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:
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
