Psyche and the Skin Flashcards
Describe the psychological aspects of skin disease.
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Stress - affects the skin’s capacity to heal.
- Affects the immune cells in the skin.
- Stigmatization - cause a reduction in human interaction.
- Social anxiety - fear of shame, embarassment leading to low self esteem.
Describe the classification of diagnoses in skin conditions that present with a psychologicla component.
- Common skin conditions –> psychological impact.
- Psycahitric conditions –> dermatological impact.
- Primary cause is neither psychological or dermatological.
What are some psychiatric disorders that have dermatological symptoms?
- Dermatitis artefacta
- Delusional parasitosis
- Trichotillomania
- OCD
- Phobic states
- Dysmorphophobia
- Eating disorders
- Neurotic excoriations.
- Psychogenic pruritus.
Describe some dermatological disorders that have psychiatric symptoms?
- Alopecia areata
- Vitiligo
- generalized psoriasis
- Eczema
- Ichtyosiform syndromes
- Rhinophyma
- Neurofibroma
- Albinism
Describe some conditions that fit into neither camp?
- Cutaneous sensory syndromes
- Glossodynia
- Vulvodynia
- Chronic itch of the scalp
- Psychogenic purpura syndrome.
- Suicide in dermatology patients.
What is this?
Acne Excoriee
- Common in women.
- Distrubted like acne but have excoriated surfaces.
What is this?
Trichotillomania
- Self inflicted hair pulling of the scalp.
What is this?
Dermatitis Artefacta
(In this case it is self inflicted burns with an electric iron)
What are the non-diseases of dermatology?
(Abnormal concerns, beliefs or perceptions that are in great excess of physical signs)
- Body dysmorphic disorder - affects men and women equally.
- Delusional parasitosis - more common in women.
- Dysaesthesia - abnormal sensation of touch.
- OCD - e.g. obsessive washing of hands etc.
What are the less common primarily psychiatric disorders in dermatology?
- Psychogenic pruritus - elderly and associated with depressive illness. Exclude organic factors.
- Psychogenic purpura (aka Gardner-Diamond syndrome) - rare, incompletely understood group of disorders. Painful bruising and bleeding associated with emotional factors. Interesting when suggests religious stigmata.
- Dermatitis stimulata - the patient intentionally feigns symptoms or inflicts signs of a disease in order to assume a sick role that then has beneficial consequences - e.g. attracts sympathy.
- Dermatological pathomimicry - patients who mimic their original dermatological disease by reproducing the original mechanisms of disease or by interfering with therapy.
What is the treatment for psycho-dermatological treatments?
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Antidepressants
- TCAs - for anxiety and OCD - Start at low dose.
- SSRIs - Fluoxetine, sertraline and paroxetine - for Anxiety, OCD and depression.
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Neuroleptics
- Pimozide - for primary cutaneous delusional disorder. But it can be cardiotoxic - therefore requires ECG monitoring and low dosage.
- Risperidone and Olanzapine - new agents.
Describe some psychological interventions for psycho-dermatological conditions?
- Habit reversal
- Psychodynamic therapy
- Counselling
- CBT
- Systemic family therapies
