Psychodermatology

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Psychodermatology is the treatment of skin disorders using psychological and psychiatric techniques by addressing the interaction between mind and skin. Though historically there has not been strong scientific support for its practice, there is increasing evidence that behavioral treatments may be effective in the management of chronic skin disorders. [1]

Contents

The practice of psychodermatology is based on the complex interplay between neurological, immunological, cutaneous and endocrine systems, known alternatively as the NICE network, NICS, and by other similar acronyms. The interaction between nervous system, skin, and immunity has been explained by release of mediators from network. In the course of several inflammatory skin diseases and psychiatric conditions, the neuroendocrine-immune-cutaneous network is destabilized.

Concept

The disorders that proponents classify as psychodermatologic fall into three general categories: psychophysiologic disorders, primary psychiatric disorders and secondary psychiatric disorders. [2] Proponents frequently claim treatment for psoriasis, eczema, hives, genital and oral herpes, acne, warts, skin allergies, pain, burning sensations, and hair loss. Psychodermatological treatment techniques include psychotherapy, meditation, relaxation, hypnosis, acupuncture, yoga, tai chi, and anti-anxiety drugs. [3] [4] [5] [6]

Psychophysiologic disorders are conditions that are precipitated by or worsened by experiencing stressful emotions. [7] These conditions are not always related to stress and in many cases respond to medication but stress can be a contributing factor in some cases. [8]

Diagnoses Associated with Psychodermatologic Disorders [9]
Major CategoriesExamples
Psychophysiologic DisordersAcne, Alopecia Areata, Atopic Dermatitis, Psoriasis, Psychogenic Purapura, Rosacea, Seborrheic Dermatitis, Urticara (Hives)
Primary Psychiatric DisordersBromosiderophobia, Delusions of Parasitosis, Dysmorphophobia, Facticial Dermatitis, Neurotic Excoriations, Trichtillomania
Secondary Psychiatric DisordersAlopecia Areata, Cystic Acne, Hemangiomas, Ichthyosis, Kaposi’s Sarcoma, Psoriasis, Vitiligo

Controversy

In a 2013 paper published in the Clinics in Dermatology , the official journal of the International Academy of Cosmetic Dermatology, the facts and controversies of this topic were examined with the conclusion: [1]

Although clinical experience is often in concordance with this notion, apparently scientific proof can sometimes be challenging rather than straight forward. Although many data have been published, it appears that not enough good statistical evidence exists to support them. The difficulty in validating beyond a doubt the stress-skin interactions has rendered some skepticism among physicians.

Harriet Hall notes that the specialty may not be needed at all because medicine already takes a holistic approach to treating a patient. [10] A 2007 review of the literature generated from 1951 to 2004 finds that most dermatologists and psychologists recommend a synthesis of treatment rather than seeing another specialist. [11]

See also

Association for Psychoneurocutaneous Medicine of North America (APMNA)

Related Research Articles

Dermatology is the branch of medicine dealing with the skin. It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical doctor who manages diseases related to skin, hair, nails, and some cosmetic problems.

<span class="mw-page-title-main">Psoriasis</span> Skin disease

Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.

<span class="mw-page-title-main">Pityriasis lichenoides et varioliformis acuta</span> Medical condition

Pityriasis lichenoides et varioliformis acuta is a disease of the immune system. It is the more severe version of pityriasis lichenoides chronica. The disease is characterized by rashes and small lesions on the skin. The disease is more common in males and usually occurs in young adulthood, although it has been seen in every age group and every race. It is possible for the disease to go into remission for short periods of time or forever.

Auspitz's sign is the appearance of punctate bleeding spots when psoriasis scales are scraped off, named after Heinrich Auspitz. It may also be seen in Darier's disease and actinic keratosis.

Parapsoriasis refers to one of a group of skin disorders that are characterized primarily by their resemblance to psoriasis, rather than by their underlying cause.

<span class="mw-page-title-main">Blaschko's lines</span> Anatomical structure

Blaschko's lines, also called the lines of Blaschko, are lines of normal cell development in the skin. These lines are only visible in those with a mosaic skin condition or in chimeras where different cell lines contain different genes. These lines may express different amounts of melanin, or become visible due to a differing susceptibility to disease. In such individuals, they can become apparent as whorls, patches, streaks or lines in a linear or segmental distribution over the skin. They follow a V shape over the back, S-shaped whirls over the chest and sides, and wavy shapes on the head. Not all mosaic skin conditions follow Blaschko's lines.

<span class="mw-page-title-main">Prurigo nodularis</span> Medical condition

Prurigo nodularis (PN), also known as nodular prurigo, is a skin disorder characterized by pruritic (itchy), nodular lesions, which commonly appear on the trunk, arms and legs. Patients often present with multiple excoriated nodules caused by chronic scratching. Although the exact cause of PN is unknown, PN is associated with other dermatologic conditions such as untreated or severe atopic dermatitis and systemic causes of pruritus including liver disease and end stage kidney disease. The goal of treatment in PN is to decrease itching. PN is also known as Hyde prurigo nodularis, or Picker's nodules.

Hypnodermatology is an informal label for the use of hypnosis in treating the skin conditions that fall between conventional medical dermatology and the mental health disciplines.

<span class="mw-page-title-main">Heinrich Koebner</span>

Heinrich Koebner ; was a German-Jewish dermatologist born in Breslau.

<span class="mw-page-title-main">Onychauxis</span> Medical condition

Onychauxis presents with thickened nails without deformity, and this simple thickening may be the result of trauma, acromegaly, Darier's disease, psoriasis, or pityriasis rubra pilaris, or, in some cases, hereditary.

Melanonychia is a black or brown pigmentation of a nail, and may be present as a normal finding on many digits in Afro-Caribbeans, as a result of trauma, systemic disease, or medications, or as a postinflammatory event from such localized events as lichen planus or fixed drug eruption.

Psychogenic pruritus, also known as psychogenic itch or functional itch disorder is pruritus not associated with a dermatologic or systemic cause. More often than not, it is attributed to a psychiatric cause. Psychogenic pruritus is not the same as neuropathic itch though both are conditions which require more research. This condition is not explained well in DSM-V and is typically considered a diagnosis of exclusion. This condition is not well-studied and it is difficult to ascertain as it is seen by both dermatologists and psychiatrists. In order to provide some consensus to this condition, The French Psychodermatology Group have created diagnostic criteria for this condition.

<span class="mw-page-title-main">Psoriatic erythroderma</span> Medical condition

Psoriatic erythroderma represents a form of psoriasis that affects all body sites, including the face, hands, feet, nails, trunk, and extremities. This specific form of psoriasis affects 3 percent of persons diagnosed with psoriasis. First-line treatments for psoriatic erythroderma include immunosuppressive medications such as methotrexate, acitretin, or ciclosporin.

Large plaque parapsoriasis are skin lesions that may be included in the modern scheme of cutaneous conditions described as parapsoriasis. These lesions, called plaques, may be irregularly round-shaped to oval and are 10 cm (4 in) or larger in diameter. They can be very thin plaques that are asymptomatic or mildly pruritic. Large-plaque parapsoriasis is a common associate of retiform parapsoriasis, can be accompanied by poikiloderma vasculare atrophicans, and can in rare occasions be a precursor to cutaneous T-cell lymphoma.

Senile pruritus is one of the most common conditions in the elderly or people over 65 years of age with an emerging itch that may be accompanied with changes in temperature and textural characteristics. In the elderly, xerosis, is the most common cause for an itch due to the degradation of the skin barrier over time. However, the cause of senile pruritus is not clearly known. Diagnosis is based on an elimination criteria during a full body examination that can be done by either a dermatologist or non-dermatologist physician.

Goeckerman therapy is a regimen for treatment of moderate to severe plaque psoriasis using a combination of crude coal tar and artificial ultraviolet radiation. It is a specialized form of light therapy.

Mark G. Lebwohl is an American dermatologist and author who is Professor and Chairman Emeritus of the Kimberly and Eric J. Waldman Department of Dermatology and the Dean for Clinical Therapeutics at the Icahn School of Medicine at Mount Sinai in New York City.

Brian V. Jegasothy was a dermatologist and visiting professor at over 50 Universities. and clinics, and was the Chairman of the Department of Dermatology at the University of Pittsburgh from 1987 to 1999.

Nicholas J Lowe is an English dermatologist who has published research into skin pharmacology, botulinum toxins, injectable filler and Lasers in cutaneous and cosmetic Surgery.

Jenna Lester is an American dermatologist and faculty member at the University of California, San Francisco (UCSF). Lester founded the UCSF Skin of Color Clinic, where she is the director. The clinic looks to address health disparities by providing dermatological care to people of color.

References

  1. 1 2 Orion, Edith; Wolf, Ronni (2013). "Psychological factors in skin diseases: Stress and skin: Facts and controversies". Clinics in Dermatology. 31 (6). Clinics in Dermatology, The official journal of the International Academy of Cosmetic Dermatology (IACD): 707–11. doi:10.1016/j.clindermatol.2013.05.006. PMID   24160274 . Retrieved 9 February 2017.
  2. Koo, John (1995-11-01). "Psychodermatology: A practical manual for clinicians". Current Problems in Dermatology. 7 (6): 204–232. doi:10.1016/S1040-0486(09)80012-4. ISSN   1040-0486.
  3. SINGER, NATASHA. "SKIN DEEP; If You Think It, It Will Clear". query.nytimes.com. NYT. Retrieved 9 February 2017.
  4. Jafferany M (2007). "Psychodermatology: a guide to understanding common psychocutaneous disorders". Prim Care Companion J Clin Psychiatry. 9 (3): 203–13. doi:10.4088/pcc.v09n0306. PMC   1911167 . PMID   17632653.
  5. DeWeerdt Sarah (2012). "Psychodermatology: An emotional response". Nature. 492 (7429): S62–S63. doi: 10.1038/492S62a . PMID   23254976. S2CID   44617423.
  6. Mapes, Diane (2007-02-12). "Does your skin need a shrink?". NBC News. Archived from the original on October 20, 2014. Retrieved 2013-08-03.
  7. Griesemer, Robert D (1978-08-01). "Emotionally Triggered Disease in a Dermatologic Practice". Psychiatric Annals. 8 (8): 49–56. doi:10.3928/0048-5713-19780801-08. ISSN   0048-5713 . Retrieved 2019-06-26.
  8. Gaston, Louise; Lassonde, Michel; Bernier-Buzzanga, Jeannine; Hodgins, Sheilagh; Crombez, Jean-Charles (1987-07-01). "Psoriasis and stress: A prospective study". Journal of the American Academy of Dermatology. 17 (1): 82–86. doi:10.1016/S0190-9622(87)70176-5. ISSN   0190-9622. PMID   3611457.
  9. Koo, John; Lebwohl, Andrew (2001-12-01). "Psychodermatology: The Mind and Skin Connection". American Family Physician. 64 (11): 1873–1879.
  10. "Psychodermatology?". Science-Based Medicine – Exploring issues and controversies in the relationship between science and medicine. 2018-04-17. Retrieved 2019-06-26.
  11. Jafferany M (2007). "Psychodermatology: a guide to understanding common psychocutaneous disorders". Prim Care Companion J Clin Psychiatry. 9 (3): 203–13. doi:10.4088/pcc.v09n0306. PMC   1911167 . PMID   17632653.