Journal Article Annotations
2017, 2nd Quarter

Psychodermatology

Annotations by J. Jewel Shim, MD
July 2017

Of interest:

• Kuhn H, Mennella C, Magid M, Stamu-O'Brien C, Kroumpouzos G: Psychocutaneous disease: clinical perspectives
  J Am Acad Dermatol 2017; 76(5):779-791

  While a review of psychocutaneous diseases is geared primarily toward dermatologists, it nevertheless provides a comprehensive overview of these syndromes and their treatment, including dermatological and psychiatric modalities. For each disorder, the authors provide key points, including a brief clinical description as well as the recommended treatments, and this paper can serve as an excellent reference for these diseases for the PM psychiatrist.

• Azambuja RD: The need of dermatologists, psychiatrists and psychologists joint care in psychodermatology
  An Bras Dermatol 2017; 92(1):63-71

  This is an interesting paper highlighting the skin as an organ that can manifest both medical and psychiatric illness, establishing the basis for the specialty of psychodermatology and also emphasizing the importance of the biopsychosocial model in understanding and treating patients with psychodermatological conditions. The author presents the physiologic and psychologic effects of simply touching the skin and cites the work of Renee Spitz in which he described the profound effect of touch deprivation on childhood physical and psychosocial development, and ultimately, survival. He further discusses the mind-skin connection, the role of stress, and the immune system in the pathogenesis of psychodermatoses. The author exhorts an interdisciplinary approach to treatment of patients with these disorders as essential. While geared toward dermatologists, this paper articulates a perspective very much at the heart of our work as PM psychiatrists.

• Tomas-Aragones L, Consoli SM, Consoli SG, et al: Self-inflicted lesions in dermatology: a management and therapeutic approach—a position paper from the European Society for Dermatology and Psychiatry
  Acta Derm Venereol 2017; 97(2):159-172

  This is a position paper from the European Society for Dermatology and Psychiatry regarding self-inflicted lesions. Previous to this paper, this society proposed the term self-inflicted skin lesions (SISL) and identified diseases in this classification. SISL are described as “non-suicidal, conscious, and direct damage to the skin” and include disorders in four main categories: 1) non-hidden and non-denied underlying behaviour: skin picking and related skin damaging symptoms—compulsive spectrum; 2) non-hidden and non-denied underlying behaviour: skin picking and related skin damaging symptoms—impulsive spectrum; 3) Hidden or denied underlying behaviour with no external incentives: factitious disorders in dermatology; 4) Hidden or denied underlying behaviour with no external incentives: factitious disorders in dermatology—malingering in dermatology. The authors subsequently outline comorbidities to these illnesses, describe the emotional structure and communication styles of patients with these disorders, as well as summarize specific treatment recommendations, both dermatologic and psychiatric, including specific psychotherapeutic approaches such as CBT or habit reversal therapy. While this paper is intended for dermatologists, it provides an excellent summary of SISL and the current recommended treatment modalities for these disorders.