5
Psychocutaneous Disorders
Introduction
• Psychodermatologic disorders can be classified in two ways: (1) by the specific psychodermatologic condition or (2) by the underlying psychopathology (Fig. 5.1).
• Treatment is simplified by basing the choice of psychotropic medication or therapy on the underlying psychopathology (Table 5.1).
Table 5.1
Common psychotropic medications used in dermatology.
* Increasing frequency of use because of lower risk of tardive dyskinesia, compared with pimozide.
SSRI, selective serotonin reuptake inhibitors.
The More Common Primary Psychiatric Disorders Seen in Dermatology
Body Dysmorphic Disorder
• On a psychiatric spectrum from obsessional to delusional.
• Mean age of onset is 30–35 years; females = males; present in up to 10–15% of dermatologic patients.
• Patients usually concerned with nose, mouth, hair, breasts, or genitalia.
• Consider and assess for this diagnosis in patients seeking multiple cosmetic procedures.
Psychogenic (Neurotic) Excoriations
• A conscious, repetitive, uncontrollable desire to pick, rub, or scratch skin.
• Most common in middle-age; females > males.
• Favors scalp, face, upper back, extensor forearms, shins, buttocks.
• Lesions usually in all stages of evolution: erosions (prurigo simplex), deep circular or linear ulcerations with hypertrophic borders, hypo- or hyperpigmented scars (Fig. 5.2); admixed well-healed scars point to chronicity.
