Treatment of psychodermatological disorders

What is a psychodermatological disorder?

A psychodermatological disorder is a condition that affects both the skin and the mind. It has both physical and psychosocial components. In these cases, effective management of the skin disorder must take into account the psychological/psychiatric factors.

Researchers use the term ‘neuro-immuno-cutaneous system’ (NICS) to describe this relationship.

Classification of psychodermatological disorders

Psychodermatological disorders may be divided into three categories:

• Psychophysiological disorders, where emotional stress can exacerbate symptoms; an example is psoriasis
• Primary psychological disorders, where the psychological condition results directly in cutaneous symptoms, such as delusions of parasitosis
• Secondary psychological disorders, where a disfiguring skin condition can lead to psychological problems such as depression.

Assessment tools for psychodermatological disorders include the following questionnaires:

• The Dermatology Life Quality Index (DLQI) or Children’s Dermatology Life Quality Index (CDLQI)
• The Person-Centered Dermatology Self-Care Index (PeDeSI)
• The Psoriasis Disability Index (PDI)
• The Dermatitis Family Impact (DFI) questionnaire.

Pharmacological options for psychodermatological disorders

The pharmacological treatment options for the psychological/psychiatric factors involved in psychodermatological disorders depend on the type of disorder being treated. They can include:

• Anti-anxiety agents, such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs)
• Antihistamines including hydroxyzine, beta-blockers such as propranolol, and antiepileptic drugs eg, pregabalin 
• Pimozide, which is an antipsychotic agent used to treat delusions of parasitosis 
• Antidepressants are used if depression is exacerbating a dermatological condition (note: tricyclic antidepressants also have antihistaminic properties).

Obsessive-compulsive disorder is associated with trichotillomania (compulsive hair-pulling), onychophagia (nail biting), hand dermatitis from compulsive hand washing, and other skin conditions; SSRIs, such as fluoxetine, paroxetine, sertraline and fluvoxamine, have been proven to be effective for its treatment in clinical trials.

Non-pharmacological options for psychodermatological disorders

Non-pharmacological treatments available for the psychological/psychiatric factors involved in psychodermatological disorders include:

• Stress management techniques, including relaxation, music therapy, regular exercise and meditation
• Dermatological support groups
• Counselling or psychiatric treatment (such as cognitive behavioural therapies)
• Hypnosis, which can include electromyography and blood flow training
• Complementary therapies, including aromatherapy and herbal supplements.