Update on pharmacotherapy in psychodermatological disorders

Shenoi, Shrutakirthi D; Soman, Savitha; Munoli, Ravindra N; Prabhu, Smitha

doi:10.4103/idoj.idoj_330_19

Cited by 13 publications

(6 citation statements)

References 74 publications

(76 reference statements)

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“…[9,32] On the other hand, intake high-dose doxepin (average 75–300 mg/day) was prone to having more adverse effects. [33] Based on the data on high-dose doxepin treatment, there might be an excess of admissions and poisons for the patients with anxiety or depression, so a low dose of doxepin may be necessary to reduce drug toxicity in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and safety of low-dose doxepin in Chinese patients with generalized anxiety disorder: A before–after study

et al. 2022

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Clinical and animal studies have reported that low-dose doxepin may have positive effects on generalized anxiety disorder (GAD); however, its effectiveness and clinical safety are less well understood. This study is a before-after study and aims to investigate the effectiveness and side effects of low-dose doxepin by evaluating Hamilton Anxiety Scale (HAMA) scores, hormones, blood glucose, serum lipids, body weight, and body mass index (BMI) in patients with GAD. Forty-nine patients (20 males and 29 females) with GAD were randomly assigned to receive low-dose doxepin (6.25 mg–12.5 mg per day) for 12 weeks between February 2015 and March 2016. HAMA scores, fasting blood glucose (FBG) body weight, BMI, and some serum biochemical indexes, such as adrenocorticotropic hormone (ACTH), free triiodothyronine (FT3), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDLC), and FBG, were assessed during pretreatment and post-treatment. Mean scores of HAMA decreased from 19.50 ± 1.22 to 8.50 ± 3.61 after low-dose doxepin treatment ( P < .01). The serum levels of ACTH (4.33 ± 2.14 vs 6.12 ± 3.02 pmol/L), FT3 (4.78 ± 0.51 vs 5.15 ± 0.52 pg/mL), TC (4.55 ± 1.01 vs 5.93 ± 1.66 mmol/L), TG (1.69 ± 1.51 vs 3.39 ± 2.86 mmol/L), and LDLC (2.43 ± 0.88 vs 3.76 ± 1.25 mmol/L), and FBG (5.06 ± 0.43 vs 5.78 ± 0.81 mmol/L) were higher than that pretreatment with a significant difference ( P < .01). Bodyweight (62.00 ± 7.45 vs 64.00 ± 6.44 kg, P = .23) and BMI (23.70 ± 2.35 vs 24.48 ± 2.11 kg/m 2 , P = .14) had no difference after treatment. These results suggest that low-dose doxepin has beneficial clinical efficacy and safety. Low-dose doxepin can ameliorate anxiety in GAD patients and has some effects on neuroendocrine systems and the metabolic activity of serum glucose and lipid.

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Section: Discussionmentioning

confidence: 99%

Clinical efficacy and safety of low-dose doxepin in Chinese patients with generalized anxiety disorder: A before–after study

et al. 2022

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“…84 Tetracyclic antidepressants, such as mirtazapine, are not only reported to reduce psychological symptoms at low to moderate doses (15 to 45mg), but also to improve sleep and pruritus at low doses (7.5 to 30mg). 58,[85][86][87][88] In AD, dupilumab, has been shown to reduce symptoms of anxiety and depression as early as 2 weeks through inhibition of pro-inflammatory cytokines (IL-4, IL-12) and IgE. 89 Tralokinumab (anti IL-13) has been linked to overall QoL improvement in AD patients due to its proposed anti-pruritic, anti-depressant, anti-anxiety, and sedative effects.…”

Section: Atopic Dermatitismentioning

confidence: 99%

The Mind Body Connection in Dermatologic Conditions: A Literature Review

Mar,

Rivers

2023

J Cutan Med Surg

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Psychodermatology pertains to the relationship between the skin and brain. This review aims to summarize the evidence of the mind body connection in four psychophysiological conditions: rosacea, atopic dermatitis (AD), acne vulgaris (AV), and psoriasis. A literature search was conducted using several English language databases. All four conditions share similar psychiatric co-morbidities, including but not limited to anxiety, depression, and suicidality. In rosacea, the upregulation of transient receptor potential vanilloid type 1, Toll like receptor 2, and Th17 cells releases downstream products that are simultaneously implicated in mood disorders. Stress exacerbates AV through the hypothalamic-pituitary-adrenal (HPA) system, which alters functioning of sebocytes and Cutibacterium acnes. In AD and psoriasis, the HPA axis influences Th1, Th2, Th22, and Th1, Th17 immune mediated responses, respectively. This leads to the secretion of pro-inflammatory cytokines which are also involved in the pathogenesis of anxiety and depression. Neurotransmitters implicated in mental illness, such as gamma-aminobutyric acid and serotonin, may also play a role in the development of AD and psoriasis. The management of cutaneous disease may mitigate psychological distress, and future research may show the corollary to also be true.

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“…Patients with severe scalp sensitivity or refractory to previous therapies may benefit from oral treatment. Classic drugs in the management of chronic pain and psychodermatological disorders such as tricyclic antidepressants (amitriptyline, doxepin), selective serotonin-norepinephrine reuptake inhibitors (venlafaxine), and anticonvulsants (gabapentin and pregabalin) are used especially in cases of trichodynia [18, 27, 32, 50]. Although common practice, the use in SSc is not supported by clinical studies.…”

Section: Managementmentioning

confidence: 99%

“…Tricyclic antidepressants inhibit serotonin and norepinephrine reuptake: block histamine, muscarinic acetylcholine, and noradrenergic receptors. Due to its antihistamine-blocking activity, amitriptyline (10–25 mg/day) and doxepin (10–20 mg/day) can be effective in the management of chronic pruritus and scalp dysesthesia [34, 50]. Low dose of selective serotonin-norepinephrine reuptake inhibitors, as venlafaxine, may be helpful in cases with scalp discomfort due to psychogenic triggering factors [34].…”

Section: Managementmentioning

confidence: 99%

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Sensitive Scalp and Trichodynia: Epidemiology, Etiopathogenesis, Diagnosis, and Management

Souza,

Anzai,

Fechine

et al. 2023

Skin Appendage Disord

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Sensitive scalp (SSc) is considered a sensitive skin on the scalp, with its particularities. Although it is not rare in the dermatological practice and the term is commonly present in personal care products, this entity is poorly investigated in the medical literature. The etiopathogenesis is still uncertain, and the sensitivity may be associated with hair loss. Clinical manifestations are subjective symptoms of pruritus, burning, pain, pricking, and/or trichodynia, often with scalp erythema. SSc can be triggered by several factors (endogenous or exogenous). The diagnosis is guided by the anamnesis, and there are still no specific trichoscopic features. Trigeminal trophic syndrome and postherpetic neuralgia are the main differential diagnosis to be considered. We organized the therapeutical approach in three steps: scalp care, topical and systemic treatment.

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Update on pharmacotherapy in psychodermatological disorders

Cited by 13 publications

References 74 publications

Clinical efficacy and safety of low-dose doxepin in Chinese patients with generalized anxiety disorder: A before–after study

Clinical efficacy and safety of low-dose doxepin in Chinese patients with generalized anxiety disorder: A before–after study

The Mind Body Connection in Dermatologic Conditions: A Literature Review

Sensitive Scalp and Trichodynia: Epidemiology, Etiopathogenesis, Diagnosis, and Management

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