Exploring the Psychological Impact of Childhood-Onset Psoriasis: A Systematic Review.

BACKGROUND: Childhood-onset psoriasis (COP) is often associated with various psychological challenges. While numerous studies have delved into the connection between adult-onset psoriasis and its potential to heighten a patient's susceptibility to various psychological challenges, less has been written about the influence of childhood psoriasis on psychological disorders, particularly anxiety and depression, eating disorders, and substance abuse. In this study, we delve into studies that shed light on these associated risks. METHODS: A systematic literature review was conducted using PubMed, focusing on the psychological impacts of childhood-onset psoriasis. From an initial pool of 313 articles, we utilized Covidence for screening and selection, adhering to strict exclusion criteria such as psoriasis in adulthood and incorrect study designs. This process refined our focus to 12 relevant articles, which were critically analyzed to understand the psychological comorbidities associated with childhood-onset psoriasis. RESULTS: Our review reveals a significant link between childhood-onset psoriasis and increased instances of depression and anxiety. Notably, children with psoriasis demonstrate higher frequencies of suicidal thoughts and behaviors, as well as a marked propensity for substance abuse and addiction. The study also uncovers a strong connection between psoriasis in children and the development of eating disorders like anorexia nervosa and bulimia nervosa. CONCLUSION: COP significantly affects the psychological wellbeing of children, with heightened risks for depression, anxiety, suicidality, substance abuse, and eating disorders. These findings underscore the need for comprehensive management strategies that encompass not only the physical symptoms but also the mental health and psychological support for children with psoriasis. Early intervention and regular screenings are crucial in mitigating these risks and improving the quality of life for pediatric patients with psoriasis.

Psychosocial Comorbidities in patients with pediatric alopecia areata: A Literature Review.

BACKGROUND: Alopecia areata (AA), a chronic autoimmune disorder causing non-scarring hair loss, has a greater prevalence in the pediatric population. Like many visible dermatologic disorders, AA can cause significant psychosocial impairment, particularly in children who are undergoing critical periods of psychosocial development. This paper investigates the psychosocial impact of AA on children. METHODS: A systematic review was conducted using PRISMA guidelines. SCOPUS and PubMed databases were utilized with the terms "alopecia areata," "pediatric," and "psychosocial comorbidities." 12 articles were reviewed, with 6 meeting inclusion criteria for detailed analysis. RESULTS: The review revealed prominent associations between AA and psychosocial comorbidities in children. Psychiatric conditions including anxiety, depression, and OCD, were prevalent in pediatric AA patients, with exacerbation due to increased disease severity. These negatively impacted the Quality of Life (QoL) in affected children. Additionally, the comorbidities extended beyond psychiatric diagnoses, impacting self-esteem, academic performance, peer relationships, and body image satisfaction in children. CONCLUSION: This literature review highlights the significant impact of various psychosocial comorbidities in children with AA, emphasizing the need for early identification and intervention. Healthcare professionals, including psychiatrists, therapists, and dermatologists, can play a significant role in treating pediatric patients with AA. Dermatologists can play a critical role in diagnosing AA and identifying psychosocial comorbidities that may arise and refer patients to appropriate care. Future research should focus on elucidating effective screening tools for dermatologists to identify these comorbidities early, ultimately improving the overall well-being of children with AA.

From tugs to treatments: a systematic review on pharmacological interventions for trichotillomania.

BACKGROUND: Trichotillomania (TTM) is a psychiatric disorder with dermatological consequences, characterized by recurrent hair pulling. It affects 1-3% of the population, and often coexists with other psychiatric disorders, leading to emotional distress. Effective management of TTM can be challenging because of underdiagnosis, symptom heterogeneity and stigma. Pharmacological interventions, including selective serotonin reuptake inhibitors and N-acetyl cysteine (NAC) are commonly used. OBJECTIVES: To assess the existing literature on pharmacotherapy for TTM and identify potential avenues for future research and treatment advancements. METHODS: A systematic review of the literature was performed using PubMed and Scopus databases within the past 10 years (PROSPERO: CRD42023454009). Included studies assessed pharmacotherapy for TTM and provided insights into current evidence and potential directions for future research and treatment advancements. RESULTS: In total, 23 articles were identified that met inclusion criteria. The most successful interventions were NAC, aripiprazole and monoamine oxidase inhibitors. NAC was identified as the most impressive adjunctive therapy to selective serotonin reuptake inhibitors and behavioural therapies in treatment through its mechanism of decreased glutamate-induced excitatory neuronal damage, with adjunctive antioxidant properties. Most of the other therapeutics that were identified require further research and controlled trials to validate their findings. CONCLUSIONS: Even if successful therapeutic outcomes are achieved, it is important to consider the patient's comorbidities and to combine pharmacological interventions with behavioural therapy interventions to comprehensively manage TTM.

Classification of psychodermatological disorders: Proposal of a new international classification.

INTRODUCTION: Several classifications of psychodermatology disorders have been proposed, with most of them based on two to four main disorder category groups. However, there is, to date, no classification that has resulted from a consensus established by psychodermatology experts. The DSM-5-TR (Diagnostic and statistical manual of mental disorders (5th ed.), Text Revision) and the ICD-11 (International classification of diseases (11th revision)) also do not provide a systematized approach of psychodermatology disorders. Taking into consideration that classifications are a key pillar for a comprehensive approach to the pathologies of each branch of medicine, the proposal of a classification in psychodermatology appeared as a central need for the recognition of psychodermatological disorders, in an attempt to improve their recognition and, in that sense, to find a common language for the development of this subspecialty that crosses dermatology and psychiatry. METHODS: Previously published classifications in psychodermatology were critically reviewed and discussed by expert opinion from an international multidisciplinary panel of 16 experts in psychodermatology and a new classification system is proposed, considering classical concepts in general dermatology and psychopathology. RESULTS: Two main categories of disorders are presented (a main group related to primary mental health disorders and another main group related to primary skin disorders), which are subsequently subdivided into subgroups considering pathophysiological and phenomenological similarities, including key aspects of dermatological examination, namely the presence of visible skin lesions (primary and secondary skin lesions) and psychopathological correlates. CONCLUSION: This new classification aims to unify previous classifications, systematize the disorders that belong to psychodermatology and highlight their tenuous boundaries, to improve their management. It has been built and approved by the Psychodermatology Task Force of the European Academy of Dermatology and Venereology (EADV), the European Society for Dermatology and Psychiatry (ESDaP) and the Association for Psychoneurocutaneous Medicine of North America (APMNA).

Habit-reversal training: a psychotherapeutic approach in treating body-focused repetitive behaviour disorders.

Body-focused repetitive behaviours (BFRBs) are recurrent, compulsive, destructive behaviours directed towards the body. Although studies have demonstrated a 12-14% prevalence rate, researchers found that dermatologists and psychiatrists show a lack of knowledge regarding psychodermatology resources and information about BFRB disorders (BFRBDs) such as trichotillomania (TTM). There is limited research about treatments including ones investigating the clinical applications of various self-help training such as decoupling (DC) and DC in sensu (DC-is) as well as about habit-reversal training (HRT). HRT is a five-component behavioural intervention that aims to develop a competing response to a specific unwanted behaviour. Studies have found substantial support for HRT's efficacy in treating a variety of maladaptive repetitive behaviours including onychotillomania, TTM, skin-picking disorder and chronic cheek biting. Additionally, many psychotherapies can augmented HRT. Psychotherapies include acceptance and commitment therapy, dialectical behaviour therapy, psychodynamic psychotherapy, mindfulness mediation and the cognitive psychophysiological model. A recently investigated variant of HRT, DC-is, resulted in consistently satisfactory objective and subjective improvement for treating BFRBDs, and HRT showed good subjective but poor objective improvement compared with standard DC. HRT and HRT variants are effective therapeutic treatments for BFRBDs; however, further randomized double-blinded and placebo-controlled trials are required to examine HRT's therapeutic profile.

Psychodermatology knowledge, awareness and patterns of practice among Moroccan dermatologists: a national survey study.

We aimed to assess the knowledge, attitudes and patterns of practice of Moroccan dermatologists and their awareness of psychodermatology (PD). A survey questionnaire was distributed to dermatologists and dermatology trainees from May to July 2022. A total of 112 completed surveys were received. Of these, 63.4% were dermatologists and 36.6% were dermatology residents. Of the participants, 72.3% summarized PD as the psychological impact of dermatological conditions and 50.9% reported frequent involvement with PD. Patients with a psychocutaneous condition represented a significant proportion of dermatological consultations (41.1% of dermatologists stated that 10-25% of their consultations were for psychocutaneous conditions). Only 17% felt 'very comfortable' in the management of PD conditions and 56.3% were not confident prescribing psychotropics. A total of 88.4% had never participated in PD training. Moroccan dermatologists lack a full understanding and proper training in PD. We recommend the incorporation of PD curriculum in training programmes and advocate dermatology and psychiatry liaison.

INDIVIDUAL ARTICLE: Prurigo Nodularis: Current Clinicopathologic Overview and Psychodermatological Perspectives.

Prurigo nodularis (PN) is a quintessential neurocutaneous condition characterized by neural sensitization and intractable itch leading to intense scratching. This causes the formation of nodules with epidermal thickening and further release of pro-inflammatory mediators that recruit immune cells and increase dermal nerve proliferation and hypertrophy perpetuating the itch-scratch cycle. Those with PN have a significant quality-of-life (QoL) burden due to itch, anxiety, and sleep disturbance. In addition, PN exhibits psychiatric comorbidities that affect mental wellbeing such as depression, mood disorders, and substance abuse. This paper serves as an overview of the clinicopathologic aspects of PN, the burden of PN on QoL, and the psychodermatological aspects of the disease state.  J Drugs Dermatol. 2023;22:12(Suppl 2):s6-11.

Management and prevention of laser complications in aesthetic medicine: An analysis of the etiological factors.

Growing popularity of laser treatment has understandably resulted in increased incidence of potential complications. The analysis of complications, taking into account the causes of their occurrence, is of particular interest. The identification of etiological factors and the development of a step-by-step prophylactic algorithm with their consideration is the way to reduce the number of possible complications in future practice. In this article, we present a classification of the causes of complications associated with various types of laser procedures. This classification was developed on the basis of a review of last 20 years' literature and our own experience in a network of clinics "Linline" in Russia. We identified six groups of the etiological classification of laser complications: errors of patient selection, errors of treatment tactics, wrong choice of device and technology, neglect of treatment protocol, inadequate post-procedural care, individual response of the patient. The causes of all specified groups of complication, except the last one, are preventable causes.

Bupropion in dermatology: A brief update.

There is currently an interest in evaluating the role that antidepressants may play in the treatment of primary cutaneous disorders. It has been proposed that antidepressants could have anti-inflammatory effects, but the clinical relevance of this effect has not been adequately established. In the case of bupropion, evidence for its specific use in dermatologic conditions currently come only from a pilot study and a case report. While this level of evidence is unlikely to be sufficient to guide clinical practice, the authors of this brief update hope to sort the available information to serve as a guide and provide a structure for future research.

Psychodermatology knowledge and awareness in Chinese dermatologists: Results of a survey study.

To assess the knowledge, awareness, practice patterns, and attitudes of Chinese dermatologists toward psychocutaneous disorders and explore their interest in continuing medical education (CME) of psychodermatology. An online survey study was conducted from October to November 2019. The survey questionnaire link was sent to the members of the national and local association of dermatology through a social media App. After confirming the informed consent to enrol in the study, the participants filled out the online questionnaire anonymously. About 1047 dermatologists completed the survey. The most common diagnoses referred to the psychiatrist from Chinese dermatologists were venereal phobia (51.77%), delusion of parasitosis (44.03%), and trichotillomania (32.28%). Compared with dermatologists, Traditional Chinese Medicine (TCM) dermatologists had less training experience on psychodermatologic CME (4.21% vs 8.34% who had attending more than twice CME, P < .05). Although TCM dermatologist experience more frequency with psychodermatology (24.21% TCM vs 15.71% dermatologists), they had lower comfort level in treating psychodermatologic patients (51.58% TCM vs 58.89% dermatologist) (P > .05). While 818 (78.13%) dermatologists never received any training course, 84.53% of the dermatologists expressed interest in attending CME events on psychodermatology. The most popular CME themes of psychodermatology were emotional disorders related to skin diseases, delusion of parasitosis, and trichotillomania. Chinese dermatologists have insufficient knowledge and awareness toward psychodermatology. TCM dermatologists have higher awareness on psychocutaneous diseases compared with dermatologists. Psychodermatology continuing medical education programs should be carried out as soon as possible.

Psychiatric morbidity, stress and quality of life among geriatric dermatology patients: Therapeutic considerations from an Indian perspective.

We aimed to determine the prevalence of psychiatric morbidities, stress and quality of life, the pattern of skin diseases and associated psychosocial factors in geriatric population. Patients aged 60 years and older were recruited. Demographics and dermatological history and findings were collected using a preset Proforma. Geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), perceived stress scale (PSS), and dermatology life quality index (DLQI) were instituted in all the patients. A total of 310 patients were included in the study, 173 males and 137 females. Infectious diseases (39.6%), papulosquamous diseases (17.1%), and eczema (15.5%) were common disorders. 45.5% were depressed and 43.2% had anxiety (hospital anxiety and depression scale). 55.8% had depression (geriatric depression rating scale), 20.3% had high stress and 11% had extremely large effect on DLQI. Divorced/widowed patients experienced more depression (p = 0.037) and had more impairment in quality of life (p = 0.05). Patients living in three generation family experienced more impairment in quality of life (p = 0.000). Our study demonstrated high prevalence of psychiatric morbidities in geriatric dermatology patients. It implies the need of special care with more attention to psychiatric co morbidities. The role of psychiatry-dermatology liaison clinic may benefit these patients.

Hair-pulling disorder (Trichotillomania): Etiopathogenesis, diagnosis and treatment in a nutshell.

Hair-pulling disorder (Trichotillomania) is a disabling mental disorder. Patient's behavior is characterized by the recurrent pulling of own hair with hair loss and a marked dysfunction in various areas of daily life. Trichotillomania is a relatively common disorder with pediatric onset, often associated with significant morbidity, comorbidity, and functional decline. Surprisingly, children or adolescents have been little studied in the research studies on the pathophysiology and psychopathology of trichotillomania. Furthermore, more evidences regarding the effective and evidence-based pharmacological interventions for the treatment of this condition are encouraged. This narrative review will report on the etiopathogenesis and clinical manifestations of trichotillomania including criteria for diagnosis and treatment issues of this complex mental disorder.

Psychodermatology in Balkans: Knowledge, awareness, and practice patterns of dermatologists in Albania.

The aim of this study is to find out the practice patterns, awareness, and knowledge about psychodermatology in Albanian dermatologists. A survey questionnaire was sent to Albanian dermatologists by mail and distributed during a regional dermatology conference. The dermatologists were requested to provide information on demographic variables, level of training, referral patterns, degree of comfort in managing psychocutaneous disorders, awareness of community resources, and interest in continuing medical educational activities. A total of 75 surveys were mailed in and 41 were returned for analysis. Only 13.2% of dermatologists reported clear understanding of psychodermatology and 41.5% reported being somewhat comfortable in diagnosing and treating psychocutaneous disorders, however requiring further help. Psoriasis, prurigo, and acne were the most common diagnoses associated with psychiatric involvement. The most common diagnoses referred by dermatologists to psychiatrists were psoriasis, prurigo, acne, and trichotillomania. Almost all 98% of dermatologists were not aware of any community resources. About 70% of dermatologists expressed interest in attending continuing medical educational activities. Albanian dermatologist have significant gap in the knowledge, training, awareness, and in treating psychocutaneous disease.

Giant condyloma acuminatum (Buschke-Lowenstein tumor): Combined treatment with surgery and chemotherapy.

We present a case of giant condyloma acuminatum (Buschke-Lowestein tumor) managed with combined treatment of surgery of chemotherapy.

Trichopsychodermatology: The Psychiatric and Psychosocial Aspects of Hair Disorders.

Medical conditions involving hair are typically managed by a dermatologist. However, a significant psychosocial association has been found both in the development of hair conditions through primary pathologic involvement and as secondary comorbidity. Trichopsychodermatology is an emerging field aiming to better understand the psychiatric and psychosocial impacts of disorders involving hair. Trichotillomania or hair-pulling disorder, alopecia areata, telegenic effluvium, anagen effluvium, and cicatricial alopecia represent common conditions within trichopsychodermatology. A lack in awareness, knowledge, and training of the field exists, which can act as a barrier for improving patient outcomes. This review provides a holistic understanding of specific psychotrichologic conditions that healthcare providers may encounter in order to facilitate the process of developing high-quality future therapeutic interventions.

"The unfair drive to be fair": Psychosocial aspects and implications of the use of skin lightening agents.

The quest to be fair is not a concept of the new world. For centuries untold, having a lighter skin tone has been considered as a trait of beauty and supremacy. Society implicates fairness as a factor for getting a prospective life partner. Media portrays fair skin tone as a predecessor for success. These subtle influences affect young minds and drive them towards wanting fair skin. Physicians observe that it is one of the most common forms of body dysmorphic disorder. This article aims to highlight the psychosocial factors that mold this mentality and the possible ill effects it can have on a person, both psychologically as well as physically.

Excoriation disorder vs skin-centered body dysmorphic disorder: A clinical and therapeutic update.

Skin-centered body dysmorphic disorder (BDD) and excoriation disorder (ED) are categorized under Obsessive Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and are characterized by excessive or inappropriate skin picking. Patients with skin-centered BDD and ED often first present to dermatology. These conditions are important to recognize and appropriately diagnose, as perpetuation of the disorder is inevitable without appropriate psychiatric treatment. These conditions are associated with increased morbidity and BDD is associated with increased suicide risk. This review aims to present a combined dermatologic and psychiatric approach to diagnosing, differentiating, and managing skin-centered BDD and ED. Patient presentation, DSM-5 criteria, and management approaches are reviewed.

Neurotransmitter imbalance in serum of psoriatic patients in exacerbation stage with comorbid psychoemotional disorders.

The role of psychological factors in the manifestation and exacerbation of psoriasis is well known. Acute and chronic stress, anxiety, and depression affect the reactions of innate and acquired immunity. The exacerbations of psoriatic lesions are accompanied by increased production of inflammatory mediators, which could contribute to the imbalance of neurotransmitters and the development of symptoms of depression and anxiety. The role of inhibitory neurotransmitters in the serum of patients with psoriasis exacerbation with comorbid emotional disorders is assessed. Forty patients with psoriasis in the exacerbation stage were examined. Spielberger State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI) scale were used to assess anxiety and depression parameters. We also evaluated the concentration of serotonin and gamma-aminobutyric acid (GABA) in the serum. Patients with psoriasis had significant anxiety and depressive disorders. An imbalance in serotonin levels and a decrease in serum GABA levels in patients with psoriasis in the acute stage were noted. Only patients with anxiety disorder had increased serotonin levels. Our findings suggest that the imbalance of neurotransmitters in patients with psoriasis in the acute stage is important in predicting the development of the emotional well-being.

Recent advances in the treatment of trichotillomania (hair-pulling disorder).

Trichotillomania (TTM) is a condition in which affected individuals pull out their hair resulting in hair loss. This disorder affects roughly 0.5% to 2.0% of the population and can have significant psychological morbidity. Behavioral therapy has been used with success in the treatment of TTM, but not all patients are willing or able to comply with this treatment strategy. There is a need for effective pharmacological treatment options. Historically, pharmacotherapy for TTM has been inadequate in most cases, but recent advances have been made in this regard. Fluoxetine, clomipramine, olanzapine, and naltrexone have all been used in the treatment of TTM, but evidence of benefit has varied, and side effect profiles can limit practical utility. Recent advances in the understanding of the pathophysiology of TTM, as well as evidence of benefit seen with some glutamate-modulating agents such as N-acetylcysteine and dronabinol, have provided newer potential pharmacotherapy options.

Habit reversal therapy in the management of body focused repetitive behavior disorders.

Body-focused repetitive behavior disorders are a group of disorders characterized by repetitive actions that include skin picking, hair pulling, nail biting, and other compulsions. These disorders can range from a common habit to a pathological disorder, that negatively impacts the psychiatric health and social well-being of an individual. Diagnosis can be made clinically, and monitored using different scales and assessments. Various treatments have been tried with differing successes. There are currently no first line curative medications for these disorders, but cognitive behavioral therapy has seen the most success in treatment. Specifically habit reversal therapy has shown the most promise in reducing the repetitive behaviors and symptoms seen in these disorders. Habit reversal therapy has also seen success through augmentation with additional therapies such as mindfulness, or treatment with a selective serotonin reuptake inhibitor in a patient with comorbid obsessive compulsive disorder. This paper aims to explore the efficacy of different treatment modalities specifically the effectiveness and approach of habit reversal therapy.