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Flashcards in Psyche and the Skin Deck (12)
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Describe the psychological aspects of skin disease.

  • 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.

  1. Common skin conditions --> psychological impact.
  2. Psycahitric conditions --> dermatological impact.
  3. 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?


  • 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?

  • Antidepressants
    • TCAs - for anxiety and OCD - Start at low dose.
    • SSRIs  - Fluoxetine, sertraline and paroxetine - for Anxiety, OCD and depression.
  • 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