RT Book, Section
A1 Nakamura, Mio
A1 Howard, Josie
A1 Koo, John Y. M.
A2 Kang, Sewon
A2 Amagai, Masayuki
A2 Bruckner, Anna L.
A2 Enk, Alexander H.
A2 Margolis, David J.
A2 McMichael, Amy J.
A2 Orringer, Jeffrey S.
SR Print(0)
ID 1161327687
T1 Delusional, Obsessive-Compulsive, and Factitious Skin Diseases
T2 Fitzpatrick's Dermatology, 9e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9780071837798
LK dermatology.mhmedical.com/content.aspx?aid=1161327687
RD 2024/04/19
AB It  is  estimated  that  approximately  one-third  of  patients  seeking  treatment  of  skin  complaints  have  associated  psychological  stress  or  psychiatric  disease.1  The  field  of  psychodermatology  studies  the  overlap  of  psychology/psychiatry  and  dermatology.2  Psychophysiologic  skin  disorders  are  primary  skin  diseases  that  can  be  precipitated  or  exacerbated  by  psychosocial  stress,  such  as  psoriasis,  atopic  dermatitis,  and  acne.  Such  skin  diseases  are  also  known  to  lead  to  and/or  exacerbate  psychiatric  disorders  such  as  anxiety  and  depression,3-5  which  are  referred  to  as  secondary  psychiatric  disorders.  On  the  other  hand,  in  primary  psychiatric  skin  disorders,  there  is  an  underlying  psychiatric  component  that  causes  self-induced  physical  findings  on  the  skin.6  Underlying  psychiatric  issues,  such  as  anxiety,  depression,  obsessive-compulsive  disorder  (OCD),  and  psychosis,  result  in  destructive  manipulation  of  the  skin,  hair,  or  nails,  often  as  an  expression  of  highly  dysregulated  emotions.7  Lastly,  cutaneous  sensory  disorders  are  conditions  in  which  the  patient  has  various  abnormal  sensations  on  the  skin,  such  as  itching,  burning,  stinging,  biting,  and  crawling,  in  the  absence  of  any  diagnosable  dermatologic,  neurologic,  medical,  or  psychiatric  diagnosis.8Table  100-1  shows  the  categorization  of  psychodermatologic  disorders.  Although  these  categories  are  extremely  useful  in  conceptualizing  psychodermatologic  disorders,  it  is  important  to  note  that  there  can  be  considerable  overlap  or  coexistence  of  these  conditions.  This  chapter  focuses  on  primary  psychiatric  skin  disease,  which  broadly  includes  delusional,  obsessive-compulsive,  and  factitious  skin  disorders  (Table  100-2).