder, depression and somatoform disorder in patients with melasma, vitiligo and acquired dermal macular hyperpigmentation (ADMH).

METHODS

A prospective cross-sectional study involving 100 patients each with melasma, ADMH and vitiligo with lesions on exposed body parts was conducted in the pigmentary clinic of a tertiary care referral hospital from June 2015 to December 2017. Dermatology life quality index, PRIME-MD Patient Health Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Patient Health Questionnaire-15 were used for assessment of quality of life, psychiatric comorbidities, depression, general anxiety disorder and somatoform disorders, respectively, and correlated with age, gender, occupation, marital status, severity and progression of the disease.

RESULTS

The prevalence of anxiety disorder in patients with melasma, vitiligo and ADMH was 11.6%, 21% and 18.7%, respectively. Depression was seen in 12.8%, 27% and 24.1% patients with melasma, vitiligo and ADMH, respectively. Somatoform disorder was more common in vitiligo (17.9%) as compared to ADMH (14.3%) and melasma (8.1%). There were positive correlations between the severity of disease and the point prevalence of anxiety and depression in all disorders.

CONCLUSION

A high point prevalence of anxiety, depression and somatoform disorders was observed with pigmentary diseases, especially vitiligo and ADMH. The prevalence of anxiety and depression correlated with the disease severity and activity. Future research involving comparison with the general healthy population is required for a more affirmative conclusion.