Management of Psychodermatologic Disorders

Philip D. Shenefelt, MD, MS

Dermatology Nursing

Conclusion

Psychodermatologic disorders are seen in dermatologic practice due to the link between the skin and the nervous system. Various treatments are available including pharmacologic, non-pharmacologic, and behavioral interventions. Psychotropic drugs are often somewhat effective by themselves, but adding non-drug psychocutaneous treatments such as biofeedback, cognitive-behavioral methods, hypnosis, meditation, placebo effect, suggestion, or yoga often enhances the effectiveness of treatment. A multidimensional and when necessary multidisciplinary approach to these complex problems often optimizes treatment response.

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Cite this: Management of Psychodermatologic Disorders - Medscape - Jul 01, 2010.

Table 1. Management of Psychodermatologic Disorders
Psychosomatic Aspects of Skin Disorders
Roles of stress and emotion
Reducing stress and emotions in specific skin disorders
Primary Psychiatric Disorders
Anxiety
Delusions
Depression
Dissociative somatization
Impulse control
Obsessive-Compulsive
Neurogenic Cutaneous Sensory Dysesthesias
Central nervous system
Peripheral nervous system
Psychiatric Disorders Secondary to Skin Diseases
Anxiety
Depression
Management Options
Standard pharmacologic psychocutaneous therapies
Complementary pharmacologic psychocutaneous therapies
Non-pharmacologic treatments for psychocutaneous disorders

Table 2. Griesemer Index
Diagnosis	Percent Emotionally Triggered	Time Elapsed from Stressor to Clinical Change
Hyperhidrosis	100	Seconds
Lichen simplex chronicus	98	Days to 2 weeks
Neurotic excoriations	97	Seconds
Alopecia areata	96	2 weeks
Warts, multiple and spreading	95	Days
Rosacea	94	Days
Pruritus	86	Seconds
Lichen planus	82	Days to 2 weeks
Dyshidrotic hand dermatitis	76	2 days for vesicles
Atopic dermatitis	70	Seconds for itching
Factitial dermatosis	69	Seconds
Urticaria	68	Minutes
Psoriasis	62	Days to 2 weeks
Traumatic dermatitis	56	Seconds
Dermatitis not otherwise specified	56	Days
Acne vulgaris	55	2 days for papules
Telogen effluvium	55	2 to 3 weeks
Nummular dermatitis	52	Days
Seborrheic dermatitis	41	Days to 2 weeks
Herpes simplex and zoster	36	Days
Vitiligo	33	2 to 3 weeks
Pyoderma and bacterial infections	29	Days
Nail dystrophy	28	2 to 3 weeks
Cysts	27	2 to 3 weeks
Warts, single and multiple	17	Days
Contact dermatitis	15	2 days
Fungal infections	9	Days to 2 weeks
Basal cell carcinoma	0	Not applicable
Keratoses	0	Not applicable
Nevi	0	Not applicable

Source: Modified from Griesemer (1978)

Table 3. Comparison of Drug and Non-Drug Treatments
Mode of Action	Category	Name of Agent	Patient Assessment	Patient Education
Antidepressants	SSRI	Citalopram (Celexa®) Escitalopram (Lexapro®) Fluoxetine (Prozac®) Fluvoxamine (Luvox®) Paroxetine (Paxil®) Sertraline (Zoloft®) Venlafaxine (Effexor®)	Sedation Insomnia GI symptoms Sedation GI symptoms	SSRIs slow onset of effect; taper off slowly; multiple drug interactions
	Tricyclic	Amitriptyline (Elavil®) Clomipramine (Anafranil®) Doxepin (Sinequan®) Imipramine (Tofranil®) Nortriptyline (Pamelor®) Protriptyline (Vivactil®) Trimipramine (Surmontil®)	Sedation, dry mouth Sedation, dry mouth Sedation Orthostatic hypotension Dry mouth Dry mouth Sedation	Tricyclics risk of seizures, heart dysconduction
	NE/DUI	Bupropion (Wellbutrin®)
	Herbs	St. John's wort	Photosensitivity	Drug interactions
	Supplements	Same
	Non-drug	Exercise
		Hypnosis	Tardive dyskinesia	Avoid use while driving
Antipsychotics	Typical	Haloperidol (Haldol®) Pimozide (Orap®)	Tardive dyskinesia	Mild sedation
Antipsychotics	Atypical	Olanzapine (Zyprexa®) Risperidone (Risperdal®) Ziprasidone (Geodon®)	Weight gain
Anticonvulsants	GABA	Gabapentin (Neurontin®) Pregabalin (Lyrica®)
Antipruritics	Herbs	Capsaicin Camphor Menthol	Burning sensation	Avoid eyes
Antipruritics	Non-drug	Hypnosis		Avoid use while driving
Anxiolytics	Benzodiazepine	Alprazolam (Xanax®) Lorazepam (Ativan®) Diazepam (Valium®)	Sedation Sedation Sedation	Use caution driving with each
	Azaperone	Buspirone (BuSpar®)
	Herbs	Magnolia bark Passion flower
	Non-drug	Biofeedback Cognitive-behavioral Hypnosis Meditation Placebo Suggestion Yoga	Methods of use Self talk Avoid use while driving Avoid use while driving Positivity
Sedatives	Antihistamines	Cetirizine (Zyrtec®) Diphenhydramine (Benadryl®) Doxepin (Sinequan®) Hydroxyzine (Atarax®) Levocetirizine (Xyzal®) Promethazine (Phenergan®)	Sedative Sedative Sedative Sedative Sedative Sedative	Use caution driving with each
	Herbs	Valerian
	Supplements	Melatonin
	Non-drug	Hypnosis		Avoid use while driving

Notes: SSRI = selective serotonin reuptake inhibitor; NE/DUI = norepinephrine and dopamine reuptake inhibitor; GABA = gamma amino butyric acid

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Management of Psychodermatologic Disorders

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