Nonpharmacological treatment approach in trichotillomania (hair-pulling disorder).

Trichotillomania (TTM) is a fairly common psychodermatological disorder. This is characterized by recurrent urges to pull hair from hair-containing parts of the body and produces bald patches on scalp. Besides scalp, eye lashes, eyebrows, and pubic area may be involved. Clinically two types are recognized, the automatic and focused types. Currently, this is classified into obsessive- and compulsive-related disorder. Most common psychiatric manifestations include anxiety, depression, and low self-esteem. It has bimodal distribution in children and adolescents and adults. No recognized treatment is available. Pharmacological treatment is based on limited trials and case reports. Psychotherapies are mainstay of treatment. This review mainly focuses on evidence-based psychotherapeutic techniques used in the treatment of TTM.

Psychotropic drugs in dermatology: A dermatologist's approach and choice of medications.

Psychiatric symptoms in dermatology practice are increasingly being recognized. The use of psychiatric medications by dermatologist is dealt with caution and uncertainty in several psychodermatological conditions. Several skin conditions are associated with anxiety, depression, and obsessive-compulsive symptoms. Some conditions such as delusion of parasitosis require antipsychotic medication treatment. Keeping in mind the importance of psychotropic medications and its use in dermatology, following brief review will familiarize dermatologists about the ease of understanding and prescribing psychotropic medications to help their patients with psychiatric symptoms and increase the compliance in treatment.

Therapeutic implications of personality disorders in dermatology.

There is a significant psychiatric comorbidity that exists in multiple dermatological conditions, stemming from the patient''s own psychological make up. This article reviews personality disorders and their types, which influence the course and prognosis of several psychodermatological disorders. Self-inflicted skin lesions, for example, are usually associated with obsessive-compulsive behavior, but they also share connections to Narcissistic and Borderline personality disorders. Body dysmorphic disorder is another psychodermatological condition seen in dermatology, aesthetic, and cosmetic surgery clinics, which is influenced by patient's personality type. In general, there is a significantly high proportion of personality disorders seen in aesthetic and cosmetic surgery. The management of patients with personality disorders is challenging, but joint liaison between psychiatry and dermatology has proven helpful and can provide patients with the best care for their psychological needs and dermatologic care.

Management of psychocutaneous disorders: A practical approach for dermatologists.

Psychodermatology is a growing specialty which is gaining momentum in different parts of the world. It focuses on the connection between skin and psyche. Psychocutaneous conditions are characterized by those disorders where stress is the key element in exacerbating skin conditions or flare ups of dermatoses like psoriasis and atopic dermatitis. There is a direct relationship of stress with the course, and prognosis of the skin disease. In some situations, there is no skin condition but the lesions are self-inflicted and such disorders are always associated with underlying psychopathology or psychological conflicts. Sometimes emotional problems are more prominent as a result of having skin disease, and the psychological consequences may be more severe than the physical symptoms. Management of these conditions require a combination of psychpharmacology, psychotherapy, and liaison clinics of psychiatry and dermatology. This review focuses on the common management approach which can be adopted by dermatologists in treating patients with psychodermatological disorders, improving doctor-patient relationship and therapeutic bond.

Treatment of skin picking disorder: Interdisciplinary role of dermatologist and psychiatrist.

Skin picking disorder (excoriation disorder) is a common psychodermatological disorder characterized by irresistible urges to pick skin on dominant hand accessible parts of the body. There is no specific recommended treatment available. Various pharmacological agents particularly selective serotonin reuptake inhibitors and glutamatergic agents have been tried with variable success. Habit reversal therapy has been commonly employed in the treatment and has some evidence-based success. This review focuses on the interdisciplinary team approach consisting of a liaison with psychiatry, in the management of this disorder. The specific roles of dermatologist and psychiatrist are discussed in detail.

Psychological aspects of aesthetic and cosmetic surgery: Clinical and therapeutic implications.

Recently there is a surge in cosmetic and aesthetic surgery procedures. Several patient seeking various cosmetics procedures present to aesthetic surgery clinics and demanding procedures which are out of proportion. Several of these patients have under-recognized or untreated psychiatric disorders. Proper screening and evaluation of these patients could save money and resources. This brief review focuses on current trends, clinical and psychological assessment and expectations on the part of patients and recommendations regarding management of these patients.