Psychodermatology is a relatively new discipline in psychosomatic medicine. It is the interaction between mind and skin. The two disciplines are interconnected at the embryonal level through ectoderm. There is a complex interplay between skin and the neuroendocrine and immune systems. Skin responds to both endogenous and exogenous stimuli; it senses and integrates environmental cues and transmits intrinsic conditions to the outside world.

The exact prevalence of psychological factors that affect skin disease is not known; however, it has been estimated to be 25% to 33% in various studies. Research has shown that stimuli received in the skin can influence the immune, endocrine, and nervous systems at both the local and central levels. In several skin diseases, such as atopic dermatitis, the tissue levels of nerve growth factors and neuropeptides, such as substance P, have been associated with the pathogenesis of disease and markers of disease activity.

Diagnosing an underlying psychiatric component in a patient who has skin disease involves several dimensions. The evaluation of these dimensions plays a major role in creating an effective treatment plan and includes:

• Establishing a good physician-patient relationship

• Evaluating the patient’s level of functioning as well as different physical and psychosocial stressors that may influence the level of functioning

• Evaluating concurrent affective components that influence the level of functioning

• Weighing the presence of secondary gain

• Considering the real and authentic quality of consultation

Several psychological test instruments have been used to evaluate a patient with psychocutaneous disease: Symptom Checklist-90-Revised, Beck Depression Inventory, Hospital Anxiety and Depression Scale, Dysmorphic Concern Questionnaire, Dermatology Life Quality Index, Skindex Questionnaire, and Marburg Skin Questionnaire.

There is no universally accepted classification of psychodermatological diseases. However, Koo and Lee4 describe the most commonly used classification, which includes the following:

• Psychophysiological disorders: Skin diseases are precipitated or exacerbated by psychological stress. Patients experience a clear and chronological association between stress and exacerbation. Examples in this category include atopic dermatitis, psoriasis, and acne.

• Psychiatric disorders with dermatological symptoms: There is no skin condition and everything seen on the skin is self-inflicted. These disorders are always associated with underlying psychopathology and are known as stereotypes of psychodermatological diseases. Examples include dermatitis artefacta, trichotillomania, body dysmorphic disorder, and neurotic excoriations.

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Journal of Clinical & Experimental Dermatology Research
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