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Mar K, Rivers JK. The Mind Body Connection in Dermatologic Conditions: A Literature Review. J Cutan Med Surg 2023; 27:628-640. [PMID: 37898903 PMCID: PMC10714694 DOI: 10.1177/12034754231204295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/14/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023]
Abstract
Psychodermatology pertains to the relationship between the skin and brain. This review aims to summarize the evidence of the mind body connection in four psychophysiological conditions: rosacea, atopic dermatitis (AD), acne vulgaris (AV), and psoriasis. A literature search was conducted using several English language databases. All four conditions share similar psychiatric co-morbidities, including but not limited to anxiety, depression, and suicidality. In rosacea, the upregulation of transient receptor potential vanilloid type 1, Toll like receptor 2, and Th17 cells releases downstream products that are simultaneously implicated in mood disorders. Stress exacerbates AV through the hypothalamic-pituitary-adrenal (HPA) system, which alters functioning of sebocytes and Cutibacterium acnes. In AD and psoriasis, the HPA axis influences Th1, Th2, Th22, and Th1, Th17 immune mediated responses, respectively. This leads to the secretion of pro-inflammatory cytokines which are also involved in the pathogenesis of anxiety and depression. Neurotransmitters implicated in mental illness, such as gamma-aminobutyric acid and serotonin, may also play a role in the development of AD and psoriasis. The management of cutaneous disease may mitigate psychological distress, and future research may show the corollary to also be true.
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Affiliation(s)
- Kristie Mar
- University of British Columbia, Vancouver, BC, Canada
| | - Jason K. Rivers
- Pacific Derm, Vancouver, BC, Canada
- Department of Dermatology and Skin Science, University of British Columba, Vancouver, BC, Canada
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Ajani AA, Olanrewaju FO, Oninla OA, Ibigbami O, Mosaku SK, Onayemi OE, Olasode O. Psychodermatological Disorders in Patients With Primary Psychiatric Conditions: Cross-Sectional Study. JMIR DERMATOLOGY 2023; 6:e47769. [PMID: 37782534 PMCID: PMC10580141 DOI: 10.2196/47769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Psychodermatological disorders (PDs) and their associations with mental health problems are one of the most frequent research themes in dermatology outpatient settings. Surprisingly, very few studies have been conducted to evaluate PDs among patients with primary psychiatric conditions. As such, the relationship between preexisting psychiatric conditions and comorbid PDs is underrepresented in the literature. OBJECTIVE This study examined the prevalence and distribution of PDs among adults with primary psychiatric conditions and determined their association with underlying psychiatric diagnoses. METHODS We conducted a cross-sectional analysis at a tertiary health care facility in southwestern Nigeria. Comorbid PDs were identified and classified using preexisting classification systems. A bivariate analysis was conducted to determine the association between PDs and underlying psychiatric conditions. The level of statistical significance was set at P<.05. RESULTS The study included 107 patients with mental health disorders, of whom 64 (59.8%) were female. The mean age of the patients was 40.73 (SD 13.08) years. A total of 75 (75/107, 70%) patients had at least one comorbid PD. The prevalence of PDs was highest in patients with affective disorders (15/20, 75%) and least in those with schizophrenia (45/66, 68%). PDs associated with delusions or hallucinations and somatoform symptoms were 9 and 13 times more frequent in patients with anxiety disorders compared to those with other psychiatric conditions (P=.01; odds ratio [OR] 9.88, 95% CI 1.67-58.34 and P=.003; OR 13.13, 95% CI 2.34-73.65), respectively. In contrast, patients with schizophrenia were significantly less likely to be diagnosed with dermatoses resulting from delusions or hallucinations (P=.002; OR 0.04, 95% CI 0.00-0.75). A weak but significant negative association was also found between psychophysiological PDs and anxiety disorders (ϕ=-0.236; P=.02). CONCLUSIONS This study provides important insights into the overwhelming burden of psychodermatological conditions in patients with mental health disorders and specific associations with underlying psychiatric diagnosis.
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Affiliation(s)
- Atinuke Arinola Ajani
- Department of Dermatology and Venereology, Obafemi Awolowo University, Ile Ife, Nigeria
| | | | | | - Olanrewaju Ibigbami
- Department of Dermatology and Venereology, Obafemi Awolowo University, Ile Ife, Nigeria
| | | | | | - Olayinka Olasode
- Department of Dermatology and Venereology, Obafemi Awolowo University, Ile Ife, Nigeria
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Gill PK, Zeglinski-Spinney A. Diagnosing the Dermatologic Blues: Systematic Review of the Rare Conundrum, Psychogenic Purpura. JMIR DERMATOLOGY 2023; 6:e48153. [PMID: 37703091 PMCID: PMC10534291 DOI: 10.2196/48153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Psychogenic purpura is an idiopathic psychodermatologic condition of recurrent, painful purpura precipitated by psychological stress, predominantly affecting young females. Little consensus exists on the diagnostic guidelines for this rare condition, often resulting in costly, unnecessary, and stressful investigations as well as prolonged hospital admissions. OBJECTIVE With this first up-to-date systematic review of 134 cases of psychogenic purpura in over a decade, we aim to thoroughly investigate the diagnostic strategy and treatment regimens used in the last decade. With a sooner diagnosis, patient stress and nosocomial ecchymoses can be minimized, and treatment can be expedited. METHODS We conducted a literature review of 4 databases (PubMed, Ovid Embase, Ovid MEDLINE, and Web of Science) on October 5, 2022 that yielded 46 full-text articles, which were reviewed and extracted by 2 independent reviewers. RESULTS We analyzed a total of 134 cases, consisting largely of females (125/134, 93.3%) with purpura on the upper (103/134, 76.9%) or lower limbs (112/134, 83.6%). Apart from a paresthesia prodrome, patients commonly experienced headaches, malaise, and arthralgia or myalgia. Approximately 70% (95/134) of patients reported a physiological or psychological stressor or psychiatric diagnosis before the development of the purpura. Laboratory testing almost always revealed unremarkable results. The intradermal washed autoerythrocyte sensitization test was positive in 98% (42/43) of cases. Histopathology biopsy findings commonly revealed dermal erythrodiapedesis or hemorrhage (n=34) and perivascular inflammatory infiltrates (n=17). Approximately 42% (56/134) of patients received a novel psychiatric diagnosis, with depression being the most common (40/72, 56%). In both patients with and those without a novel psychiatric diagnosis, observation, counseling, treatment with antidepressants (ie, selective serotonin reuptake inhibitors), and psychotherapy (ie, cognitive behavioral therapy) prevailed in the resolution of the purpura. CONCLUSIONS Due to the unclear etiology and infrequent presentation of this condition, it remains a diagnosis of exclusion based on clinical suspicion evaluating the presence of stressors or psychiatric comorbidities and exclusion of systemic conditions. Clinical confirmation can be sought through a positive autoerythrocyte sedimentation test, characteristic histopathology findings, and remission of purpura after psychiatric treatment.
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Affiliation(s)
- Praneet K Gill
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Platsidaki E, Efstathiou V, Markantoni V, Kouris A, Kontochristopoulos G, Nikolaidou E, Rigopoulos D, Stratigos A, Gregoriou S. Self-Esteem, Depression, Anxiety and Quality of Life in Patients with Melasma Living in a Sunny Mediterranean Area: Results from a Prospective Cross-Sectional Study. Dermatol Ther (Heidelb) 2023; 13:1127-1136. [PMID: 36995579 PMCID: PMC10149543 DOI: 10.1007/s13555-023-00915-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/01/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Melasma is a common acquired disorder of hyperpigmentation and has a significant effect on quality of life. The aim of this prospective cross-sectional study was to assess the effect of melasma on depression, social anxiety and self-esteem in the Greek population. METHODS The study included a total of 254 participants: 127 patients with melasma and an equal sample of healthy controls. Both participant groups completed the following psychometric measures: the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and Rosenberg's Self-esteem Scale (RSES) for self-esteem. Furthermore, in patients with melasma, quality of life was assessed using Melasma Quality of Life (MELASQoL). RESULTS Melasma patients (7.47 ± 4.53) presented statistically significantly higher anxiety compared to healthy controls (6.06 ± 3.59, p = 0.006), while no differences emerged with regard to depression or self-esteem. It is important to note that the difference regarding anxiety remained significant (b = 1.25, p = 0.003) even after adjusting for age, depression and self-esteem. A higher disease severity (MASI) correlated statistically significantly with longer disease duration (r = 0.24, p < 0.001), higher depression (r = 0.28, p = 0.002), and a more impaired health-related quality of life (MelasQol; r = 0.29, p < 0.001). Notably, a more impaired health-related quality of life was also correlated with higher depression (r = 0.19, p = 0.027) and lower self-esteem (r = - 0.31, p < 0.001). CONCLUSION The results of this study highlight the importance of evaluating quality of life, anxiety and depression in patients with melasma. The therapeutic approach should not be based solely on clinical findings; it should also include an evaluation of the patient's psychological aspects. Dermatologists can further improve their patient care by being supportive or requesting psychological intervention when needed, resulting in better compliance with treatment and an improved social and psychological status.
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Affiliation(s)
- Eftychia Platsidaki
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasiliki Efstathiou
- Department of Psychiatry, University of Athens Medical School, "Attikon" University General Hospital, Athens, Greece
| | - Vasiliki Markantoni
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anargyros Kouris
- Department of Dermatology, Andreas Sygros Hospital, Athens, Greece
| | | | - Electra Nikolaidou
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Stratigos
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Gregoriou
- 1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Heim‐Ohmayer P, Freiberger A, Gedik M, Beckmann J, Ziehfreund S, Zink A, Hähl W, Schielein MC. The impact of stigmatization of psoriasis, atopic dermatitis and mastocytosis in different areas of life-A qualitative interview study. SKIN HEALTH AND DISEASE 2022; 2:e62. [PMID: 36479263 PMCID: PMC9720196 DOI: 10.1002/ski2.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND Stereotypes and false assumptions about chronic and visible skin diseases can determine the behaviour towards affected individuals and result in stigmatization or discrimination. OBJECTIVE The aim of this study was to analyze the perceived disease-related stigmatization of individuals with psoriasis, atopic dermatitis (AD) or mastocytosis. The study also aims to broaden people-centred knowledge of the effects of stigmatization in different areas of life, namely in everyday life, at work, in sports and in relationships. METHODS Qualitative in-depth semi-structured interviews were conducted among individuals with either psoriasis, AD or mastocytosis. Participants were recruited via self-help networks and were asked to express their experience of stigmatization in different areas of life. All interviews were audio recorded, transcribed verbatim and evaluated based on Mayring's content analysis. RESULTS In total, 24 individuals aged 19-79 years and living in Germany were included in the study-eight for each disease. Stigmatization was experienced in all three diseases in all mentioned areas of life as well as in interaction with medical professionals. Self-exclusion, negative self-perception and negative behaviour of others were the most frequent experiences with stigmatization. CONCLUSION Stigmatization, both internal and external, is an important factor contributing to the mental burden of people with chronic skin diseases. More research is needed to gain deeper insight into stigmatization and its psychological burden in various contexts to enhance people-centred care in chronic skin diseases.
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Affiliation(s)
- P. Heim‐Ohmayer
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - A. Freiberger
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - M. Gedik
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - J. Beckmann
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
- School of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneQueenslandAustralia
| | - S. Ziehfreund
- Department of Dermatology and AllergySchool of MedicineTechnical University of MunichMunichGermany
| | - A. Zink
- Department of Dermatology and AllergySchool of MedicineTechnical University of MunichMunichGermany
- Unit of Dermatology and VenereologyDepartment of MedicineKarolinska University HospitalKarolinska InstitutetSolnaSweden
| | - W. Hähl
- Department of Sport and Health SciencesTechnical University of MunichMunichGermany
| | - M. C. Schielein
- Department of Dermatology and AllergySchool of MedicineTechnical University of MunichMunichGermany
- Unit of Dermatology and VenereologyDepartment of MedicineKarolinska University HospitalKarolinska InstitutetSolnaSweden
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Turk T, Liu C, Straube S, Dytoc M, Hagtvedt R, Dennett L, Abba-Aji A, Fujiwara E. The Global Prevalence of Primary Psychodermatologic Disorders: A Systematic Review. J Eur Acad Dermatol Venereol 2022; 36:2267-2278. [PMID: 35924420 DOI: 10.1111/jdv.18478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
The management of primary psychodermatologic disorders (PPDs) (i.e., psychiatric disorders with dermatologic presentation) is challenging. The scarceness of reported prevalence hinders the development of coordinated interventions to improve healthcare delivery. This review aimed to explore the global prevalence of PPDs. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Of the 4632 identified publications, 60 were included. Five PPDs were investigated from the included studies: delusional parasitosis (n=9), skin picking disorder (n=26), trichotillomania (n=22), tanning dependence (n=5), and repetitive nail biting (n=6). Delusional parasitosis was rare in the general population (prevalence ranging from 0.0002% to 0.03%), with higher rates in the psychiatric settings (outpatient=0.5%; inpatient=0.1%). Other pathologic or subclinical forms of PPDs had a minimum prevalence of 0.3% (median=7.0%; mean=17.0%). The distribution of the prevalence rates was highly skewed, with large differences based on the study setting (e.g., dermatologic settings, psychiatric settings, and general population). The most common condition was pathologic skin picking (prevalence, 1.2%-11.2%) in the general population. Its rates were higher in the psychiatric settings (obsessive-compulsive disorder, 38.5%; Tourette syndrome, 13.0%; body dysmorphic disorder, 26.8%-64.7%). The prevalence of trichotillomania in the general population ranged from 0.6% to 2.9%, while that of pathologic tanning and nail biting could not be ascertained as the studies were mainly in students (range; 12.0%-39.3% and 3.0%-10.1%, respectively). In conclusion, PPDs are common, especially in the dermatologic and psychiatric settings. Further population-based studies are needed to determine more accurate prevalence rates.
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Affiliation(s)
- T Turk
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - C Liu
- Department of Dermatology and Skin Science, University of British Colombia, Vancouver, BC, Canada
| | - S Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Dytoc
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Hagtvedt
- ABA, Alberta School of Business, University of Alberta, Edmonton, AB, Canada
| | - L Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - A Abba-Aji
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - E Fujiwara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Mahadi AR, Rafi MA, Shahriar T, Seemanta S, Rabbani MG, Akter M, Majumder MI, Hasan MT. Association Between Hair Diseases and COVID-19 Pandemic-Related Stress: A Cross-Sectional Study Analysis. Front Med (Lausanne) 2022; 9:876561. [PMID: 35647001 PMCID: PMC9133810 DOI: 10.3389/fmed.2022.876561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/05/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction:Psychological stress from the ongoing coronavirus disease 2019 (COVID-19) pandemic can potentially aggravate the course of several stress-sensitive skin and hair diseases. This study aimed to determine the potential association of COVID-19 stress with hair diseases, such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD), among medical students in Bangladesh.MethodsThis online-based cross-sectional study was conducted among 404 medical students of Bangladesh using a self-administered questionnaire, including sociodemographic information, status of hair diseases (i.e., TE, AA, and SD), COVID-19 fear scale, impact of event scale specific for COVID-19 (IES-COVID-19), and COVID-19 student stress questionnaire (CSSQ) scale, to determine pandemic-related stress. The logistic regression model was used to analyze the association.ResultsOverall prevalence of TE, AA, and SD was 61.1, 24.7, and 57.7%, respectively, with female predominance in case of TE and male predominance in case of AA and SD. More than half of the participants had COVID-19-related fear and traumatic stress symptoms. In the multiple logistic regression model, smoking [adjusted odds ratio (aOR) 2.93, 95% CI 1.29–6.65 for AA and aOR 4.19, 95% CI 1.83–9.56 for TE], COVID-19-related fear (aOR 1.70, 95% CI 1.01–2.89 for AA and aOR 2.620, 95% CI 1.25–5.48 for TE), and COVID-19-related traumatic stress symptoms (aOR 1.84, 95% CI 1.08–3.13 for AA, aOR 2.61, 95% CI 1.19–5.68 for TE, and aOR 1.92, 95% CI 1.14–3.25 for SD) were the risk factors of hair fall disorders.ConclusionOur study showed that a large number of medical students experienced TE, AA, and SD during the pandemic era. COVID-19-related stress and fear potentially have an association with these diseases.
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Affiliation(s)
- Ashrafur Rahaman Mahadi
- Central Medical College, Cumilla, Bangladesh
- Public Health Foundation, Dhaka, Bangladesh
- *Correspondence: Ashrafur Rahaman Mahadi
| | | | | | | | - Md. Golam Rabbani
- Public Health Foundation, Dhaka, Bangladesh
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - M. Tasdik Hasan
- Public Health Foundation, Dhaka, Bangladesh
- Department of Public Health, State University of Bangladesh, Dhaka, Bangladesh
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
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Khademi M, Roohaninasab M, Goodarzi A, Seirafianpour F, Dodangeh M, Khademi A. The healing effects of facial BOTOX injection on symptoms of depression alongside its effects on beauty preservation. J Cosmet Dermatol 2021; 20:1411-1415. [PMID: 33565223 DOI: 10.1111/jocd.13990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/13/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Beauty is closely associated with a sense of calm, confidence, and hope for a better life. Therefore, it is expected that improving the appearance or even correcting one's view of appearance can prevent depression and even improve different degrees of depression in individuals. AIMS Investigation of whether using botulinum injections (a common method of improving facial esthetics) can improve the degree of depression in clients. METHODS This prospective interventional before-after study was conducted on 121 consecutive individuals referred for beautifying the face. Before performing the interventional procedure by facial botulinum injection as well as one month later, the depression status was examined by the Beck Depression Inventory II (BDI) questionnaire. RESULTS The mean baseline depression score dropped from 18.9 ± 4.8 to 10.6 ± 2.9 during the follow-up time (P < .001). Using the multivariable linear regression modeling and with the presence of baseline parameters, the main determinants of improving depression score included young ages (beta = -0.541, P = .001), higher educational level (beta = 0.595, P = .015), and previous experiences of botulinum toxin use (beta = 1.072, P = .036). CONCLUSION The improvement in people's moods along with correction of their facial defects following botulinum toxin injections would be expected.
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Affiliation(s)
| | - Masoumeh Roohaninasab
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Farnoosh Seirafianpour
- Student Research Comittee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Milad Dodangeh
- Student Research Comittee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Khademi
- The British Board of Antiaging & Integrated Medicine, London, UK
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Okeafor C, Altraide D, Otike-Odibi B. Psychiatric morbidity among dermatology patients: A hospital-based cross-sectional study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2021. [DOI: 10.4103/jdds.jdds_41_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Lukmanji A, Basmadjian RB, Vallerand IA, Patten SB, Tang KL. Risk of Depression in Patients With Psoriatic Disease: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2020; 25:257-270. [PMID: 33263264 DOI: 10.1177/1203475420977477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous systematic reviews have assessed the prevalence and odds ratio (OR) of depression for patients with psoriatic disease. Due to probable bidirectional effects, prevalence and prevalence ORs are difficult to interpret. No prior reviews have quantified the relative risk (RR) of depression following a diagnosis of psoriatic disease. OBJECTIVE To estimate the RR of depression in individuals with psoriasis and in psoriatic arthritis (PsA), clear-to-moderate psoriasis, and moderate-to-severe psoriasis subgroups. METHODS Observational studies investigating the risk of depression in adults with psoriatic disease were systematically searched for in Medline, EMBASE, PsycINFO, and CINAHL databases; 4989 unique references were screened. Studies that reported measures of incident depression in psoriasis patients were included. Thirty-one studies were included into the systematic review, of which 17 were meta-analyzed. Random effects models were employed to synthesize relevant data. Sources of heterogeneity were explored with subgroup analysis and meta-regression. RESULTS Seventeen studies were included in meta-analyses. The pooled RR of depression in psoriasis patients compared to nonpsoriasis controls was 1.48 (95% CI: 1.16-1.89). Heterogeneity was high (I2 = 99.8%). Subgroup analysis and meta-regression did not indicate that PsA status or psoriasis severity (clear-to-mild, moderate-to-severe) were sources of heterogeneity. No evidence of publication bias was found. CONCLUSIONS This review demonstrates that the risk of depression is greater in patients with psoriasis and PsA. Future research should focus on developing strategies to address the mental health needs of this patient population for depression, including primary prevention, earlier detection, and treatment strategies.
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Affiliation(s)
- Aysha Lukmanji
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Robert B Basmadjian
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Isabelle A Vallerand
- 2129 Department of Medicine, University of Calgary, AB, Canada.,70401 Division of Dermatology, University of Calgary, AB, Canada
| | - Scott B Patten
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada.,2129 Department of Medicine, University of Calgary, AB, Canada.,2129 Mathison Centre for Mental Health Research & Education, University of Calgary, AB, Canada.,2129 Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, AB, Canada
| | - Karen L Tang
- 2129 Department of Community Health Sciences, University of Calgary, AB, Canada.,2129 Department of Medicine, University of Calgary, AB, Canada
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11
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Jafferany M, Stamu‐O'Brien C, Mkhoyan R, Patel A. Psychotropic drugs in dermatology: A dermatologist's approach and choice of medications. Dermatol Ther 2020; 33:e13385. [DOI: 10.1111/dth.13385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammad Jafferany
- Department of Psychiatry, CMU Medical Education Partners Central Michigan University College of Medicine Saginaw Michigan USA
| | | | | | - Arsh Patel
- Wake Forest University School of Medicine Winston‐Salem North Carolina USA
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12
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Bekić S, Martinek V, Talapko J, Majnarić L, Vasilj Mihaljević M, Škrlec I. Atopic Dermatitis and Comorbidity. Healthcare (Basel) 2020; 8:healthcare8020070. [PMID: 32218222 PMCID: PMC7349599 DOI: 10.3390/healthcare8020070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023] Open
Abstract
Atopic dermatitis is the most common chronic inflammatory skin disease. It is often the first indicator of allergic diseases, and a certain percentage of patients are affected by allergic rhinitis and/or asthma as a consequence. The study aimed to investigate the link between atopic dermatitis and comorbidity in family medicine. In the specialist family medicine practice Osijek, a retrospective study was conducted in the period from January 1, 2016 to July 1, 2017 on the percentage of patients with atopic dermatitis in the total number of patients, and their comorbid diseases. The data source was the E-chart. The results showed that 195 (10.53%) out of 2056 patients had atopic dermatitis, 80 (41%) patients had atopic dermatitis and allergic rhinitis, 34 (17.4%) asthma, 132 (67.7%) infections, 59 (30.3%) gastrointestinal disturbances, and 68 (34.3%) had mental disorders. Patients up to 18 years old were more likely to have infections, and adult patients were exposed to chronic stress. The most commonly used drug was loratadine (60.5%), while mometasone was the most commonly administered topical drug (40%). The result of this research showed the steps of the ˝atopic march˝. Atopic dermatitis is followed by changes in the skin and its progression to other organ systems in most of the patients.
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Affiliation(s)
- Sanja Bekić
- Family Medicine Practice, HR-31000 Osijek, Croatia; (S.B.); (V.M.)
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia;
| | | | - Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia;
| | - Ljiljana Majnarić
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia;
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia;
| | | | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia;
- Correspondence:
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Chikin VV. Guselkumab in the treatment of patients with plaque psoriasis of moderate and severe severity: Efficacy and safety of interleukin-23 blockade. VESTNIK DERMATOLOGII I VENEROLOGII 2020. [DOI: 10.25208/0042-4609-2019-95-6-68-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- V. V. Chikin
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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Ferreira B, Pio‐Abreu J, Reis J, Figueiredo A. First psychodermatology clinic in a Portuguese Department of Dermatology. J Eur Acad Dermatol Venereol 2018; 33:e119-e120. [DOI: 10.1111/jdv.15303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B.R. Ferreira
- Department of Dermatology Coimbra Hospital and University Centre Coimbra Portugal
| | - J.L. Pio‐Abreu
- Department of Psychiatry Coimbra Hospital and University Centre Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | - J.P. Reis
- Department of Dermatology Coimbra Hospital and University Centre Coimbra Portugal
| | - A. Figueiredo
- Department of Dermatology Coimbra Hospital and University Centre Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
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Bin Saif GA, Alotaibi HM, Alzolibani AA, Almodihesh NA, Albraidi HF, Alotaibi NM, Yosipovitch G. Association of psychological stress with skin symptoms among medical students. Saudi Med J 2018; 39:59-66. [PMID: 29332110 PMCID: PMC5885122 DOI: 10.15537/smj.2018.1.21231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To evaluate the association between psychological stress and skin symptoms among medical students. Methods: A cross-sectional study was carried out between January and June 2015. Electronic survey consists of Perceived Stress Questionnaire (PSQ) and Self-Reported Skin Complaints Questionnaire were distributed to all 1435 undergraduate students at College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia. Results: Final analysis was performed on data from 529 (36.9%) students. Students were divided into three groups: least stressed students, n=135, PSQ index <0.39; highly stressed students, n=136, PSQ index >0.61; and moderately stressed students, n=258. Older age, female gender, during exam weeks, and fourth and fifth years of medical school (all p<0.01) were associated with the highest perceived stress levels. When compared to least stressed students, highly stressed students suffered from more oily, waxy patches or flakes on scalp (p≤0.0001), dry/sore rash (p≤0.0001), warts (p≤0.0001), pimples (p≤0.0001), itchy skin (p≤0.0001), hands itchy rash (p≤0.0001), hair loss (p≤0.0001), pull-out own hair (p=0.008), scaly skin (p=0.012), troublesome sweating (p=0.016), nails biting (p=0.028), and other rashes on face (p=0.028). Conclusion: Various common skin conditions could appear in context of psychological stress among medical students.
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Affiliation(s)
- Ghada A Bin Saif
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Abstract
Psychodermatology, a relatively neglected branch of dermatology in India, refers to a holistic approach to skin diseases involving not only the mind and skin, but also the cutaneous effects of psychologic stress. Among many Indian people, culture, religion, the belief in karma, and the tendency to prefer indigenous medical systems can all have a major impact on lifestyle, as well as the approach to managing various diseases, including dermatologic conditions. The origin of psychodermatology in India can be traced to Buddha's period. Indigenous medical systems, such as Ayurveda, Yoga, and Unani, advocate control of skin disease through meditation, exercises, and related practices. Scientific practice of psychodermatology is still lacking in India, although there is an increasing understanding of the mind-skin connection among both health care providers and patients who have access to information over the Internet. The first dedicated psychodermatology liaison clinic was established in 2010 in Manipal, India. The common problems encountered have been anxiety, dysthymia, and depression, especially in patients with psoriasis, vitiligo, and urticaria.
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Deshpande SS, Khatu SS, Pardeshi GS, Gokhale NR. Cross-sectional study of psychiatric morbidity in patients with melasma. Indian J Psychiatry 2018; 60:324-328. [PMID: 30405259 PMCID: PMC6201670 DOI: 10.4103/psychiatry.indianjpsychiatry_115_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
CONTEXT Patients with dermatological problems have higher prevalence of psychiatric illnesses than the general population. Melasma, hyperpigmentation of skin over sun-exposed areas, has bidirectional cause-effect relationship with depression and stress through psycho-neuro-endocrine pathways. AIMS The aim of this study is to study the psychiatric morbidity and perceived stress in patients with melasma and statistically compare objective study parameters with those without melasma. SETTINGS AND DESIGN This cross-sectional descriptive study was carried out in Tertiary hospital in urban setting, jointly by psychiatrist and dermatologist. METHODS AND MATERIALS The study involved 50 consecutive patients with melasma and 30 relatives of patients coming to dermatology clinic not having any skin disorder. Cases were assessed by psychiatrist as per the International Classification of Diseases-10 Diagnostic Criteria for Research, Cohen's 4 item perceived stress scale, Disability Assessment Scale 2.0 by WHO and Hospital Anxiety Depression Scale (HADS) and Dermatologist calculated melasma area severity index score (MASI). RESULTS Majority patients were females (88%) in the reproductive age group. The most common psychiatric morbidity seen in 42% cases was major depressive disorder. Adjustment disorder (26%) was the second most common diagnosis. Nonparametric analysis using Mann-Whitney U test revealed significantly more perceived stress (P = 0.001), more disability (P = 0.000) and anxiety-depression on HADS (P = 0.0 16) in cases than in their relatives. LIMITATIONS This was a hospital-based study and thus melasma patients in the community are not represented. Small sample size, less number of controls, lack of structured diagnostic interview are other limitations of this study. CONCLUSIONS There is high psychiatric comorbidity (76%) of depressive and stress disorders, higher functional disability and perceived stress in patients with melasma compared to controls.
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Affiliation(s)
| | - Swapna S Khatu
- Department of Dermatology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Geeta S Pardeshi
- Department of Community Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neeta R Gokhale
- Department of Dermatology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Kim SJ, Park MY, Pak K, Han J, Kim GW, Kim HS, Ko HC, Kim MB, Kim BS. Improvement of depressive symptoms in patients with moderate-to-severe psoriasis treated with ustekinumab: an open label trial validated using beck depression inventory, Hamilton depression rating scale measures and 18fluorodeoxyglucose (FDG) positron emission tomography (PET). J DERMATOL TREAT 2018; 29:761-768. [PMID: 29658378 DOI: 10.1080/09546634.2018.1466021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin disease associated with psychiatric co-morbidities, especially depression. Early detection of psychological vulnerability in patients with psoriasis seems to be of great clinical importance and significantly impacts the quality of life of the patients. OBJECTIVES We sought to clarify the association between psoriasis and depressive symptoms in patients with moderate-to-severe psoriasis, and to determine the risk factors for depressive symptoms and analyze the effect of ustekinumab on the symptoms. We also aimed to evaluate the changes in glucose metabolism using 18fluorodeoxyglucose (FDG) positron emission tomography (FDG-PET). METHODS Fifteen patients with moderate-to-severe psoriasis scheduled to be treated with ustekinumab were enrolled. At baseline and after achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI) score (PASI75), all patients underwent a psychiatric interview and FDG-PET. Fifteen healthy volunteers were enrolled for comparison. RESULTS Patients with moderate-to-severe psoriasis were more depressed than those in the control group were (p < .05). The severity of psoriasis at baseline did not correlate with the depression symptoms. Treatment with ustekinumab significantly reduced the depressive symptoms, as verified using Beck Depression Inventory and Hamilton Depression Rating Scale psychiatric interviews (p < .05). However, FDG-PET of the brain showed no significant difference before and after PASI75 achievement using ustekinumab injection. CONCLUSIONS Patients with moderate-to-severe psoriasis are at an increased risk for depressive symptoms, and treatment with ustekinumab may be beneficial. FDG-PET does not reflect the changes in depressive symptoms in such patients.
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Affiliation(s)
- Seong-Jang Kim
- a Department of Nuclear Medicine, School of Medicine , Pusan National University , Busan , Korea
| | - Min-Young Park
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Kyoungjune Pak
- a Department of Nuclear Medicine, School of Medicine , Pusan National University , Busan , Korea
| | - Junhee Han
- c Department of Statistics and Institute of Statistics , Hallym University , Chuncheon , Korea
| | - Gun-Wook Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Hoon-Soo Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Hyun-Chang Ko
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea
| | - Moon-Bum Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea.,d Biomedical Research Institute, Pusan National University Hospital , Busan , Korea
| | - Byung-Soo Kim
- b Department of Dermatology, School of Medicine , Pusan National University , Busan , Korea.,d Biomedical Research Institute, Pusan National University Hospital , Busan , Korea
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George A, Girisha BS, Rao S. A perspective study of cutaneous manifestations in primary psychiatric disorders in a tertiary care hospital. Indian J Psychiatry 2018; 60:213-216. [PMID: 30166678 PMCID: PMC6102963 DOI: 10.4103/psychiatry.indianjpsychiatry_156_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cutaneous disorders are frequently seen in psychiatric patients. This may be attributed to the common ectodermal origin of skin and neurons. There is a paucity of data on cutaneous comorbidity in primary psychiatric disorders. AIMS The aim of this study is to determine the pattern of cutaneous manifestations in patients with primary psychiatric disorders. SETTINGS AND DESIGN This was a hospital-based observational study. SUBJECTS AND METHODS A total of 210 patients suffering from various psychiatric disorders along with associated skin disease were recruited. Patients with an age <18 years and with history of substance abuse were excluded from this study. STATISTICAL ANALYSIS IBM SPSS Statistics, version 22 (IBM Corp, Armonk, NY, USA) was used for the statistical analysis. RESULTS A total of 314 cutaneous manifestations were observed in the psychiatric patients recruited in this study. Among the patients surveyed, 88 patients were male (41.9%) and the remaining 122 patients (58.1%) were female. Primary psychiatric conditions observed were schizophrenia (25.7%), major depressive disorder (23.8%), bipolar mood disorder (23.3%), and psychosis not otherwise specified (11.9%). A majority (63.06%) of the cutaneous manifestations were noninfective dermatoses, and the rest (36.94%) were infective dermatoses. Fungal skin infections and eczema were seen in 33.8% and 24.8% of the cases, respectively. Seborrheic dermatitis (16.2%) was the most common eczema encountered. Nearly 75.2% of cases were found to have an insight into their skin problems. The common medical comorbidities seen in our patients were diabetes mellitus and hypertension. CONCLUSIONS In our study, cutaneous manifestations were quite common in primary psychiatric disorders. A collaborative approach, between psychiatry and dermatology, should be an integral part of management in such cases.
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Affiliation(s)
- Anne George
- Department of Dermatology, Justice KS Hegde Charitable Hospital, Deralakatte, Mangalore, Karnataka, India
| | - Banavasi Shanmukha Girisha
- Department of Dermatology, Justice KS Hegde Charitable Hospital, Deralakatte, Mangalore, Karnataka, India
| | - Satish Rao
- Department of Psychiatry, Justice KS Hegde Charitable Hospital, Deralakatte, Mangalore, Karnataka, India
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Al Alawi M, Al Sinawi H, Al Qasabi AM, Al Mamari AM, Panchatcharam SM, Al-Adawi S. Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman. Int J Dermatol 2018; 57:284-290. [PMID: 29369339 DOI: 10.1111/ijd.13912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/08/2017] [Accepted: 12/18/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations. OBJECTIVES The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinical-demographic factors associated with depressive symptoms. METHODS A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs). RESULTS A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR = 9.41, 95% confidence interval [CI]: 2.27-39.05, P = 0.002; OR = 2.0, 95% CI: 1.2-3.21, P = 0.05; OR = 2.28, 95% CI: 1.09-4.76, P = 0.028; and OR = 2.78; 95% CI: 1.08-7.19, P = 0.035, respectively). CONCLUSION This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.
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Affiliation(s)
- Mohammed Al Alawi
- Oman Medical Specialty Board, Muscat, Oman.,Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hamed Al Sinawi
- Oman Medical Specialty Board, Muscat, Oman.,Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | | | - Samir Al-Adawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Kouris A, Platsidaki E, Christodoulou C, Efstathiou V, Markantoni V, Armyra K, Potouridou I, Rigopoulos D, Kontochristopoulos G. Patients' self-esteem before and after chemical peeling procedure. J COSMET LASER THER 2017; 20:220-222. [PMID: 29286838 DOI: 10.1080/14764172.2017.1400168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Chemical peeling is a safe method, widely used to treat a variety of skin conditions and reduce the aging effects. This study aims to evaluate self-esteem among adolescents who undergo chemical peelings. MATERIAL AND METHODS One hundred and twenty six patients constituted the study group. Sixty seven individuals had undergone chemical peeling for therapeutic reasons and 59 individuals for cosmetic reasons. To assess patients' self-esteem, the Rosenberg's Self-esteem Scale (RSES) was used before and after treatment. The control group included 71 healthy, age- and sex-matched volunteers from the general population. They were also asked to complete the RSES, after the same time interval as the patients. RESULTS The healthy controls (23.01 ± 3.12) presented statistically significantly higher self-esteem than both the groups of individuals who would be submitted to chemical peeling. Furthermore, patients who would undergo peeling for therapeutic reasons (21.58 ± 3.20) had statistically significantly higher self-esteem than those who would undergo the procedure for cosmetic reasons (18.97 ± 3.36). After the chemical peeling sessions, the self-esteem of patients treated for therapeutic reasons (23.48 ± 2.43) and of patients treated for cosmetic reasons (22.83 ± 3.34) improved statistically significantly, while the self-esteem of the healthy controls remained stable, as expected. CONCLUSION Patients who undergo chemical peelings tend to have low levels of self-esteem. Although facial lesions in skin diseases such as acne, acne scars, rosacea, and melasma seem to have negative effect on individuals' self-consciousness, patients who would be submitted to chemical peeling in order to treat wrinkles, loss of radiance, and skin tone clarity have even lower self-esteem. Chemical peelings were shown to favorably affect patient's self-esteem since all patients showed an increase in self-esteem after treatment, while the control group experienced no change.
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Affiliation(s)
- Anargyros Kouris
- a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece
| | - Eftychia Platsidaki
- a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece
| | | | - Vasiliki Efstathiou
- b 2nd Department of Psychiatry , "Attikon" University Hospital , Athens , Greece
| | - Vasiliki Markantoni
- a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece
| | - Kalliopi Armyra
- a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece
| | - Irene Potouridou
- a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece
| | - Dimitrios Rigopoulos
- a Department of Dermatology and Venereology , Andreas Sygros Hospital , Athens , Greece
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Leite Júnior AC, Katzer T, Ramos DG. Three Cases of Hair Loss Analyzed by the Point of View of the Analytical Psychology. Int J Trichology 2017; 9:177-180. [PMID: 29118523 PMCID: PMC5655627 DOI: 10.4103/ijt.ijt_106_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Psychotrichology is the science, which covers the psychosomatics applied to hair problems, i.e., body-psyche phenomena involving scalp and hair disorders. The approaches involving psychotricology are varied and may include psychiatric,[1] psychoanalytical,[23] and those involving knowledge related to analytical psychology.[4] An analysis from the analytical psychology point of view, a theory developed by the physician Carl Gustav Jung, favors a symbolic view to the disease, providing it attributions and meanings that go beyond those related to physical body signs and symptoms only. This paper aims to describe and analyze, under the analytical psychology view, three cases the psychic and clinical demonstrations of which relate to symbolic and historic aspects concerning life of patients as possibilities of cause and maintenance of hair problems. The first of them is related to an 8-year-old girl who witnessed a scene of physical aggression by her father against her mother and developed a case of total alopecia. The second case is related to a 43-year-old woman who developed self-inflicted scalp dermatitis due to severe anxiety; and at last, the case of a telogen effluvium in a 23-year-old woman who developed hyperprolactinemia after the death of her mother, having to substitute her in the care about her husband and brothers. Looking at the clinical history and symbolic matters of scalp and hair diseases enabled, in the aforementioned cases, a better understanding of patients' psychoemotional disorders that may be related to the beginning and maintenance of clinical cases presented by them.
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Affiliation(s)
| | - Tatiele Katzer
- Department of Aesthetics in Dermatology, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Denise Gimenez Ramos
- Department of Clinical Psychology, Pontifícia universidade Católica de São Paulo, São Paulo, Brazil
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Zhou S, Mukovozov I, Chan AW. What Is Known About the Psychodermatology Clinic Model of Care? A Systematic Scoping Review. J Cutan Med Surg 2017; 22:44-50. [DOI: 10.1177/1203475417719045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Psychodermatology focuses on the interaction between skin and mental health. Existing research discusses the recognition and treatment of these disorders. However, little is known about the operational structure of subspecialised psychodermatology clinics. Objective: To identify literature on the structure and logistics of delivering a psychodermatology service. Methods: A systematic search of MEDLINE, PsycINFO, Embase, and Google Scholar was performed. Articles were included if they discussed the concept and organisation of a psychodermatology practice. Results: We identified 693 studies; after screening titles and abstracts, 35 full-text articles were assessed, and 17 were included in the scoping review. Most articles discussed aspects of clinic organisation in general; others discussed management of a clinic in the context of specific diseases or made recommendations on incorporating psychotherapeutic techniques in a solo practitioner setting. A weekly multidisciplinary clinic or resident teaching clinic with joint dermatologist-psychiatrist consultation is the most commonly reported model. Specifically, a stepped level of care approach is often used, where patients in increasing level of distress are stratified to the appropriate team of trained professionals. A corresponding curriculum to supplement practitioners’ knowledge is recommended. Conclusions: Various clinic models have been described to provide specialised psychodermatology care in specific settings. Research is needed to assess the impact of these multidisciplinary models of care on patient outcomes and health care costs.
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Affiliation(s)
- Stephanie Zhou
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ilya Mukovozov
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - An-Wen Chan
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Mavrogiorgou P, Juckel G. [Dermatological diseases and their importance for psychiatry]. DER NERVENARZT 2017; 88:254-267. [PMID: 26975652 DOI: 10.1007/s00115-016-0082-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The relationship between skin and psychiatric disorders is not an uncommon occurrence in the clinical practice; however, there are only a few systematic studies and in addition knowledge about the neurobiological and immunological mechanisms is lacking. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. In the sense of true psychosomatics, psychiatrists should also be aware of this relationship as far as possible. This review article focuses on the most important dermatological diagnoses in relation to the respective psychiatric comorbidities and presents the most important aspects of epidemiology, symptomatology, pathophysiology and treatment options.
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Affiliation(s)
- P Mavrogiorgou
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr Universität Bochum, Alexandrinenstr.1, 44791, Bochum, Deutschland
| | - G Juckel
- Klinik für Psychiatrie Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr Universität Bochum, Alexandrinenstr.1, 44791, Bochum, Deutschland.
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Azambuja RD. The need of dermatologists, psychiatrists and psychologists joint care in psychodermatology. An Bras Dermatol 2017; 92:63-71. [PMID: 28225959 PMCID: PMC5312181 DOI: 10.1590/abd1806-4841.20175493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/16/2016] [Indexed: 12/24/2022] Open
Abstract
The mind-skin connection has been studied since the nineteenth century. The last 40 years have set the development of new research areas which allowed the clarifying of how these two dimensions interact. The diseases that involve skin and mind constitute the field of psychodermatology and require that specialists in dermatology, psychiatry and psychology together and integrated take part in it, since skin, nervous system and mind are simultaneously affected. This paper aims to expose how psychodermatoses are currently conceptualized and the need of integration of these three specialties for conveniently treating the patients.
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Affiliation(s)
- Roberto Doglia Azambuja
- Service of Dermatology of the Hospital
Universitário de Brasília - Universidade de Brasília (UnB)
- Brasília (DF), Brazil
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Sarkar S, Patra P, Mridha K, Ghosh SK, Mukhopadhyay A, Thakurta RG. Personality disorders and its association with anxiety and depression among patients of severe acne: A cross-sectional study from Eastern India. Indian J Psychiatry 2016; 58:378-382. [PMID: 28196993 PMCID: PMC5270261 DOI: 10.4103/0019-5545.196720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In many patients, emotional stress may exacerbate acne. Psychological problems such as social phobias, low self-esteem, or depression may also occur as a result of acne. The presence of acne may have some negative effect on the quality of life, self-esteem, and mood of the affected patients. While some studies have been undertaken about anxiety, depression, and personality patterns in patients with acne, only a few studies have been done to identify specific personality disorders in patients with acne. Furthermore, there is a dearth of data regarding the effect of personality disorder on the psychological states of the patients which prompted us to undertake the present study. METHODOLOGY This was a descriptive cross-sectional study, undertaken in a Tertiary Care Teaching Hospital in Eastern India. Consecutive patients suffering from severe (Grade 3 and 4) acne, attending the Dermatology Outpatient Department, aged above 18 years were included to the study. RESULTS A total of 65 patients were evaluated with a mean age of 26 years. Personality disorder was present in 29.2% of patients. The diagnosed personality disorders were obsessive compulsive personality disorder (n = 9, 13.8%), anxious (avoidant) personality disorder (n = 6, 9.2%), and borderline personality disorder (n = 2, 3%), mixed personality disorder (n = 2, 3%). All patients with personality disorder had some psychiatric comorbidity. Patients having personality disorder had higher number of anxiety and depressive disorders which were also statistically significant. CONCLUSION The present study highlights that personality disorders and other psychiatric comorbidities are common in the setting of severe acne.
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Affiliation(s)
- Sharmila Sarkar
- Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Paramita Patra
- Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Kakali Mridha
- Department of Dermatology, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sudip Kumar Ghosh
- Department of Dermatology, Venereology and Leprosy, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Asish Mukhopadhyay
- Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Rajarshi Guha Thakurta
- Department of Psychiatry, Calcutta National Medical College, Kolkata, West Bengal, India
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Khawaja AR, Bokhari SMA, Tariq R, Atif S, Muhammad H, Faisal Q, Jafferany M. Disease Severity, Quality of Life, and Psychiatric Morbidity in Patients With Psoriasis With Reference to Sociodemographic, Lifestyle, and Clinical Variables: A Prospective, Cross-Sectional Study From Lahore, Pakistan. Prim Care Companion CNS Disord 2015; 17:14m01629. [PMID: 26644955 DOI: 10.4088/pcc.14m01629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psoriasis is an immune-mediated, chronic disease with a genetic background that involves skin, nails, and joints. The incidence of psoriasis varies from 2.0% to 4.0% depending on the geographical location, ethnic background, and environmental conditions. Recent research has proved that psoriasis is a systemic inflammatory disease with extensive systemic implications. Objectives of the study were to explore the severity of psoriasis, dermatology-related quality of life, and psychiatric health of the patients with reference to sociodemographic, lifestyle, and clinical characteristics. METHOD Consecutive patients with psoriasis (ICD-10 criteria) from skin outpatient clinics of 3 tertiary care hospitals in Lahore, Pakistan, between November 1, 2012, and December 31, 2012, were assessed in this prospective cross-sectional study. The final sample includes 87 patients who were evaluated for severity of psoriasis (Psoriasis Area Severity Index [PASI]), dermatology-related quality of life (Dermatology Life Quality Index [DLQI]), and psychiatric morbidity (12-item General Health Questionnaire [GHQ-12]) and were assessed on 23 sociodemographic, lifestyle, and clinical variables. RESULTS Of the 23 variables, the PASI was significantly associated with education and habit of drinking alcohol (P < .05), the DLQI was significantly associated with disturbed eating (P < .05), and the GHQ-12 score was significantly associated with hair disease (P < .05), current income (P < .05), and disturbed eating and sleeping (P < .01). The PASI, DLQI, and GHQ-12 were not usually affected by sociodemographic, lifestyle, and clinical factors, except for some variables such as education of the patient, alcohol intake, eating and sleeping disturbance, and income status. A statistically significant correlation (P < .01) was found between all 3 scores (ie, PASI, DLQI, and GHQ-12). The correlation coefficients of the PASI with the DLQI and GHQ-12 are 0.345 and 0.460, respectively, and that of the DLQI with the GHQ-12 is 0.635. A moderating effect of the DLQI score was found on the relationship between the PASI and GHQ-12 scores. CONCLUSIONS Psoriasis has an immense impact on the life of patients and common comorbidities in psoriasis including coronary heart disease, depression, cerebrovascular disease, and metabolic syndrome. Screening for these comorbidities in psoriasis patients is essential. Impaired quality of life negatively affects the psyche of patients and initiates coping mechanisms, which may lead to depression and anxiety, social dysfunction, and loss of confidence, and the psychosocial burden of the disease may become more than the physical burden. The dermatologist usually manages physical disease and fails to address the social, emotional, and psychological aspects. Quality of life improves if these psychological aspects are also properly dealt with.
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Affiliation(s)
- Abdul Rahman Khawaja
- AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany)
| | - Syed Muhammad Azam Bokhari
- AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany)
| | - Rasheed Tariq
- AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany)
| | - Shahzad Atif
- AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany)
| | - Hanif Muhammad
- AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany)
| | - Qadeer Faisal
- AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany)
| | - Mohammad Jafferany
- AIMC Research Cell, Allama Iqbal Medical College, Jinnah Hospital, Lahore (Dr Khawaja); Department of Dermatology Services, Institute of Medical Sciences Services Hospital, Lahore (Dr Bokhari); Department of Dermatology, Fatima Jinnah Medical College, Sir Ganga Ram Hospital, Lahore (Dr Rasheed); Department of Dermatology, Postgraduate Medical Institute, Lahore General Hospital, Lahore (Dr Shahzad); Department of Statistics, National College of Business Administration and Economics, Lahore (Dr Hanif); Lahore Business School, The University of Lahore, Lahore (Dr Qadeer), Pakistan; and Department of Psychiatry, College of Medicine, Central Michigan University, East Campus, Saginaw (Dr Jafferany)
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Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am 2014; 37:625-51. [PMID: 25455069 DOI: 10.1016/j.psc.2014.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article explores the way stress affects the skin, both at the molecular level, where the skin has an intricate connection to the neurocutaneous and immune systems, and at the clinical level. The concept of psychodermatology is reviewed with regard to the way skin reacts to stress, how stress is a trigger for several common skin diseases, and how neuropsychiatric disorders may have skin manifestations. The article is directed at making the dermatologist, the psychiatrist, the psychologist, and the primary physician familiar with the brain-skin mechanisms involved in stress and the resultant clinical expressions on the skin.
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Affiliation(s)
- Edgardo Rodriguez-Vallecillo
- Private Practice, 29 Washington Street, Suite 507, San Juan, PR 00907, USA; Dermatology, HIMA San Pablo Hospital, Sta. Cruz Street, Bayamon, PR 00961, USA.
| | - Michel A Woodbury-Fariña
- Department of Psychiatry, University of Puerto Rico School of Medicine, 307 Calle Eleonor Roosevelt, San Juan, PR 00918-2720, USA
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Cömert A, Akbaş B, Kılıç EZ, Akın Ö, Gökçe E, Göktuna Z, Taşkapan O. Psychiatric comorbidities and alexithymia in patients with seborrheic dermatitis: a questionnaire study in Turkey. Am J Clin Dermatol 2013; 14:335-42. [PMID: 23609607 DOI: 10.1007/s40257-013-0019-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the study was to determine the levels of anxiety, depression, and obsessive-compulsive symptoms in patients with seborrheic dermatitis (SD) compared with healthy subjects. Additionally, we aimed to investigate the presence of alexithymia among patients and its association with these psychiatric comorbidities. METHODS A total of 117 consecutive adult patients (66 male, 51 female) with SD and 95 age- and gender-matched healthy controls selected from the community (46 male, 49 female) were enrolled in the study. The demographic characteristics of the patients were recorded. The clinical severity of the disease was assessed according to the Seborrheic Dermatitis Area and Severity Index (SDASI) scoring system. Both patients and controls were evaluated by the validated Turkish versions of the Hospital Anxiety and Depression Scale (HADS), Maudsley Obsessive Compulsive Inventory (MOCI), and Toronto Alexithymia Scale (TAS-26). RESULTS There were no statistically significant differences between the patient and control groups regarding the mean scores of depressive or obsessive-compulsive symptoms or alexithymia (all p > 0.05). However, anxiety scores in patients with SD were higher than in controls (p = 0.001). No significant relationship was present between anxiety and disease severity nor disease duration (p > 0.05). Thirty-eight patients with high anxiety scores were found to be more alexithymic (p = 0.000). CONCLUSION SD is one of the inflammatory skin disorders that is known to be triggered or aggravated by stress. However, little scientific evidence exists to confirm this view. In addition, very limited data are available about the presence of the personality profiles leading to emotional dysregulation such as alexithymia and concurrent psychiatric disorders in patients with SD. Our study showed that anxiety levels were significantly higher in patients with SD compared with healthy controls but there was no significant association with alexithymia, depression, or obsessive-compulsive symptom levels. Dermatologists should be particularly vigilant to the possibility of concurrent psychiatric morbidity in patients with SD in order to improve patients' well-being.
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Affiliation(s)
- Asuman Cömert
- Department of Dermatology, School of Medicine, Yeditepe University, Devlet Yolu Ankara Cad. No: 102/104, Kozyatağı, 34752 Istanbul, Turkey.
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Abstract
Several skin conditions seen in small mammals are thought to have a behavioral cause but their epidemiology and pathogenesis are poorly understood. A significant amount of research exists on barbering in mice that suggests it is an impulse control disorder and may represent a good animal model for trichotillomania in humans. Stress seems to play a complex role in the development and maintenance of some behavioral dermatopathies, but genetics and experiences, especially during development, also likely play a role. Pain or discomfort may underlie the development of many of these problems.
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Affiliation(s)
- Valarie V Tynes
- Premier Veterinary Behavior Consulting, PO Box 1413, Sweetwater, TX 79556, USA.
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Ghosh S, Behere RV, Sharma P, Sreejayan K. Psychiatric evaluation in dermatology: an overview. Indian J Dermatol 2013; 58:39-43. [PMID: 23372211 PMCID: PMC3555371 DOI: 10.4103/0019-5154.105286] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Psychodermatology is an exciting field which deals with the close relationship that exists between dermatological and psychiatric disorders. A combined bio-psycho-social approach is essential for effective evaluation and treatment of these conditions. This review aims to give the practicing clinician an overview of psychiatric evaluation in patients with dermatological conditions.
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Affiliation(s)
- Sreyoshi Ghosh
- Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Rivers J. Pourquoi la psychodermatologie gagne du terrain. J Cutan Med Surg 2013. [DOI: 10.1177/120347541301700102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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