Overview:
Dermatological conditions are responsible for a significant source of the social stigma in our modern society. This leads to the development of psychiatric illnesses, like depression and anxiety. Stress is an important factor in the etiology of various psychocutaneous disorders; it can be environmental, physical, or psychological factors. A few skin conditions with psychiatric illness are discussed here for further understanding.
What Is the Association Between Skin and Psychology?
We have to agree that the skin is the largest organ. This enormous site gives possibilities to get affected at various places of the skin. Healthy and glowing skin provides a higher level of confidence and charm. But, when the mental stability of a person is known to get disturbed, then they might lose interest in dressing themselves up well. Also, in severe cases, they might engage in different abnormal habits that can be disastrous both for the physical and mental health. The surrounding family members are also affected because of the poor and unhealthy habits.
The association between psychology and dermatology is studied in detail in psychodermatology. It is a recent advancing branch. Psoriasis, acne, and eczema that are caused due to psychological issues are discussed in this field of psychology. Medical reports suggest that people who are overstressed are more likely to be affected by such psychological conditions. Surveys also show that the anxiety and depression level was very high in patients who suffer from skin problems due to psychological issues.
What Is Delusional Parasitosis?
Delusional parasitosis is primarily a psychiatric disorder. These patients had a false belief that they are already infested with some parasite that brings them with bits of skin scales, lint, and other specimens to prove their existence. Any imbalance in the chemical secretions in the brain can result in delusional parasitosis. Usage of cocaine can also cause this condition. In this disorder, patients have a preoccupation with an imagined defect in appearances, such as thinning of hairs, large nose, small genitals and breast, excessive greasiness of the face, and persistent burning sensation in the face. In all such patients, an interview is required with the treating psychiatrist to know the depth of illness and treat accordingly with antipsychotic medicine.
What Is Dermatitis Artefacta?
It is primarily a psychiatric illness, but the patient will be reported to the dermatologist.
The dermatitis artefacta patients will be presented with various types of bizarre skin lesions, with sharp geometric borders surrounded by normal skin mainly involved in the self-approachable areas of the body, and these lesions do not mimic other dermatoses.
These lesions may be done unconsciously (in the dissociated state) or consciously (for satisfying some unconscious needs). The supportive approach is necessary, which includes avoiding direct discussion of the self-inflicting nature of the lesions. If the patient is explained about their behavior also, they tend to deny it. Most patients improve after stressful life events are over. Relaxation exercise may be helpful and dermatological treatment is symptomatic only. Topical corticosteroids might be necessary for overcoming the condition. If the cause is known to be depression, then antidepressants might be necessary. A multidisciplinary approach might be needed for overcoming this condition.
How Is Neurotic Excoriation Associated With Skin Disorders?
Neurotic excoriation results from a repetitive and compulsive desire to pick, scratch, or rub the skin. In this condition, the patient is aware of the activity but unable to stop this. Unlike dermatitis artefacta, neurotic excoriation can be expressed as a symptom of depression. Stress is the leading cause of neurotic excoriation. This habit of picking and scratching is known to provide a certain degree of psychological satisfaction in the individual. They can do it knowingly or unknowingly, and this habit becomes their routine. They are not worried about the inferior expression they might create among the others in public. Dermatological treatment is symptomatic only.
Why Is Dermatitis Artefacta Associated With Obsessive-Compulsive Disorder?
Dermatitis artefacta is considered an obsessive-compulsive disorder. Obsessive condition is the one in which the individual experiences repetitive thoughts to perform a particular activity or think about a specific thought. This is often seen along with compulsions faced by the individual to do a specific normal or abnormal behavior. The abnormal behavior can be identified in the initial stages itself, whereas the compulsive behavior will take a very long time to be identified. Here, the patient with dermatitis artefacta tries to continue their scratching behavior in response to the compulsive thoughts in mind.
What Is Trichotillomania?
Trichotillomania is a condition in which the person has to urge to pull out their hair in a mild or aggressive manner due to the obsessive thoughts they have. They often do this as a self-harm behavior. Most of the patients affected by this condition have poor self-esteem and are known to avoid any social setup.
What Is Munchausen Syndrome?
Patients with this illness are notorious hospital hoppers. They present with a dramatic and false story of illness in successive visits to hospitals and OPD (outpatient department). This is also known as a factitious disorder. Even though an actual health issue does not exist with the patient, they create a false notion that they are sick. Poor self-esteem and childhood abuse is the main cause. In other cases, it is difficult to identify the reason for the occurrence of this syndrome. Patients with Munchausen syndrome are known to be good attention seekers.
Munchausen Syndrome by Proxy:
This is usually seen in pediatric practice, where the illness is fabricated by the mother. It is also seen in dependent persons like the old and the handicapped, where the illness is fabricated by their caretaker to get rid of them. This proxy disorder is noted in the father also.
These illnesses stress the fact that only treating dermatological illness is not sufficient in all skin diseases. We must read and understand the psyche and needs of the patient before giving some treatment.
Temporary conditions of these psychological problems do not require any special treatment options. In order to overcome the skin disorder, the psychiatric issues should be resolved first. Psychotherapy treatment is often recommended along with medications.
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