Management of Psychodermatologic Disorders

Philip D. Shenefelt, MD, MS

Disclosures

Dermatology Nursing 

In This Article

Abstract and Introduction

Abstract

Management options for psychodermatologic disorders include standard psychotropic drugs, alternative herbs and supplements, biofeedback, cognitive-behavioral methods, hypnosis, meditation, placebo effect, suggestion, and yoga. When single approaches fail, combinations of drugs and/or non-pharmacologic therapies may produce better results.

Introduction

The skin and the nervous system develop alongside each other in the fetus and remain intimately interconnected throughout life. Cutaneous nerves constitute the largest sense organ of the body and are vital to skin protection and health. Many skin disorders have a significant psychosomatic or behavioral component (Zane, 2003). Neurocutaneous interactions permit prescription of drugs and non-pharmacologic psychotherapeutic interventions that have positive effects on many cutaneous diseases. On the other hand, many skin disorders have negative psychosocial effects. Psychotropic drugs and non-pharmacologic psychotherapeutic interventions may be needed to counteract the negative effects of the skin disorder on the psyche (see Table 1) (Fried, 2002). Often, patients who would benefit from referral to a psychiatrist or psychologist refuse to do so, leaving treatment, if any, in the hands of the dermatologists and their staff. A multimodal approach with both psychotropic drugs and nonpharmacologic psychotherapies is frequently better in treating complex psychosomatic (mind/emotions affecting the body/skin) and somato-psycho-social (body/skin affecting the mind/emotions and interpersonal interactions) problems.

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