Body dysmorphic disorder in patients with acne: a multicentre study.

BACKGROUND AND OBJECTIVE: Body dysmorphic disorder (BDD) is a mental disorder that is difficult to diagnose, causes a lot of suffering and is more prevalent in dermatology patients than in the general population. Our objective was to screen for possible cases of BDD in patients with acne and to determine the prevalence according to DSM-IV and DSM-5 criteria, as well as to analyse the relationship between dermatological and sociodemographic variables. METHODS: A total of 245 patients diagnosed with acne in 11 dermatological centres in Spain were included in the study by members of the Aragon Psychodermatology Research Group and Spanish Research Group of Psychiatric Dermatology. We used the Body Dysmorphic Disorder Questionnaire (BDDQ) as a screening tool. RESULTS: In our sample, we obtained a prevalence for BDD of 10.6% (95% CI: 7.6-13.6%). The prevalence was the same with DSM-IV or DSM-5 criteria. Possible cases of BDD were predominantly women (P = 0.021), and 56% had non-inflammatory lesions vs. 30% of negative patients (P = 0.002). Positive patients as possible cases of BDD spent more than two hours on average a day worrying about their appearance. Most people only worried about one part of their body (86%), and in 95% of the cases, the part of their body that worried them was the face. The three most frequent compulsive behaviours in patients who screened positive for BDD were mirror checking (90.7%), camouflaging (79.1%) and using make-up (72.1%). CONCLUSIONS: As a consequence of the high prevalence of possible cases of BDD in patients with acne observed in our study, there is a need for dermatologists to screen for BDD so that they can be referred to a mental health unit to confirm the diagnosis and be offered treatment to reduce the progression of psychosocial deterioration and the development of comorbid disorders.

Detección de trastorno dismórfico corporal en pacientes con acné: estudio piloto / Screening for Body Dysmorphic Disorders in Acne Patients: A Pilot Study

Introducción: El trastorno dismórfico corporal (TDC) es una enfermedad mental difícil de diagnosticar; puede causar una gran cantidad de sufrimiento, y el tratamiento a menudo es complejo y desafiante. Material y método: La población de estudio comprendía 81 pacientes ambulatorios dermatológicos consecutivos que cumplían los criterios de inclusión para la participación. Fueron tratados en hospitales en zonas urbanas (Zaragoza) y rurales (Alcañiz). Es un estudio piloto prospectivo y observacional. Se utilizaron como instrumentos de evaluación: a) La escala de gradación del acné de Cook y b) El Cuestionario de Trastorno Dismórfico Corporal (Body Dysmorphic Disorder Questionnaire, BDDQ) (traducción al español). Los posibles casos de TDC se identificaron mediante 2 criterios: 1) Un resultado positivo en el BDDQ (4 puntos positivos y una pregunta de exclusión negativa); y 2) Escala de gradación del acné de Cook que reflejó lesiones no perceptibles/leves (los criterios más estrictos) o lesiones moderadas (criterios menos estrictos) Resultados: El rango de edad de los pacientes era de 13 a 43 años. La edad promedio fue 19 con una desviación estándar de 6,2. De los 81 participantes, el 54,3% eran mujeres y el 45,7% eran hombres. El 61,7% vivía en el área rural cubierta por el hospital de Alcañiz y el 38,3% era del área urbana atendida por el Hospital Universitario de Zaragoza. Cuando se aplicaron criterios más restrictivos con respecto a la gravedad de la afección (solo los pacientes con acné leve), el proceso de detección de BDDQ resultó en una tasa de prevalencia de TDC del 8,6% (7 pacientes); si los criterios fueron menos restrictivos (incluidos los pacientes con lesiones moderadas), la tasa fue del 14,8% (12 pacientes). Discusión: Vale la pena recordar que los pacientes con TDC que participaron en este estudio pasan un promedio de 2 h al día pensando y preocupándose por su apariencia. Este hecho es un recordatorio de la importancia de diagnosticar y tratar correctamente el TDC ya que la afección claramente tiene un impacto serio y negativo en las vidas de los afectados

Introduction: Body dysmorphic disorder (BDD) is a mental health condition that is difficult to diagnose; it can cause a great deal of suffering, and treatment is often complex and challenging. Material and method: The study population comprised 81 consecutive dermatology out-patients who met the inclusion criteria for participation. Participants were treated at hospitals in both urban (Zaragoza) and rural areas (Alcañiz). The project was based on a prospective and observational pilot study. Assessment instruments used: Cook's Acne Grading Scale and Body Dysmorphic Disorder Questionnaire (BDDQ) (Spanish translation). Possible cases of BDD were identified by means of 2 criteria: 1) A positive result in the BDDQ (4 positive points and a negative exclusion question); and, 2) A Cook's Acne Grading Score that reflected non-noticeable/mild lesions (the most stringent criteria) or moderate lesions (least stringent criteria). Results: The age range of the patients was from 13 to 43 years old. The average age was 19 with a standard deviation of 6.2. Of the 81 participants, 54.3% were women. 61.7% were seen in a rural hospital (Alcañiz Hospital) and 38.3% in an urban one (University Hospital of Zaragoza). When more restrictive criteria regarding the seriousness of the condition were applied (only patients with mild acne), the BDDQ screening resulted in a positive BDD prevalence rate of 8.6% (7 patients); if the criteria were less restrictive (including patients with moderate lesions), the rate was 14.8% (12 patients)

Screening for Body Dysmorphic Disorders in Acne Patients: A Pilot Study. / Detección de trastorno dismórfico corporal en pacientes con acné: estudio piloto.

INTRODUCTION: Body dysmorphic disorder (BDD) is a mental health condition that is difficult to diagnose; it can cause a great deal of suffering, and treatment is often complex and challenging. MATERIAL AND METHOD: The study population comprised 81 consecutive dermatology out-patients who met the inclusion criteria for participation. Participants were treated at hospitals in both urban (Zaragoza) and rural areas (Alcañiz). The project was based on a prospective and observational pilot study. Assessment instruments used: Cook's Acne Grading Scale and Body Dysmorphic Disorder Questionnaire (BDDQ) (Spanish translation). Possible cases of BDD were identified by means of 2 criteria: 1) A positive result in the BDDQ (4 positive points and a negative exclusion question); and, 2) A Cook's Acne Grading Score that reflected non-noticeable/mild lesions (the most stringent criteria) or moderate lesions (least stringent criteria) RESULTS: The age range of the patients was from 13 to 43 years old. The average age was 19 with a standard deviation of 6.2. Of the 81 participants, 54.3% were women. 61.7% were seen in a rural hospital (Alcañiz Hospital) and 38.3% in an urban one (University Hospital of Zaragoza). When more restrictive criteria regarding the seriousness of the condition were applied (only patients with mild acne), the BDDQ screening resulted in a positive BDD prevalence rate of 8.6% (7 patients); if the criteria were less restrictive (including patients with moderate lesions), the rate was 14.8% (12 patients). DISCUSION: Patients who screened positive for BDD reported spending an average of 2hours a day thinking and worrying about their appearance. These results highlight the importance of screening for possible cases of BDD in order to follow up these patients and recommend they be seen by a mental health specialist to confirm the diagnose and offer treatment for the disorder. BDD has a serious and negative impact on the lives of those affected.

[Lipedematous scalp]. / Cuero cabelludo lipedematoso.

Lipedematous scalp is a rare condition first described by Cornbleet in 1935. An increased thickness of subcutaneous tissue in the scalp gives rise to a soft spongy appearance of the surface and occasionally causes pruritus and pain in the affected area. When hair loss is also associated with the condition, it is described as lipedematous alopecia. To date, 10 cases of lipedematous scalp and 13 of lipedematous alopecia have been reported. We present the case of a 77-year-old white woman who developed dysesthesia on her scalp 5 months after the death of her husband. Biopsy revealed subcutaneous tissue thickening that even extended to the dermis. Computed tomography showed thickening of subcutaneous tissue at the vertex and in the occipital region. We diagnosed a new case of lipedematous scalp in a white woman. This case highlights the importance of differential diagnosis in cases of dysesthetic syndrome of the scalp.

Cuero cabelludo lipedematoso / Lipedematous Scalp

El cuero cabelludo lipedematoso es una rara entidad que fue descrita por Cornbleet en 1935, en la que un aumento del tejido subcutáneo del cuero cabelludo produce un aspecto suave y esponjoso de la superficie del mismo y ocasionalmente prurito y dolor de la zona afectada. Cuando además esta condición produce alopecia se denomina alopecia lipedematosa. Hasta la fecha se han descrito 10 casos de cuero cabelludo lipedematoso y 13 de alopecia lipedematosa. Presentamos el caso de una mujer de 77 años de raza caucásica con sensación disestésica en el cuero cabelludo 5 meses después de la muerte de su esposo. Realizamos una biopsia donde se observaba un engrosamiento del tejido graso subcutáneo que incluso se extendía a la dermis. Una tomografía computarizada mostraba este engrosamiento de los tejidos subcutáneos en el vértex y el área occipital. Diagnosticamos un nuevo caso de cuero cabelludo lipedematoso en una mujer caucásica, destacando la importancia del diagnóstico diferencial con el síndrome disestésico del cuero cabelludo (AU)

Lipedematous scalp is a rare condition first described by Cornbleet in 1935. An increased thickness of subcutaneous tissue in the scalp gives rise to a soft spongy appearance of the surface and occasionally causes pruritus and pain in the affected area. When hair loss is also associated with the condition, it is described as lipedematous alopecia. To date, 10 cases of lipedematous scalp and 13 of lipedematous alopecia have been reported. We present the case of a 77-year-old white women who developed dysesthesia on her scalp 5 months after the death of her husband. Biopsy revealed subcutaneous tissue thickening that even extended to the dermis. Computed tomography showed thickening of subcutaneous tissue at the vertex and in the occipital region. We diagnosed a new case of lipedematous scalp in a white women. This case highlights the importance of differential diagnosis in cases of dysesthetic syndrome of the scalp (AU)