Psychodermatology

The skin is our largest organ and is often referred to as the "mirror of the soul" due to its various psychosomatic interactions. Skin diseases inevitably change the outward appearance of a person. Patients suffering from diseases such as atopic eczema, urticaria or acne vulgaris feel disfigured, ugly, withdraw socially. Their health-related quality of life is reduced, and about 1/3 of those affected also suffer from psychological disorders such as depression or anxiety.

According to the valid classification principle, the main areas of psychodermatology (psychosomatic dermatology) are divided into 3 groups:

• Skin diseases of primary psychological origin (psychiatric component is in the foreground)
  • Artifacts
  • Delusions
    • Dermatozooen madness
    • Morgellons disease
  • Somatoform disorders
    • Pruritus
    • Erythrophobia
    • Hyperhidrosis
    • Vulvodynia
    • Glossodynia
    • Dysmorphophobia
    • Dorian Gray syndrome
    • Non-objectifiable hair loss (see below Effluvium)
  • Obsessive-compulsive disorder
• Multifunctional skin diseases
  • Worsening of a skin disorder due to stress or psychologically stressful events (e.g. atopic eczema, urticaria, perioral dermatitis)
  • Para-artifacts
    • Acne excoriee "des jeunes filles
    • skin-picking syndrome (neurotic excoriations)
    • Lip lick eczema
    • Trichotillomania
    • Onychophagia
    • Knuckle pads, false
    • Trichotillomania
    • Morsicatio buccarum
• Secondary mental disorders /comorbidities (mental changes and disorders due to a present skin disease (e.g. psoriasis vulgaris, atopic eczema, urticaria)

Drugs prescribed in dermatology can also induce psychiatric side effects:

• Depression (antihistamines, glucocorticoids, cyproterone acetate, isotretinoin)
• Confusion (antihistamines, glucocorticoids)
• Psychoses (dapsone, glucocorticoids, antimalarials, UV therapy)
• Affective disorders (methotrexate)

1. Taube KM et al (2014) Psychodermatology. Act Dermatol 40: 363-371