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.

A cross-sectional study on dermatoses among underwater workers: a new clinical sign of peculiar distribution pattern of lesions in sea urchin prick reaction revealed.

BACKGROUND: The pattern of dermatoses among underwater workers is undocumented and, hence, worth studying. The objective of the study was to document the pattern of dermatoses among underwater workers in a tropical seaside area. METHODS: A population-based cross-sectional study of 1 year from April 2015 among people regularly involved in underwater occupation, especially the collection of mollusks. RESULTS: Among 62 participants analyzed, the commonly noted dermatoses were scars of previous injuries, sea urchin prick reaction, onychomycosis, tinea versicolor, dermatophytosis, warts, and intertrigo. These workers stabilize their position under water by fixing elbows and knees to rocks, where they get accidentally pricked by sea urchins attached to the rocks. Hands also get pricked by sea urchins while trying to pluck mollusks from rocks, thus leading to the predominance of lesions in elbows, knees, and hands. CONCLUSION: Documenting the pattern of dermatological diseases in any group of underwater workers has not been done previously. Along with doing that, the study also brought to light the existence of a rare disease, sea urchin prick reaction, in notable proportions among an underprivileged group. This study also detected a previously unrecorded clinical finding of a peculiar distribution pattern of lesions over the body in patients with sea urchin prick reaction. The evidence toward possible commensalism between the two species of organisms noted in this study extends its scope beyond the realms of dermatology and opens new areas for research in other branches of science also.

Therapeutic considerations related to stress levels associated with hand eczema: A clinico-etiological study.

Understanding the etiological factors, stress and quality of life have important implications in the management. There is dearth of the literature in this subject, assessing the stress levels in hand eczema and disparities exist in results of the available literature. Primary objective of this study is to assess the clinico-etiological factors in cases of hand eczema. The secondary objectives include to find any correlation between morphological types and the etiological factors, and to determine the role of stress level in these patients. Patients with hand eczema who attended the outpatient department of our tertiary care institution were enrolled in this descriptive study. Sociodemographic and clinico-etiologic data were collected and patch testing of all patients were done. Stress levels were assessed with Perceived stress scale (PSS). Among the 62 patients enrolled, allergic contact dermatitis predominated with 37 (59.7%) cases and patch test was positive in 41 (66.1%). Potassium dichromate was the most common allergen in males, and fragrance mix in females. Significant levels of stress were seen in 67.7% of the subjects. There was no significant correlation between morphological subtypes and the identified aetiologies. Hand eczema is most commonly due to allergic contact dermatitis, and patch testing is helpful in reaching an etiological diagnosis in most of the cases. A large proportion of patients have high stress levels, and hence stress management should also be a part of treatment in addition to traditional treatment.

Relaxation therapy in the management of psoriasis.

Several studies have demonstrated a direct link between psoriasis, stress and psychiatric comorbidity. We assessed the effect of relaxation therapy on psoriasis severity, quality of life, stress level and psychiatric comorbidity. Patients were assessed for stress, anxiety, depression, quality of life and severity of disease, using standard instruments. Patients were divided into two as cases and pair matched controls. The first group was given relaxation therapy in addition to the standard dermatology treatment and the second group was given only the standard dermatology treatment. The patients were followed up on first week, second week, first month and second month. Twenty one out of 30 cases (70%) achieved PASI 50 at the end of 2 months. While only 4 out of 30 (13.3%) of the control group achieved the same at the end of the study. There was statistically significant difference between cases and controls in PASI, DLQI, HADS scores with a P value of .000 each at the end of the study. But there was no statistically significant difference in perceived stress score between cases and controls. Psoriasis has significant impact in the quality of life and psychiatric comorbidity. Psychological interventions like relaxation therapy can decrease disease severity and improve quality of life.

Awareness of psychodermatology in Indian dermatologists: A South Indian perspective.

This study was aimed to survey the awareness, knowledge, practicing patterns, and attitudes of dermatologists toward psychocutaneous disorders in a South Indian State. The questionnaire-based study was performed from August 1 to October 31, 2019. Study participants included 123 dermatologists. The questionnaire consisted of nine multiple-choice questions and two open-ended questions regarding knowledge, practicing patterns, and attitude to psychodermatology. Forty five (36.6%) dermatologists completed this online survey. Out of them 73% were women and 40% were trainees. Nine respondents (20%) had frequent experience with psychodermatology, but only 6 (13.3%) were very comfortable in diagnosing and treating psychodermatology patients. Vitiligo was the disease with maximum respondents reported encountering >10 patients monthly with psychologic co morbidities (30, 66.7%). The most common diagnoses which required psychiatric referral were delusion of parasitosis (22.2%), trichotillomania (20%) and neurodermatitis (8.9%). Thirty six respondents (80%) were unaware of any patient or family resources on psychodermatology. Thirty-nine respondents (86.7%) expressed interest in attending educational events on psychodermatology. Survey results showed high need of liaison clinics of dermatology and psychiatry. Many dermatologists lack proper training in treating psychodermatology cases while they may be the sole service provider to the patients. We propose incorporation of psychodermatology curriculum in residency training programs.

Pigmented purpuric dermatosis or mycosis fungoides: A diagnostic dilemma.

Pigmented purpuric dermatoses (PPD), a group of vascular disorders with variable clinical picture is reported in all races and age groups with a male predilection. There are reports of mycosis fungoides manifesting as pigmented purpura as well as progression of PPD to cutaneous T-cell lymphoma. The diagnostic dilemma is compounded by PPD manifesting histological similarity to mycosis fungoides. Currently, it is believed that PPD with monoclonal T-cell population is more likely to progress to malignancy. We report a 31-year-old male patient who presented with the lichenoid clinical variant of PPD lesions that mimicked mycosis fungoides on histopathology. Gene rearrangement studies identified a polyclonal T-cell population. The patient responded to photochemotherapy, which is beneficial in both PPD and mycosis fungoides. Our case signifies the limitations of current diagnostic modalities in accurately distinguishing PPD from cutaneous lymphoma. Data on disease progression in similar cases may enable us to formulate better diagnostic definitions.