Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines

Abstract

Dermatological disease can be devastating for patients, and although dermatologists are focused on remedying the cutaneous manifestations of these conditions, it is easy to miss the psychological suffering lurking below. Studies reveal that psychiatric comorbidity in dermatology is highly prevalent. Undetected psychopathology can greatly decrease a patient’s quality of life and even contribute significantly to the clinical severity of their skin disease. For these reasons, it is vital that practitioners learn to detect psychological distress when it is present, and it is equally essential that they understand the treatment options available for effective intervention. Without training in psychiatric diagnosis and psychopharmacology, dermatologists can easily feel overwhelmed or out of their comfort zone when faced with the need to manage such conditions, but with the negative stigma associated with psychiatric disease in general, a psychiatric referral is often refused by patients, and the dermatologist is thus left with the responsibility. Uncertainty abounds in such situations, but this review seeks to alleviate the discomfort with psychodermatological disease and share practical and impactful recommendations to assist in diagnosis and treatment. In a busy dermatology clinic, the key is effective and efficient screening, combined with a repertoire of pharmacological and non-pharmacological treatment options that can be dispersed through an algorithmic approach according to the specific findings of that screening. By implementing these recommendations into practice, dermatologists may begin to gain comfort with the management of psychocutaneous disease and, as a specialty, may expand to fill a hole in patient care that is truly significant for patients, their families, and our communities as a whole.

Psychiatric comorbidity, depression, and anxiety levels and quality of life of the patients with mycosis fungoides

“…31 Psychopharmacological and psychotherapeutic interventions may enhance the psychological effects of dermatological diseases. 32,33 Studies investigating this aspect of the subject clearly indicate the adverse effects of low QoL on the treatment success and positive contribution of cognitive and behavioral therapy options. 34,35 The results of QoL assessments may provide important guidance for therapy options and evaluation of treatment efficacy.…”

“…Medical treatment nonadherence has been shown to be three times greater in depressed patients than in nondepressed ones 31 . Psychopharmacological and psychotherapeutic interventions may enhance the psychological effects of dermatological diseases 32,33 . Studies investigating this aspect of the subject clearly indicate the adverse effects of low QoL on the treatment success and positive contribution of cognitive and behavioral therapy options 34,35 .…”

Body dysmorphic disorder and other obsessive-compulsive related diseases in dermatological practice

“…Az impulzív kórképeknél ezzel ellentétes változást valószínűsítettek a frontális lebenyben és a szerotonin receptorokat tekintve (7,8). A terápiában ezért a szelektív szerotonin illetve a szerotonin-noradrenalin reuptake inhibitorok (SSRI-ok és SNRI-ok) az elsőként választandó gyógyszerek (7)(8)(9)(10). A szerotoninerg transzmiszió zavarai mellett a kényszercselekvés végrehajtásakor aktiválódnak a dopaminerg rendszerek is, bár a tapasztalatok szerint a neuroleptikumok önmagukban nem hatásosak a kórkép kezelésében (2, 7).…”

Dermatology Resident Training on Depression Screening: A Cross-Sectional Survey

“…Psychiatric disturbances have been reported in at least 30% of patients with dermatologic disorders [ 1 ]. Common cutaneous conditions implicated in the development of depression include acne vulgaris, atopic dermatitis, psoriasis, and skin cancers [ 2 - 4 ]. Others associated with an increased risk include vitiligo, alopecia areata, ichthyosis, and hidradenitis suppurativa [ 4 , 5 ].…”

“…Common cutaneous conditions implicated in the development of depression include acne vulgaris, atopic dermatitis, psoriasis, and skin cancers [ 2 - 4 ]. Others associated with an increased risk include vitiligo, alopecia areata, ichthyosis, and hidradenitis suppurativa [ 4 , 5 ]. Currently, there is no literature discussing the level of dermatology residency training on depression screening.…”