Management of Psychodermatologic Disorders

Philip D. Shenefelt, MD, MS

Dermatology Nursing

Complementary Pharmacological Psychocutaneous Therapies

Herbs and Supplements

Psychoactive herbs and supplements may have some indirect impact on skin diseases through anxiolytic, antidepressant, or soporific activities. Herbal therapy in psychiatry was reviewed by Sarris (2007). Herbal therapy in dermatology was re viewed by Bedi and Shenefelt (2002) and herbs and supplements in dermatology by Levin and Maibach (2002). Additional information is available in the Complete German Commission EMonographs (Blumenthal, 1998) and in many other textbooks and monographs. Information about individual herbs, their actions, interactions, and adverse effects is available in the PDRfor Nonprescription Drugs, DietarySupplements and Herbs (PDR Staff, 2008).

Anxiolytics

Lavender oil aromatherapy, lemon balm, magnolia bark, and passion flower have moderate anxiolytic effects. Kava Kava also has moderate anxiolytic effects, but its use is not recommended due to its hepatotoxicity.

Antidepressants

Saint John's wort is helpful in mild-to-moderate depression but not for severe depression (Linde et al., 1996). It has significant interactions with the metabolism of a number of other drugs. S-adenosyl-Lmethionine (SAMe) is also taken as an antidepressant. A meta-analysis of studies comparing SAMe with controls showed significant clinical improvement with SAMe similar to that of standard SSRI treatment with fewer side effects (Bressa, 1994) (see Table 3).

Soporifics

Melatonin is effective at producing drowsiness. Caution should be used in operating dangerous machinery. Valerian is approved by the German Commission E for insomnia caused by nervousness.

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

Abstract and Introduction
Psychosomatic Aspects of Skin Disorders
Primary Psychiatric Disorders Affecting the Skin
Neurogenic Cutaneous Sensory Dysesthesias
Psychiatric Disorders Secondary to Skin Diseases
Management Options
Complementary Pharmacological Psychocutaneous Therapies
Non-pharmacologic Treatments for Psychocutaneous Disorders
Education for Patient and Family
Conclusion
References

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

Complementary Pharmacological Psychocutaneous Therapies

Herbs and Supplements

Anxiolytics

Antidepressants

Soporifics

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

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