Background: Among our dermatologic outpatients who respond little or only temporarily to dermatologic therapeutic methods alone patients with psychogenic pruritic disorders are frequently seen. Objective: This study was conducted to uncover the underlying psychopathologies of the patients suffering from psychopruritic disorders. Methods: Patients who came to our dermatologic clinic were screened by a dermatologist for possible underlying psychopathologies. In order of their reference 65 patients, 16 male and 49 female, were introduced to a psychiatrist for identification of their mood, personality and thought disorders. These cases included 36 patients with lichen simplex chronicus (LSC), 20 with neurotic excoriation (NE), 1 with prurigo nodularis (PN), and 8 with more localized or generalized intermittent, short-term, and usually very severe pruritus without any physical signs (i.e. with no lichenification or no signs of scratching) who were labeled as psychogenic pruritus (PP). A semi-structured interview based on multiaxial DSM-IV interview criteria as well as Beck’s and Tailor’s inventories for depressive and anxiety disorders were performed with all patients. Results: All 65 patients were found to have affective disorders including depressions (20 cases), anxieties (6 cases), and mixed anxiety and depressive disorders (39 cases). 12 patients also had associated personality disorders. No thought disorder was identified. Conclusion: Patients with psychogenic pruritus had one or more underlying psychopathologies. These should be identified and approached for helpful and successful management of their skin condition.
A Note from the Editors DERMATOLOGY + PSYCHOSOMATICS is a journal dedicated to a high scientific standard. Therefore, a review process is a prerequisite for publication of manuscripts. Nevertheless, the editors of the journal feel the need to offer a platform for comments which can be printed without the demand for corrections and adaptation to rather formalistic criteria. To provide the opportunity for the presentation of ‘methodologically unstandardized’ spontaneous observations in clinical practice / of clinical experience or comments concerning previously published articles we maintain the section ‘Letters to the Editors’ to hereby encourage the interaction among psychodermatology researchers and clinical practitioners. We would be pleased to promote a discussion within the context of psychodermatological issues in a broad sense and to contribute to interdisciplinary discussions. Furthermore, the section ‘Letters to the Editors’ can be used to give feedback on articles published in the latest issues of the journal. We are grateful for comments with respect to methodological aspects of the treatises as well as to the results or conclusions drawn by the authors. We hope that the new section will be taken up by interest and will contribute to a lively and interesting discussion. Background: Preoccupation with hair loss and fear of getting bald is a frequent finding among patients referred to dermatological clinics. Objective: Identification of depression and anxieties that may be the underlying psychopathology of a patient with this preoccupation. Patients and Methods: 50 patients with the preoccupation of pathological hair loss who were referred to our clinic within a period of 2 months. The Beck, Taylor and Maudsley inventories were performed on all patients to determine the presence and level of depression, anxiety, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD). Results: 45 out of 50 patients, i.e. 90%, were found to have affective disorder such as depression, anxiety, OCD, OCPD or a combination of these. Different levels of depression could be identified in 33 cases, OCD in 32, OCPD in 19, and anxiety in 29 patients. Most patients suffered from more than one psychological disorder: 21 patients suffered from 3, and 14 patients from 2 disorders. 10 patients suffered from only one co-existing disorder: 4 from mild depression, 4 from OCD, and 2 from OCPD. The remaining 5 patients showed no psychological problem according to the inventories used. Conclusion: Many patients with normal looking hair but the preoccupation of losing too much hair and the fear of getting bald may actually suffer from hair loss dysmorphic disorder. These people may have one or more psychopathologies, which should be identified and treated properly.
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