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.

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.

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.

Consensus Statement on the Psychological Needs of Patients With Chronic Inflammatory Skin Diseases. / Documento de consenso sobre las necesidades psicológicas de los pacientes con enfermedades inflamatorias crónicas dermatológicas.

OBJECTIVE: To establish recommendations to determine, identify, and manage the psychological and emotional needs of patients with chronic inflammatory skin diseases in clinical practice. METHODS: A guided discussion was held at meeting of a nominal group of expert dermatologists and psychologists on the psychological and emotional needs of patients with chronic inflammatory skin diseases, how to manage these cases, and which referral criteria to employ. Based on the results of the discussion, and with the aid of a patient focus group and a review of the literature, a master document was drawn up with recommendations for discussion. A Delphi survey was circulated among a larger group of dermatologists and psychologists to assess the level of agreement with the recommendations. RESULTS: Ten recommendations were established and can be summarized as follows: explore the psychological sphere of the patients with open questions at the time of diagnosis and during the course of the disease; provide patients with clear explanations that address their concerns and inform them of the existence of patient associations; investigate symptoms of anxiety and depression and, if confirmed by means of a Hospital Anxiety and Depression score (HADS) of 11 or greater, consider referral to a mental-health specialist; and, during visits, create a climate of trust, empathize with patients, agree goals and treatment options with them, and motivate them to adhere to those treatments. CONCLUSIONS: These recommendations may help health care professionals address psychological and emotional aspects of their patients in daily clinical practice.

Síndrome de Munchausen por poderes: dificultades diagnósticas y terapéuticas / Munchausen syndrome by proxy: diagnostic and therapeutic difficulties

Niña de diez años que consulta por la aparición de lesiones cutáneas diseminadas de morfología variada, asintomáticas y de carácter evanescente, de dos meses de evolución. Inicialmente fue catalogado como rash inespecífico, pero ante la persistencia de las consultas por este síntoma, se solicitan estudios para descartar vasculitis o exantema de origen vírico, con resultados normales, y una valoración dermatológica sin diagnóstico claro. Posteriormente la niña acude a urgencias con el cuero cabelludo teñido de rosa y varios mechones de pelo de este color, evidenciándose que desaparece al frotarlo con una solución alcohólica; pero tanto la madre como la niña niegan que se haya aplicado algún tipo de producto colorante (pintura, espray, maquillaje...). Ante la sospecha de una etiología no orgánica, se solicita interconsulta con Salud Mental y, tras la valoración de los síntomas referidos, de las fotografías aportadas especialmente por la madre y del perfil psicológico de esta, se llega a la impresión diagnóstica, apoyada por todos los profesionales implicados (pediatra de Atención Primaria, pediatra del Servicio de Urgencias hospitalario, dermatólogos y psiquiatra) de trastorno facticio o síndrome de Munchausen por poderes

A ten-year-old girl who consulted for the appearance of spots spread on the skin, of varied morphology, asymptomatic and of evanescent character, of two months of evolution. Initially cataloged as non-specific rash, but before the torpid evolution of the picture, studies are requested to rule out vasculitis or rash of viral origin, with normal results; and dermatological assessment without clear diagnosis. Later the girl comes with a lock of pink hair, evidencing that they disappear when rubbing it with alcoholic solution; but both the mother and the girl deny that any type of coloring product has been applied (paint, spray, makeup...). Given the suspiction of a non-organic etiology, interconsultation is requested with Mental Health and, after the hostile attitude of the mother in it, the diagnostic impression is reached, supported by all the professionals involved (primary care pediatrician, pediatrician of the hospital emergency department, dermatologists and psychiatrist) of factitious disorder or Munchhausen syndrome by proxy

Dermatitis neglecta: a challenging diagnosis in psychodermatology.

Dermatitis neglecta is a condition affecting the skin caused by a lack of hygiene. It may be related to psychiatric and neurological disturbances. The appearance of skin lesions results from neglect, which helps distinguish this condition from other similar clinical entities. Resolution of the lesions with adequate cleansing aids a definitive diagnosis.

Dermatitis artefacta in childhood and adolescence: a spectrum of disease.

Dermatitis artefacta (DA) or artefactual skin disease (ASD) is a factitious skin disorder rarely reported in the pediatric population. Skin lesions are produced deliberately either consciously or in a dissociative state to satisfy an underlying psychological need. Children may present with acutely formed skin changes or with chronic lesions, quite often having seen other specialists during their journey. The mechanism of formation of skin lesions can vary from the application of pigment onto the skin to simulate disease or more destructive techniques like the injection of irritant substances into the skin. Whichever mode used, it is important to focus on why rather than how the lesions are produced. Establishing a strong physician-patient-family relationship is important in managing this condition. The prognosis of the condition is variable, but it has been shown that resolution of the underlying psychosocial stressor leads to improvement of the skin. We advocate a multidisciplinary team approach in managing DA as it has shown to improve outcomes.

Obsessive-compulsive skin disorders: a novel classification based on degree of insight.

Individuals with obsessive-compulsive features frequently visit dermatologists for complaints of the skin, hair or nails, and often progress towards a chronic relapsing course due to the challenge associated with accurate diagnosis and management of their psychiatric symptoms. The current DSM-5 formally recognizes body dysmorphic disorder, trichotillomania, neurotic excoriation and body focused repetitive behavior disorder as psychodermatological disorders belonging to the category of Obsessive-Compulsive and Related Disorders. However there is evidence that other relevant skin diseases such as delusions of parasitosis, dermatitis artefacta, contamination dermatitis, AIDS phobia, trichotemnomania and even lichen simplex chronicus possess prominent obsessive-compulsive characteristics that do not necessarily fit the full diagnostic criteria of the DSM-5. Therefore, to increase dermatologists' awareness of this unique group of skin disorders with OCD features, we propose a novel classification system called Obsessive-Compulsive Insight Continuum. Under this new classification system, obsessive-compulsive skin manifestations are categorized along a continuum based on degree of insight, from minimal insight with delusional obsessions to good insight with minimal obsessions. Understanding the level of insight is thus an important first step for clinicians who routinely interact with these patients.

[Dermatitis artefacta]. / Dermatitis artefacta.

Dermatitis artefacta is a self-inflicted skin disease with a multifactorial aetiology. The condition can be a symptom of an underlying psychiatric condition or a sign of psycho-social stressors. This paper gives an updated view on dermatitis artefacta. The majority of the patients have some form of psychiatric co-morbidity including depression and anxiety. Many have experienced negative life events such as diseases or deaths. Personality disorders were reported in only two studies. Treatment options besides the acute treatment of the skin were psychotherapy and psychotropic drugs.

Psicodermatología en la atención primaria / Psychodermatology in primary care

The skin has the distinction of being the largest, visible and accessible part of the human body, and it hides a close and old relationship with the human psyche, and so has been demonstrated in the last years, where more elements of the Mental Health are elucidated playing a role in the pathogenesis of skin diseases, as well as there are some descriptions of the inverse relationship, this is, on how the skin diseases affect Mental Health of the individual. In this paper we propose to emphasize the importance of the issue, to consider a comprehensive approach to everyday Dermatology in Primary Care Medicine.

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.

Ojo seco y salud mental / Dry eye and mental health

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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.

Patients' quality of life and role of the ambulatory in after-surgery stoma care. A single center experience.

AIM: The aim is to assess on which aspects of everyday-life the post surgery stoma-care ambulatory should physically and psychologically assist the patients. MATERIAL OF STUDY: Seventy patients (33 male, 37 female, mean age 68 years) accepted to fill-in the Stoma-QoL questionnaire from January to December 2011. The questionnaire consists of 20 questions addressing different possible discomforts of everyday life. RESULTS: Our results demonstrate that patients with temporary ileostomy have a mean score of quality of life index of 63. Patients with ileostomy demonstrated a higher quality of life score compared to patients with colostomy. DISCUSSION: Our results confirmed that patients with ileostomy have a better perception of quality of life compared to patients with colostomy. Moreover, our data clearly show that patients are more concerned on stoma management compared to the hypothetical prejudice of society. CONCLUSIONS: The stoma care ambulatory have a crucial role, offering to the patient and his/her family an adequate psychological support, and teaching the management of the stoma and the pouch.