ABSTRACT
Dermatitis artefacta (DA) is a psycho-dermatologic condition based on patients' behavioral patterns, characterized by an intentional production of cutaneous lesions on their own skin. The clinical presentation can be highly variable. Patients with DA seldom seek psychological support or psychiatric consultation. More often, they seek help from their primary care physician or dermatologist. This review article aims to provide a practical guide for the diagnosis and management of AD and affected patients. A broad literature search was performed using the PubMed and Google Scholar electronic online databases, using key words "dermatitis artefacta", "diagnosis", "management", and "psychodermatology". The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. DA can occur in a variety of clinical presentations, and physicians should suspect DA in patients with a history of psychiatric disorders or extensive use of healthcare services. The ultimate goal of DA treatment may be a proper referral to mental health services. However, the prognosis is poor even when successful mental health referrals are achieved, with low recovery rates. A useful approach may include the suggestion that a mental health provider can help with the anxiety and the distress generated by the lesions: in this case in this case it will be crucial to discuss this with the mental health provider after obtaining informed consent from the patient. Considering the difficulty in promoting patients' adherence to treatment, the ideal setting for DA treatment is a psycho-dermatologic clinic, where both dermatologic and psychological interventions can be seamlessly integrated.
Subject(s)
Dermatitis , Humans , Dermatitis/diagnosis , Dermatitis/therapy , Skin/pathology , Prognosis , Diagnosis, Differential , AnxietyABSTRACT
Atopic dermatitis (AD) is a chronic disease of the skin with significant pruritus and phases of exacerbation and remission. The hallmarks of AD are changes in the epithelial barrier and chronic inflammation. This condition is associated with an increased risk of developing mental disorders such as depression, anxiety, and suicidal ideation. It has been proposed that psychological stress may impact on immunological factors with an up-regulation of mediating neuropeptides at the level of central nervous system and secondary involvement of endocrine glands, peripheral nervous system, and immune resident skin cells. This article provides a concise review for dermatologists on the psychodermatology of AD, in order to highlight the putative common pathways between the dermatologic and mental health issues in this illness.
Subject(s)
Dermatitis, Atopic , Anxiety/etiology , Dermatitis, Atopic/etiology , Dermatologists , Humans , Pruritus/complications , Suicidal IdeationABSTRACT
Se define a los tatuajes como la pigmentación accidental o adquirida de la piel por diversas sustancias introducidas en la dermis. Los pigmentos utilizados en los tatuajes pueden ser la causa de reacciones de hipersensibilidad. Se presentan cinco casos clínicos en los que se observan reacciones de hipersensibilidad sobre la tinta roja del tatuaje. La histología es compatible con una reacción liquenoide y/o granulomatosa (AU)
Subject(s)
Humans , Male , Adult , Female , Tattooing/adverse effects , Tattooing/history , Tattooing/methods , Lasers/therapeutic useABSTRACT
Se define a los tatuajes como la pigmentación accidental o adquirida de la piel por diversas sustancias introducidas en la dermis. Los pigmentos utilizados en los tatuajes pueden ser la causa de reacciones de hipersensibilidad. Se presentan cinco casos clínicos en los que se observan reacciones de hipersensibilidad sobre la tinta roja del tatuaje. La histología es compatible con una reacción liquenoide y/o granulomatosa
