Academic journal article Indian Journal of Psychiatry

Relevance of Psychiatry in Dermatology: Present Concepts

Academic journal article Indian Journal of Psychiatry

Relevance of Psychiatry in Dermatology: Present Concepts

Article excerpt

Byline: K. Basavaraj, M. Navya, R. Rashmi

Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between mind and skin. It is divided into three categories according to the relationship between skin diseases and mental disorders. This article reviews different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/depression and those caused by psychiatric disorders are discussed. This review intends to present the relationship between the 'skin' and the 'mind' specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted. A multidisciplinary approach for treatment from both dermatologic and psychiatric viewpoints are suggested.

Introduction

Skin has a special place in psychiatry with its responsiveness to emotional stimuli and ability to express emotions such as anger, fear, shame and frustration, and by providing self-esteem, the skin plays an important role in the socialization process, which continues from childhood to adulthood.[sup][1] The relationship between skin and the brain exists due to more than a fact, that the brain, as the center of psychological functions, and the skin, have the same ectodermal origin and are affected by the same hormones and neurotransmitters. [sup][2] Psychodermatology describes an interaction between dermatology and psychiatry and psychology. The incidence of psychiatric disorders among dermatological patients is estimated at about 30 to 60%.[sup][3] Psychiatry is more focused on the 'internal' non-visible disease, and dermatology is focused on the 'external' visible disease. Connecting the two disciplines is a complex interplay between neuroendocrine and immune systems that has been described as the NICS, or the neuro-immuno-cutaneous system. The interaction between nervous system, skin and immunity has been explained by release of mediators from NICS. [sup][4] It has been reported that psychologic stress perturbs epidermal permeability barrier homeostasis, and it may act as precipitant for some inflammatory disorders like atopic dermatitis and psoriasis.[sup][5] Dermatologists have stressed the need for psychiatric consultation in general, and psychological factors may be of particular concern in chronic intractable dermatologic conditions, such as eczema, prurigo and psoriasis. [sup][6],[7] Patients with psychocutaneous disorders frequently resist psychiatric referral, and the liaison among primary care physicians, psychiatrists and dermatologists can prove very useful in the management of these conditions. Thus consideration of psychiatric and psychosocial factors is important both for the management of psychodermatologic disorders and for some aspects of secondary and tertiary prevention of a wide range of dermatologic disorders.[sup][8] Regardless of psychiatric morbidity, skin diseases can greatly affect patients' quality of life. [sup][9] The drugs used in the treatment of dermatological diseases such as steroid and retinoid may lead to psychiatric symptoms. [sup][10] Not surprisingly, a relationship between psychological factors and skin diseases has long been hypothesized. There is a common opinion that many cases of skin disease are caused by psychological stress, or are related to certain personality traits, or represent a complication of a psychiatric disorder. Although the dermatologists awareness of the problem is increasing, [sup][11] co-occurring mental disorders go often unrecognized and are believed to be less frequent than they actually are in many skin conditions. …

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