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Psychocutaneous
diseases
1
psychodermatology
 Refers to any aspect of dermatology in which
psychological factors play a significant role.
 Many patients with psychodermatological
problems resist referral to mental health
professional.
2
Psychodermatological conditions can be grouped
into one of 4 categories:
 1- primary psychiatric disorders: cutaneous finding are self
induced.
 2- secondary psychatric disorders: due to skin diseases.
 3- psychogenic pruritis: without evidence of primary skin
disease and medical condition.
 4- psychophysiological disorders: primary skin disorder
exacerbated by emotional factors .
3
Delusional skin disorder
 Characterized by presence of usually one fixed, false
belief.
 Delusional patient by definition lack of insight.
 Consequently they primary seek care from a
dermatologist rather than psychatrist.
4
Delusion of parasitosis
Delusional infestation
Ekbom syndrome
 Classified as somatic type of delusional
disorder.
 They have isolated fixed belief that their skin is
infested by parasites, in the absence of any
objective evidence of infestation.
5
Diagnostic criteria:
 1- duration
 2- does not exhibit impaired functioning and
bizzare behavior.
 3- dose not related to medications, medical
condition, other psychatric disorder.
Morgellons disease
Is a variant of delusion of parasitosis
characterized by a fixed belief that there
are fibers extruding from the skin.
7
 They frequently collect specimen extracted
from their skin.
 The specimen are brought in contaioner.
 Matchbox sign
 Ziplog sing
8
Clinical features
 Matchbox sign
 Cutaneous sensation
 Skin finding
 location
9
 Patient often tried many coarse of antiparasitic
therapy.
 Patients close contact come to believe in
delusion as well.
10
Epidemiology
 Age of oncet 55-60.
 Women over 50 twice often as men.
11
Differential diagnosis
 Formication.
 Medical condition.
 Psychatric disorder.
12
Treatment
 Pimozide 2-4mg/day.
 Atypical antipsychotic: resperidon, olanzapine.
 Tappering.
13
Factitious disorder
Dermatitis artifacta
 Its within category of somatic disorders.
 Its characterized by self induced skin injury by
instuments.
 They are usually not consciously aware in response to
acute psychological stress.
 May suffer from personality disorder.
14
Clinical features
 Single or multiple.
 Unilateral or bilateral.
 Location
 Clue of the diagnosis: unusual shapes and
ungulated edges.
 Patient deny that their skin injuries are self induced.
 Patient often report a history of physical, sexual,
emotional abuse.
 Large proportion of patient may also have anxiety,
depression, personality disorder.
16
Diagnosis
History
Examination
Skin biopsy
17
Epidemiology
Sex: female to male ratio 8:1
age
18
Differential diagnosis:
Malignering
Neurotic excoriation
Delusion of parasitosis
19
Management
Dermatitis artefacta has chronic coarse, waxing
and waning.
Primary dermatological disorder to be excluded.
Wound care
Occlusive dressing
20
Psychatric therapy
 Non pharmacological.
 Pharmacological:
 SSRI
 Antipsychotic: pimozide
 Atypical antipsychotic: olanzapine.
21
references
 Bolognia dermatology textbook.
 Fitzpatricks dermatology textbook.
 Hunter clinical dermatology textbook.
22
Thank you
23

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Psychocutaneous diseases kopie