Psychocutaneous

Question 1

DSM criteria for delusions of parasitosis

Answer 1

1 - delusion must be present for >=1 month
2 - patients does not exhibit impaired functioning or bizarre behaviour aside from impact of delusion
3 - delusion not attributable to effects of a substance, medication, medical condition or other psych disorder
4 - delusional belief is “encapsulated” with a narrow and specific focus on skin infestation

Question 2

What is Morgellon disease

Answer 2

Controversial condition with manifestations falling within spectrum of delusions of parasitosis

• hallmark is patients claim to observe “figures” extruding from their skin
• sensations of crawling, stinging, biting under the skin
• sores that do not heal
• fibre like filaments, granules and crystals that appear on or under skin lesions
• joint and muscle pains, fibromyalgia
• debilitating fatigue
• cognitive dysfunction, poor concentration, and memory
• patients believe that Lyme disease may be to blame as well as agricultural filamentous yeasts

Question 3

Habit reversal training is the most effective intervention for trichotillomania

Answer 3

True

Question 4

Dermoscopic features of trichotillomania

Answer 4

Irregularly broken hairs,
Black dots
Split ends (trichoptilosis)
V-sign
Coiled hairs
Flame hairs (remnants of proximal hair shafts)
Tulip hairs)

Question 5

Clinical features of trichotillomania

Answer 5

• Bizarre, irregularly shaped patchy alopecia with areas of erosions
  Broken hairs and hairs of varying length
  Occipital scalp often spared, however may have full scalp alopecia (other hair bearing sites may become involved eg. Brows)

Question 6

Natural course of trichotillomania

Answer 6

In infancy and early childhood - resolves without treatment
Adulthood - low success rates with no specific approach established to be effective in large controlled studies. Trial of behavioural therapy/psychotherapy. 1st line pharmacological tx is clomipramine