The mind-skin connection: A narrative review exploring the link between inflammatory skin diseases and psychological stress.

Inflammatory skin diseases are known to negatively impact patient psychology, with individuals experiencing higher rates of stress and subsequent diminished quality of life, as well as mental health issues including anxiety and depression. Moreover, increased psychological stress has been found to exacerbate existing inflammatory skin diseases. The association between inflammatory skin diseases and psychological stress is a timely topic, and a framework to better understand the relationship between the two that integrates available literature is needed. In this narrative review article, we discuss potential neurobiological mechanisms behind psychological stress due to inflammatory skin diseases, focusing mainly on proinflammatory cytokines in the circulating system (the brain-gut-skin communications) and the default mode network in the brain. We also discuss potential descending pathways from the brain that lead to aggravation of inflammatory skin diseases due to psychological stress, including the central and peripheral hypothalamic-pituitary-adrenal axes, peripheral nerves and the skin barrier function.

Patients' experience of incontinence and incontinence-associated dermatitis in hospital settings: a qualitative study.

OBJECTIVE: To explore the experience of patients with incontinence and incontinence-associated dermatitis (IAD) in acute care hospitals and their family caregivers, including their perceptions and management, as well as the impact on their wellbeing. METHOD: A qualitative exploratory study design was employed in 18 wards across six acute/subacute hospitals in New South Wales, Australia. Patients with incontinence (with or without IAD) were invited to participate. Where interviews were not possible with the patient, their family caregiver was invited to participate. Semi-structured interviews were conducted. RESULTS: There were 45 interviewees in the study; 41 were patients with incontinence (11 of whom had IAD) and four were family caregivers. The experience of incontinence was captured by three themes: 'incontinence interrupts every aspect of my life'; 'actively concealing and cloaking'; and 'perceived as irreversible'. Incontinence was expected by the patients at their age and did not come as a surprise. It was normalised and approached with stoicism. As such, patients self-managed their incontinence by developing strategies to ensure they avoided episodes of incontinence during their stay. Incontinence left patients feeling anxious, embarrassed and with a sense of shame, and they did not communicate these feelings, or engage with health professionals about their incontinence, nor did health professionals discuss their incontinence with them. There was a strong sense of resignation that incontinence was irreversible and nothing could be done to improve it. All participants displayed little knowledge of IAD. The experience of having IAD was characterised by the theme 'debilitating and desperate for relief' and was experienced as a particularly painful, itching and burning condition that left patients distressed and irritable. CONCLUSION: Patients with incontinence in acute settings required further education from health professionals to reduce the stigma of incontinence, and provide further support to manage their incontinence. Health professionals can also play a key role in educating patients about the risks of developing IAD and how it can be prevented.

Body Image Quality of Life in Patients with Hidradenitis Suppurativa Compared with Other Dermatological Disorders.

Hidradenitis suppurativa is a chronic skin disease characterized by inflammation and disfiguring scarring in the intertriginous body areas. Hidradenitis suppurativa is associated with overweight and impaired quality of life. This study sought to describe Body Image Quality of Life (BI-QoL) in patients with hidradenitis suppurativa and to compare it with patients with other skin diseases (controls). A total of 285 participants were recruited, 141 with hidradenitis suppurativa and 144 controls, at the Department of Dermatology at Zealand University Hospital, Denmark (during 2017-18). The Danish "Body Image Quality of Life Inventory" questionnaire measured BI-QoL. Patients with hidradenitis suppurativa had significantly lower mean BI-QoL than controls: Hidradenitis suppurativa BI-QoL (standard deviation; SD) -0.87 (0.98) vs. control BI-QoL (SD) 0.01 (1.11), p < 0.001. Predictors of negative BI-QoL were hidradenitis suppurativa, increased body mass index, female sex, symptoms of depression, and body mass index moderated by hidradenitis suppurativa. These data suggest that BI-QoL is impaired in patients with hidradenitis suppurativa compared with patients with other skin diseases after adjusting for confounders.

[Pitfall cryothermic dermatitis artefacta]. / Fallstrick kryothermische Dermatitis artefacta.

We present four clinicopathological correlated cases of young patients with cryothermic dermatitis artefacta. They were initially misdiagnosed as primary bullous dermatoses or fixed drug eruptions. Cryothermic dermatitis artefacta can imitate authentic dermatoses such as linear IgA bullous dermatosis, herpes virus infection, bullous pemphigoid or fixed drug eruption. It should be considered as differential diagnosis in uncommon cases of recurrent bullae in adolescent and young adult patients. We summarize helpful clinical and histopathological criteria for correct diagnosis and therewith causative treatment.

Dermatitis Artefacta in Childhood: A Retrospective Analysis of 44 Patients, 1976-2006.

BACKGROUND: Dermatitis artefacta (DA) consists of self-inflicted skin lesions that the patient denies having produced. OBJECTIVES: To conduct a single-center retrospective clinical review of children and adolescents diagnosed with DA. METHODS: From 1976 to 2006, data were collected on children diagnosed with DA who were seen in the Department of Dermatology in our hospital. Clinical and epidemiologic features are described. Forty-four children (mean age 12.9 yrs) were selected, representing 21.9% of the total patients with DA recorded (n = 201) during this period. RESULTS: The most frequent clinical forms were excoriations (16 [36.4%]) and ulcers (10 [22.7%]), followed by blisters (7 [15.9%]), burns (3 [6.8%]), contact dermatitis (3 [6.8%]), hematomas (2 [4.5%]), panniculitis (1 [2.3%]), cheilitis (1 [2.3%]), and hyperpigmentation (1 [2.3%]). Sixteen were located exclusively on the face and neck, whereas 28 also had other locations (upper limbs, n = 10; lower limbs, n = 9; thorax, n = 5; abdomen, n = 4). Cutaneous lesions were treated with occlusive bandages using zinc paste or a plaster splint when necessary. CONCLUSION: To our knowledge, this is the largest reported series of DA in childhood. This complicated psychodermatologic condition requires correct diagnosis, appropriate management, and psychiatric assessment.

Life events and quality of life in female patients with dermatitis artefacta: a comparative study with siblings and controls.

BACKGROUND: If the severity of dermatitis artefacta (DA) is accepted by most authors, few published studies have sought to clarify its etiology and impact. It is in this context that this work aimed to compare Life Events (LE) and quality of life (QoL) scores in patients with DA, in their siblings and in control patients with other chronic dermatological diseases. METHODS: This is a descriptive and comparative cross-sectional study carried out in the dermatology department of Farhat Hached hospital in Sousse, Tunisia. Thirty female patients diagnosed with DA according to DSM-IV criteria were retrospectively recruited. For each patient with DA, one of her sisters, the closest in age, was enrolled in the siblings group. The control group consisted of thirty female patients with other chronic dermatological diseases, matched with DA patients for age and duration of disease progression. Assessment was based on Paykel inventory for LE and on SF-36 for QoL. RESULTS: Compared to both control groups, DA patients reported more LE with more objective negative impact of these events and had a lower score and more often impaired mean global score of QoL. CONCLUSIONS: LE would have a role in the pathogenesis of DA which seems to alter the QoL of patients. These results could help to improve the understanding of DA and incite clinicians to focus not only on the diagnosis and treatment of DA but also on the impact of this disease.

Dermatitis artefacta: a retrospective analysis.

BACKGROUND: Factitial dermatitis describes self-produced and consciously made skin lesions usually intended to win sympathy, avoid responsibilities and even gain disability insurance. Dermatitis artefacta belongs to an extensive spectrum of self-inflicted diseases termed factitious diseases. OBJECTIVES: The study is retrospective, and the patients were seen in our department from 2002 to 2012. MATERIALS AND METHODS: For patients with skin lesions, the demographic features and clinical descriptive characteristics of their lesions were ascertained. Patient files and photographs were reviewed and the patients were called for follow-up. RESULTS: A total of 25 patients were recorded. Mean age of the patients was 25.64 ± 11.80. With the exception of two cases, all patients were females. With regard to location, 27% of the patients showed facial localization, whereas the lesions have been localized on the extremities in 44%. The most common clinical appearance of DA was crusted eroded lesions (24%) and excoriations (24%) followed by ulcers (12%), superficial erosion (12%), acute eczematous lesions (8%), purpuric lesions (8%), pigment application (8%), diffuse erythema (8%), hyperpigmentation (8%), blister (4%), hair cutting (4%), hypopigmentation (4%) and cellulitis (4%). Forty percent of the patients had multiple lesions. There were eight children with dermatitis artefacta whose mean age was 14.50. The predominant lesion in these cases was superficial eroded plaque (37.5%). While patients with mild lesions limited in number receive ambulatory care, almost half of the patients require hospitalization. In this study, all patients were referred to psychiatric consultation, but most of them either refused treatment or did not receive medications. CONCLUSION: Although it is primarily a psychiatric disease, dermatitis artefacta is frequently diagnosed by dermatologists. Detailed history and physical examination are key factors because it imitates an extensive spectrum of diseases.

Investigation of nursing students' knowledge levels and attitudes in incontinence-associated dermatitis management through game-based learning: a mixed methods study.

PURPOSE: This study aimed to assess nursing students' knowledge levels and attitudes towards the etiology, risk factors, and preventive measures of incontinence-associated dermatitis (IAD) using an escape room game. DESIGN: A mixed-method study. SUBJECTS AND SETTING: The sample size of the study was 32 students. METHODS: Quantitative data obtained with the Knowledge, Attitude and Practice of Nurses in Managing Incontinence-Associated Dermatitis Questionnaire (KAP-IAD-Q) and qualitative data obtained through FGDs following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist were analyzed using a thematic approach. RESULTS: The average age of the participants was 22.63 ± 0.90, 87.5% of them were female (n=28), and 50% were third (n=16) and fourth-year students (n=16). KAP-IAD-Q total posttest score (88.06+7.00) was found to be high. Data obtained from the FGDs were categorized under 3 main themes: main focus areas during participation in the IAD-themed escape room game; advantages and disadvantages of teamwork in IAD management; and the game's contribution to a better understanding and classification of IAD. CONCLUSIONS: The use of the escape room game facilitated high, fast, and efficient learning of IAD knowledge and attitudes. It revealed challenges in collaborative decision-making, accurate diagnosis, distinguishing from other wounds, and attitude development in the management of IAD.

Infants' Dermatitis Quality of Life Index: a decade of experience of validation and clinical application.

The Infants' Dermatitis Quality of Life Index (IDQoL) is a questionnaire completed by parents to assess the impact of atopic dermatitis on the quality of life of infants aged 0-3 years. The aim was to review all clinical and psychometric data on the use of the IDQoL from its inception in 2001 until November 2012, to serve as a single reference source. A literature search was carried out using Medline, PubMed, EBSCOhost, Science Direct and Google Scholar. Articles and abstracts that described the clinical use of the IDQoL and those that investigated its psychometric properties were included. Articles not in English were excluded. Fifty-one publications were identified, of which 46 fulfilled the inclusion criteria. IDQoL data relating to psychometric, descriptive and clinical practice research, drug trials and therapeutic interventions were extracted. The IDQoL has been translated into 21 languages and used in 18 countries, including two multinational studies. Thirty-one studies demonstrated its psychometric properties, such as test-retest reliability, internal consistency, validity, responsiveness to change and interpretability. No studies investigated dimensionality, carried out factor analysis or described the minimal clinically important difference of the tool. Eight studies used the IDQoL to assess the effectiveness of therapeutic interventions such as education programmes, consultations and wet-wrap therapy, while seven studies described the use of IDQoL in topical interventions. When deciding whether to use the IDQoL, researchers and clinicians should consider the validation data, the relevant comparative clinical data available and the potential burden on the respondents.

Emotional stress as a trigger for inflammatory skin disorders.

Dermatologic disorders comprise 15% to 20% of complaints seen in general practice. Skin disorders result in a negative impact to the patient not only physically but also psychologically, socially, and occupationally. The most common trigger for several inflammatory skin disorders, including psoriasis, is emotional stress. Understanding the significance of emotional triggers to common inflammatory dermatologic disorders is critical to the optimal management of these conditions. This article will provide an overview of the effects of emotional stress on skin disorders and psychotherapeutic options.

A cry for help, do not omit the signs. Dermatitis artefacta--psychiatric problems in dermatological diseases (a review of 5 cases).

BACKGROUND: Dermatitis artefacta (DA) is a dermatologicopsychiatric illness that is a conscious self-infliction of lesions to accessible regions of the body. The lesions usually do not resemble those of any know skin disease and there are no specific diagnostic tests to recognize them. This makes dermatitis artefacta a very slow, challenging and expensive disease to diagnose. CASE REPORT: We present 5 different clinical cases of dermatitis artefacta treated in the Department of Dermatology, Venereology and Allergology, Medical University of Gdansk in 2011. Detailed anamnesis and physical examination were performed at the day of admission. All patients had biochemical and hematological blood tests, skin biopsies and swabs for bacteriological examination, and photographs were taken. Psychiatric consultation was recommended in all cases. Clinical symptoms before diagnosis lasted from 1 to 10 years. The female-to-male ratio is 1:0.7, with age range of 57-62 years. Of our patients, only 2 refused a psychiatric consultation. Three out of 5 patients denied self-mutilation (2 of those 3 patients finally admitted to self-manipulations). Lesions were usually within the reach of the dominant hand. Two patients have other personality disorders. In 4/5 cases visible improvement after treatment with occlusive dressings were observed. CONCLUSIONS: We discuss and attempt to depict issues associated with collaboration between dermatologists and psychiatrists, reasons for poor recognition of the disease, very long diagnosis and high costs. To conclude, we found that close collaboration between dermatologists and psychiatrists is important in diagnosing and treating DA patients.

Bullous cryothermic dermatitis artefacta induced by deodorant spray abuse.

BACKGROUND: Dermatitis artefacta belongs to a broad spectrum of factitious diseases of lesions usually self-induced by patients. Here we report a surprisingly effective induction of blisters and thermic dermatitis by excessive abuse of common deodorant sprays. OBJECTIVES: We evaluated the clinical course and outcome in three patients with dermatitis artefacta induced by deodorant spray. METHODS: A 12-year-old boy only admitted the abuse of deodorant spray after psychiatric intervention. Two adults (21-year-old and 37-year-old women) had borderline personality disorder and frankly reported the urge to induce pain by spraying for at least 100 s at a short distance. RESULTS: Bullous dermatitis was the acute presenting sign in all patients. The bullae were found on the extensor surfaces of the extremities, with a distribution of older lesions showing erosions and scarring and fresh lesions with intact bullae with a diameter of 3-15 cm. After searching for the causative agent and removal of the deodorant spray, clinical outcome showed a healing without and with scars. CONCLUSIONS: Cryo-damage by abuse of common deodorant sprays seems to become a popular mechanism by which an impressive bullous dermatitis can be artificially induced. Dermatologists and psychiatrist should be aware of this method of injury.

[Sensitive skin: a complex syndrome]. / La piel sensible: un síndrome complejo.

Epidemiologic studies indicate that ever larger numbers of people report having sensitive skin, for which a European prevalence of 50% is estimated. Sensitive skin is characterized by hyperreactivity, with manifestations varying in relation to many factors. The pathogenesis of this disorder is poorly understood, although studies point to a biophysical mechanism. Objective diagnosis of sensitive skin is difficult, as information comes mainly from the patient's report of symptoms in the absence of effective, strongly predictive tests because of great interindividual variability in skin sensitivity. Substances that trigger a reaction in hypersensitive skin also vary greatly. The impact of this syndrome on quality of life is considerable and patients often present psychiatric symptoms; therefore, dermatologists should explore this possibility when taking a patient's history. Patient cooperation and physician persistence are both essential for treating sensitive skin.

Dermatitis artefacta of the breast: a retrospective analysis of 27 patients (1976-2006).

BACKGROUND: Dermatitis artefacta (DA) is defined as all dermatological, self-inflicted skin lesions, where the patient denies having produced the lesions. OBJECTIVES: The purpose of this study is to make a single-centre retrospective clinical review of patients diagnosed as DA of the breast. MATERIALS AND METHODS: During a 30-year period (1976-2006), patients diagnosed as DA of the breast, seen in the Department of Dermatology of the Virgen Macarena Hospital in Seville, were recorded. Clinical and epidemiological features are described. RESULTS: A total of 27 women with a mean age of 34.33 years were selected representing 13.43% of the total of DA patients recorded (n=201) in this period. The most frequent clinical forms were: excoriations (nine patients, 33.33%) and ulcers (nine patients, 33.33%), followed by burns (six patients, 22.22%), blisters (one patient, 3.70%), contact dermatitis (one patient, 3.70%) and haematomas (one patient, 3.70%). Ten of the cases were located exclusively on the breasts, whereas 17 had also other locations such as face in seven cases, arms in five cases, abdomen in five cases and the entire body in two cases. Cutaneous lesions were treated with occlusive bandages using zinc paste or plaster splint when necessary. CONCLUSION: To our knowledge, this is the major series of DA of the breast studied. This complicated psychodermatological condition requires a correct diagnosis, appropriate management and psychiatric assessment.

The current management of delusional parasitosis and dermatitis artefacta.

Psychocutaneous disorders involve a unique and somewhat difficult patient population, whose treatment requires the use of drugs unusual to the dermatologist and a significant investment of the clinician's time. This paper describes an effective interpersonal approach and appropriate drug therapy for patients with delusional disorders and dermatitis artefacta, as well as outlines the expectable course and prognosis in each.

Evaluation of life quality, anxiety, and depression in patients with skin diseases.

To investigate the incidence of skin diseases, the factors affecting the life quality, anxiety, and depression of patients with skin diseases and the correlation among the 3.A total of 1127 patients with skin diseases were selected online from March 2018 to June 2018. Logistic regression was used to analyze the factors influencing life quality, anxiety, and depression. Spearman rank correlation was used to analyze the correction among the life quality, anxiety, and depression.There was no significant difference in ethnicity, education, and time of question among patients (P > .05). Sex ratio, age, marital status, and occupation were statistically significant difference among patients with different skin diseases (P < .05). The life quality index of patients with psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia were 11.96 ±â€Š6.74, 9.84 ±â€Š6.99, 11.57 ±â€Š6.85, 13.86 ±â€Š6.31, 7.86 ±â€Š6.82, respectively. The differences were statistically significant (P < .05). The main factors affecting quality of life included age, family history, and types of skin diseases. The age, ethnicity, education, and family history of skin diseases were the main factors affecting anxiety of patients with different skin diseases. Additionally, sex, marital status, education, and family history of skin diseases were the main factors influencing depression. Spearman rank correlation analysis showed that the life quality, anxiety, and depression were positively correlated.Psoriasis, atopic dermatitis, acne, steroid-dependent dermatitis, and alopecia have a certain impact on the life quality of most patients, and may cause different degrees of anxiety and depression.