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Psychiatric Disorders with Dermatological Symptoms – An Open, Cross Sectional, Observational Study

Santoshdev P. Rathod, Associate Professor, Department of Dermatology, Venereology and Leprology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat 380006, India. , Santoshdev P. Rathod1 , Ashish Jagati2 , Raju G. Chaudhary3 , Arwinder Kaur Brar4 , Soham B. Buch5 , Kalgi D. Baxi 6

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Journal of Dermatology 3(1):p 14-19, Jan-June 2018. | DOI:

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Abstract

Background: Psychodermatology encompasses disease that involve the complexinteraction between the mind, the cutaneous nerve, the cutaneous immune system and their cutaneous manifestations. The relationship between the skin and the mind is complex and despite its clinical importance, remains underexplored and under-reported.

Objectives: To detect the frequency and type of psychiatric disorders among patients with dermatologic symptoms presenting to the skin out-patient department of a tertiary care hospital in western India.

Methodology: An open, cross sectional, observational descriptive study was conducted, including all patients with some dermatologic manifestation of primary psychiatric disorder  excepting patients with known chronic/medical illness, pregnant, lactating, and those already on any psychiatric medication, the patients were then referred to psychiatry department of our hospital for further evaluation and confirmation of the diagnosis.

Results: Among 50 serial patients studied, 39 were females and 11 males. Most of the cases were in 2nd to 5th decade, the mean age being 28 years. The frequency-distribution of the associated psychodermatological disorder was neurotic excoriations (30%), being the most common, psychogenic pruritus (24%), lichen simplex chronicus (20%), acne excoriee (10%), trichotillomania (6%), delusional parasitosis (6%), onychophagia (2%), and dermatitis artefacta (2%). Most common underlying psychiatric disorders included obsessive and compulsive disorder (43%), anxiety disorders (27%), and major depression (26%). Schizophrenia, substance abuse, and bipolar disorder, each were detected in 1.3%. A stressor could be identified in 60% of psychodermatologic patients. SSRIs (Serotonin reuptake inhibitors) were the most commonly used medication along with habit reversal behavioral therapy, followed by benzodiazepines and antipsychotics.

Conclusion: It can be inferred that patients do not realize and even if they occasionally do or are made aware of their psychiatric disorder, they prefer consulting a dermatologist rather than a psychiatrist due to the prevailing stigma related to mental illness. Increased understanding of the complex needs of these patients is necessary for a dermatologist, the value of shared care with a psychologist and a psychiatrist is highly recommended.

Keywords: Psychodermatology; Primary Psychiatric Disorders; Neurotic Excoriations;  Acne Excoriee; Dermatitis Artefacta. 

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