Gardner‐Diamond syndrome: a systematic review of treatment options for a rare psychodermatological disorder

Abstract

Gardner‐Diamond syndrome (GDS) is a rare psychodermatological condition characterized by the formation of spontaneous, painful skin lesions that develop into ecchymosis following episodes of severe physiological or psychological stress. The majority of GDS cases occur in young adult females, and although the etiology of this rare disorder is unknown, there appears to be a psychological component correlated with the coexistence of previous psychiatric diagnoses. Due to the rare nature of this disorder, there exist few guidelines for prompt clinical diagnosis and optimal treatment. Here, a systematic review was conducted to include 45 cases of patients with GDS to better understand clinical presentation as well as current treatment options. Ultimately, GDS is a diagnosis of exclusion after other coagulopathies and causes of purpura are ruled out. High clinical suspicion following laboratory and clinical exclusion of known physiological causes is necessary for diagnosis. Selective serotonin reuptake inhibitors (SSRIs) and corticosteroids are cost effective first line treatments for GDS with proven efficacy in symptomatic relief. GDS refractory to initial treatment may require regular psychotherapy and titrated SSRI dosages to achieve long‐term success. This review of available case studies serves to comprehensively describe the clinical presentation and available treatment approaches to this rare psychodermatological disorder.

Oral management in a patient with Gardner-Diamond Syndrome: A case report

“…First, preoperative precautions are required. One relates to the patient’s psychological state: the appearance of GDS lesions is promoted by psychological or physical stresses, including surgery [ 1 , 2 ], and can be effectively prevented by psychotherapy, reassurance therapy, SSRIs, and TCAs [ 1 ]. To address this, our patient was under psychiatric follow-up and SSRI treatment (already since his diagnosis) and the oral surgeons provided continual verbal reassurance during the surgery.…”

“…Gardner-Diamond Syndrome (GDS) (also known as autoerythrocyte-sensitization syndrome, psychogenic purpura, or painful-bruise syndrome) is a rare condition that mainly occurs in young adolescents and females [ 1 ]. It typically starts with cutaneous pruritus that associates with fever, asthenia, myalgia, arthralgia, severe headache, abdominal pain, and dizziness.…”

“…Over the next 24 h, these lesions turn into ecchymotic patches, which then disappear progressively over days to 2 weeks [ 2 ]. GDS associates with psychiatric disorders: its acute episodes are frequently linked to psychological/physical stress [ 1 , 2 ]. While the lesions occur most commonly on the upper and lower extremities, face, and trunk, mucocutaneous lesions, particularly intra-oral haemorrhages, are also common [ [3] , [4] , [5] ].…”

“…Laboratory analyses and sometimes skin biopsies are needed to confirm the diagnosis and exclude other diseases, including disseminated intravascular coagulation, idiopathic thrombocytopenic purpura, von Willebrand disease, Henoch-Schönlein purpura, dermal angiitis, Pfeifer-Weber-Christian disease, systemic lupus erythematosus, and Ehlers-Danlos syndrome. Munchausen Syndrome, domestic violence, child abuse, and dermatitis artefacta should also be excluded [ 1 , 11 , 12 ]. The literature describes several treatments, including psychotherapy, reassurance therapy, selective serotonin-reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs).…”

“…The literature describes several treatments, including psychotherapy, reassurance therapy, selective serotonin-reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs). Adjunct treatments with corticosteroids, antihistamines, hormonal contraceptives, and immunosuppressive drugs have also been described, although their efficacy is more uncertain [ 1 ].…”