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PSYCHOLOGICAL DERMATITIS

Psychological dermatitis is a classic example of the interdependence of our body and mind. It also shows the way to a holistic practice in health care, by giving equal importance to our physical and mental wellbeing.

The relationship of our mind and our dermatological condition is broadly a two-way process, where either a skin problem has psychological implications or an existing emotional disorder triggers a skin reaction. The various skin conditions that have a direct relationship with our mental make-up can be categorized according to the role our psychology plays in their development and progression.

Skin diseases caused by habits related to our psychological state

Lichen simplex chronicus

This condition develops from the habit of continuously scratching and rubbing a skin rash. It is marked by mental anxiety. The rashes are generally confined to one side of a body location, so that they can be easily reached by the active hand. They common areas of occurrence are:

  • Nape of the neck
  • Forearms
  • Elbows
  • Scrotal skin
  • Legs
  • Ankles

Clinical features include:

  • Severe itching
  • Lichenification

Lichen amyloidosus

This is also a result of the habit of constant scratching due to lichen simplex chronicus. Here the unmanageable scratching causes necrosis (tissue destruction) of keratinocytes that in turn leans to amyloid deposition in the papillary dermis.

Common locations are:

  • Legs
  • Feet

Clinical features include:

  • Itchy brownish hyperkeratotic papules
  • Itching

Treatment includes:

  • Strong topical corticosteroids (with caution about side effects)
  • Covering the affected spots to prevent scratching
  • Antihistamines such as hydroxyzine

Acne excoriée

This condition occurs due to constant picking associated with depression, anxiety and other mental imbalances.

Clinical features are:

  • Pitted scars
  • Hypertrophic scars
  • Keloids

Therapy includes:

  • Cognitive psychotherapy to prevent picking
  • Pulsed dye laser can treat the lesions

Skin diseases aggravated by emotional stress

In these instances, psychological stress aggravates or even triggers a skin disorder.

Atopic dermatitis

Stress often affects our immunological functions, which has a hypersensitive outcome in the form of atopic dermatitis. The main psychological triggers are:

  • Stressful occurrences
  • Playing video games
  • Constantly ringing cell phones

Therapeutic control includes:

  • Rest and recreation
  • Self control of habits like scratching and picking
  • Stress management

Perioral dermatitis

This syndrome is associated with tension, insomnia, headaches and exhaustion. However, it may also be related to the over dose of topical corticosteroids.

Clinical features are:

  • Papules
  • Papulovesicles
  • Papulopustules
  • Comedones not seen

Major body locations are:

  • Perioral areas
  • Periorbital areas
  • The face is a very common spot

Therapy includes:

  • Management of the physical and psychosocial impact
  • Avoidance of strong topical corticosteroids

Dyshidrotic dermatitis or pompholyx

This skin disease occurs in the palmoplantar surfaces, caused by an atopic ailment, nickel allergy, stress or mental agony.

Clinical features are:

  • Itching
  • Stiff fluid-filled blisters

Treatment methods:

Biofeedback guidance is often an effective method when the condition cannot be managed by other treatments.

Plaque Psoriasis and Palmoplantar pustulosis

These two ailments are aggravated due to psychological stress. The former is seen both in children and in adults. Hypnosis is often a means of management in plaque psoriasis.

Skin diseases caused by psychiatric and neurological disorders

Psychiatric and neurological disorders such as restless legs syndrome and parasitophobia may directly cause skin skin conditions.

Restless legs syndrome

Here the patient complains of a crawling, creeping, and tingling sensations in the legs. Causes are:

  • Primarily familial
  • Secondarily, chronic renal disorder and diabetes mellitus

Treatment includes:

  • Addressing the core causes
  • Symptomatic cure with dopamine agonists, opioids or benzodiazepines

Parasitophobia

Here the patient suffers from a macabre fear of parasites attacking the skin. Often the patients fabricate their own evidence for the doctor.

Real clinical features are:

  • Focal excoriations and erosions on the arms and legs
  • Scabies
  • Body lice

Other than symptomatic treatment, therapy also includes psychiatric counseling.

Skin ailments caused by neurological and psychiatric drugs

Side effects of neurological and psychiatric medications cause the following skin ailments:

  • Morbilliform rash
  • Urticaria
  • Photosensitivity
  • Pigmentary conditions
  • Acne
  • Alopecia
  • Fixed drug eruptions
  • Lichenoid reactions
  • Psoriasiform rash

However, psychiatric drugs such as tricyclic antidepressants and serotonin reuptake inhibitors also have a therapeutic effect on certain skin diseases.

Psychiatric disorders directly taking the form of fictitious skin diseases

Dermatitis artefacta and Munchausen syndrome

A dermatitis artefacta patient, self inflicts skin injury to convince the doctor and appease some psychological desire. They refuse to acknowledge that it is a psychiatric problem. It is very common among adolescents with attention seeking problems.

Clinical manifestations include:

  • Lymphoedema
  • Cellulites
  • Panniculitis

Munchausen syndrome is a similar self-production of symptoms but occurs in men with psychopathic personality disorders.

Trichotillomania

This is marked by deliberate and constant hair exploitation and plucking, mostly when the patient is engrossed in some activity. Simultaneous habits of skin picking may occur.

Clinical outcomes are:

  • Bezoars in the gastric antrum
  • Non scarring alopecia generally in the scalp margin
  • Alopecia in children