Body Dysmorphic Disorder in Dermatology: a Systematic Review.

Body Dysmorphic Disorder (BDD) is a psychiatric diagnosis of an impairing condition in which the patient is preoccupied with a slight or perceived defect in their appearance. BDD patients have a higher rate of psychiatric comorbidities than the background population which include obsessive-compulsive disorder (OCD), depression, anxiety and suicide. It causes distress and affects the patient's quality of life. It is previously found that the prevalence of patients that suffers from BDD is higher among dermatology patients than in the background population. To create an overview of the original literature that exist on topic: BDD in dermatology. A systematic review was conducted by two reviewers. PubMed was searched using a predefined search string created in collaboration between the authors and a bibliographic fellow on 18th of August 2018 and again in January 2020. 45 articles were obtained and after exclusion 5 relevant articles remained. Dermatology patients have a higher incidence of BDD than the background population. BDD patients are significantly younger and it has been suggested that BDD develops during adolescence but is diagnosed with a delay of several years because patients seek out health care professionals among non-mental health specialists. BDD does not appear associated with the setting, i.e. cosmetic vs general dermatology, but BDD patients have a lower quality of life and are more commonly unemployed or on sick leave. It is often difficult to treat, and a combination of the dermatologic treatment and the psychiatric treatment may be necessary in the context of visible skin pathology.

Mucorales-disseminated infection in burn wound.

A previously fit and well man in his 50s was rescued from a burning apartment with Glasgow Coma Scale 3 and admitted to the burn intensive care unit with 18% mixed dermal and full thickness burns and inhalation injury. He received standardised acute burn treatment according to the Emergency Management of Severe Burn guidelines and was found to have acute kidney injury requiring dialysis and cerebral watershed infarcts. The burns were deep especially on the left leg that was deemed unsalvageable and on day 8, he underwent a mid-femoral amputation.A wound swab on day 8 grew mould and with progression of skin necrosis, Mucorales infection was clinically suspected. Microbiological assessment of the swab confirmed Mucorales infection-an invasive fungus with the ability to invade blood vessels leading to vessel thrombosis and tissue necrosis and associated with high mortality. Recommended radical debridement with free cutaneous margins was not possible due to the widespread disease, and the patient was treated conservatively with antifungal therapy and survived.