Psychodermatology: The Mind and Skin COnnection -- American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1873 Classification Psychodermatologic disorders can be broadly classified into three categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. The term “psychophysiologic disorder” refers to a skin disorder, such as eczema or psoriasis, that is worsened by emotional stress (Figure 1). “Primary psychiatric disorder” refers to a skin disorder such as trichotillomania, in which the primary problem is psychologic; the skin manifestations are self-induced. “Secondary psychiatric disorders” affect patients with significant psychologic problems that have a profoundly negative impact on their self-esteem and body image. Depression, humiliation, frustration and social P sychodermatology, or psychocutaneous medicine, focuses on the boundary between psychiatry and dermatology. Understanding the psychosocial and occupational context of skin diseases is critical to the optimal management of psychodermatologic disorders. The management of psychodermatologic disorders requires evaluation of the skin manifestation and the social, familial and occupational issues underlying the problem. Once the disorder has been diagnosed, management requires a dual approach, addressing both dermatologic and psychologic aspects. Even with self-induced skin problems, supportive dermatologic care is needed to avoid secondary complications, such as infection, and to ensure that the patient feels supported. Patients with psychodermatologic disorders frequently resist referral to mental health professionals. Acceptance of psychiatric treatment or consultation may be enhanced through support from the family physician. Management options include psychotropic medication, stress management courses and referral to a psychiatrist. Family physicians are well positioned to help patients with psychodermatologic disorders; these patients may be concerned about the stigma associated with psychiatrists, and family physicians are familiar with the use of psychotropic medications. A psychodermatologic disorder is a condition that involves an interaction between the mind and the skin. Psychodermatologic disorders fall into three categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychophysiologic disorders (e.g., psoriasis and eczema) are associated with skin problems that are not directly connected to the mind but that react to emotional states, such as stress. Primary psychiatric disorders involve psychiatric conditions that result in self-induced cutaneous manifestations, such as trichotillomania and delusions of parasitosis. Secondary psychiatric disorders are associated with disfiguring skin disorders. The disfigurement results in psychologic problems, such as decreased self-esteem, depression or social phobia. Most psychodermatologic disorders can be treated with anxiety-decreasing techniques or, in extreme cases, psychotropic medications. (Am Fam Physician 2001;64:1873-8. Copyright© 2001 American Academy of Family Physicians.) Psychodermatology: The Mind and Skin Connection