SlideShare una empresa de Scribd logo
1 de 55
Descargar para leer sin conexión
SEMINAR

DR. DEEPAK KUMAR MATHUR
INTRODUCTION
 Psychodermatology or psychocutaneous medicine

encompasses disorders prevailing on the boundary
between psychiatry and dermatology.
 Approximately 30-40% patients seeking treatment for skin

disorders have an underlying psychiatric or a psychological
problem that either causes or exacerbates a skin
complaint.
 Skin–psyche interactions:- An essential component of

dermatological illness is relationship that somatic dermatology
has to psychological status of sufferer at time.
 The influence that these psychological, psychosocial and
sometimes psychiatric factors play can be conveniently assessed
as:
1.
2.
3.
4.

Multifactorial dermatological disorders which can be
substantially influenced by psychological factors, e.g. psoriasis
Dermatological disorders as a result of psychiatric illness, e.g.
factitious dermatoses, body dysmorphic disorder
Psychiatric illness developing as a result of skin disease, e.g.
depression, adjustment disorder
Co-morbidity with another psychiatric disorder, e.g. alcoholism
Stigma
 Term describes situation of an individual who is

disqualified from full social acceptance.
 Commonest dermatological situations where stigma is
encountered may be:1. Physical deformities:Congenital naevae, e.g. port-wine stain
II. Acquired deformities from developmental disorders,
e.g. tuberose sclerosis
III. Widespread inflammatory skin disease.
IV. Surgical or post-traumatic deformities
I.
Implications of inferred character deficiencies:-

2.
I.

II.

III.
IV.
V.
VI.
VII.

Psychiatric disorder, i.e. their views on the skin disease are
disqualified because they also have a psychiatric diagnosis
Learning disability, i.e. they have limited emotional
capacity to respond to their dermatosis, e.g. Down’s
syndrome
Persistent treatment non–compliance, i.e. an assumption
of a fickleness of character, e.g. depressive illness
Alcoholism and drug addiction, e.g. the cutaneous signs of
substance abuse are a labelling of character weakness
Unemployment
Imprisonment
HIV status
3. Stigma of: Race, e.g. implications of vitiligo for marriage
 Religion, e.g. allowing the naked body to be seen by a
stranger
Classification
A. Psychiatric disorders without significant

dermatological disease:Delusional syndromes:-

1.
i.
ii.
iii.
iv.
v.

Parasitosis
Smell
Impregnation and contamination
Folie à deux
Other hypochondriasis, e.g. so-called Morgellons
B. Disorders of awareness of the body:1.
Phobias and obsessive compulsive disorders:i.
ii.

iii.
iv.
v.

vi.
vii.

Disorders of body image:- body dysmorphic disorder (BDD)
(synonyms dysmorphophobia, dermatological non-disease)
Disturbance of body size and eating:- e.g. anorexia nervosa,
bulimia
Phobias:- mole phobia, venereophobia, wart phobia,
erythrophobia, electrophobia and steroid phobia
Obsessive–compulsive behaviours:- hand washing, hair plucking
Atypical pain disorders:- glossodynia, vulvodynia and scrotodynia,
anodynia
Pruritis sine materia
Other dermatologic hypochondriases:- botoxophilia, tanorexia
Mental disorders and
dermatological disorders:-

B.

Classical psychosomatic
disorders:-Dermatoses in
which emotional
precipitating or
perpetuating factors may
be important:-

1.

i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.

Vesicular eczema of palms
and soles
AD
Seborrhoeic dermatitis
Psoriasis
Some cases of localized or
generalized pruritus
AA
Aphthosis
Flushing reactions and
rosacea
Hyperhidrosis
Urticarias.

2.

Dermatoses primarily
factitious in origin:Dermatitis factitia
Artefact by proxy
Witchcraft syndrome
Dermatological
pathomimicry
v.
Dermatitis simulata
vi. Malingering
vii. Compensation neurosis
viii. Münchausen’s syndrome
ix. Fabricated and induced
illness (Münchausen’s
syndrome by proxy)
x.
Deliberate self-cutting
xi. Self-mutilation
i.
ii.
iii.
iv.
3.

Dermatoses in association with
harmful habits and compulsions:i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.

Lichen simplex
Neurotic excoriations
Prurigo nodularis
Acne excoriée
Hair plucking
Trichotillomania
Trichophagia
Nail destruction
Onychotillomania
Lip-licking cheilitis
Knuckle biting

The psychogenic purpura
syndromes

4
i.

ii.
iii.
iv.

5.
6.

Autoerythrocyte sensitization
(Gardner–Diamond syndrome)
Autosensitivity to DNA
Psychogenic purpura
(idiopathic)
Stigmata

Disorders of neglect of selfcare (synonym Diogenes
syndrome)
Drug-dependence syndromes
i.
ii.

Alcohol-related syndromes
Substance abuse
7.

Mental disorders due to
dermatological treatment
i.
ii.

8.

Cortisone psychosis
Interferon depression

iii.

Lithium-induced psoriasis
Tranquillizer
hyperpigmentation
Anti-depressant hyperhidrosis

Dual non-associated disease,
dermatological and
psychiatric
i.
ii.

disorders
Skin cancer in patients with
major psychosis

Dermatological patients with
psychic symptoms not
amounting to a disorder:i.
ii.
iii.

Dermatological disorders due
to psychopharmacological
treatment:i.
ii.

9.

C.

D.

‘Troublesome patients’
Dysthymic responses to illness
Cosmetology associated
worries

Group and mass population
reactions:i.
ii.

Sick building syndrome
Epidemic hysteria
Delusions of parasitosis:- unshakeable conviction that
his or her skin is infested by parasites.
 Causes: Neurological: Cerebrovascular disease,
Dementia and
neurodegenerative diseases,
Parkinson’s disease,
Huntingdon’s disease, CNS
tumours, Head injury,
Encephalitis, Meningitis,
Multiple sclerosis, Learning
disability,
 Cardiovascular disorders: Arrhythmias, Heart failure,
Coronary artery bypass
 Renal disease:- CRF, Dialysis

 Liver disease:- Hepatitis
 Endocrine disease: Diabetes mellitus,
Hyperthyroidism,
Hypothyroidism,
Panhypopituitarism,
Hypoparathyroidism,
Acromgaly,
 Nutritional disorders:
 Pellagra ,Folate deficiency,
Vitamin B12 deficiency,
Anorexia nervosa
 Infectious diseases:- Syphilis, AIDS, Tuberculosis

(pulmonary), Leprosy
 Malignancy:- Breast cancer, Colon cancer, Lung
cancer, Lymphoma, CLL.
 Substance abuse:- Amphetamines, Cannabis, Cocaine,
Ecstasy, Opiates.
 Medicines:- Corticosteroids, Ciprofloxacin,
Mefloquine.
 Monosymptomatic hypochondriacal

psychosis.
 Middle aged/elderly females .
 Visual and tactile hallucinations of
parasites crawling, burrowing, and
biting all over their body.
 Excoriations are usual
and, sometimes, extensively
produced in an attempt to extricate
organism.
Management
 Patients with anxiety, social isolation or depression:-







psychotherapy, or antidepressants such as doxepin,
citalopram or venlafaxine.
Pimozide:- initial dose 2 mg, is increased weekly by 2
to a maximum of 12 mg daily.
Sulpiride:- 200–400 mg/day
Amisulpride:Respiridone:-1–8 mg/day
Olanzapine in small doses
 Bromidrosiphobia:- A/K Delusions of smell
 M:F= 4-5: 1
 Most patients complain that smell comes from groin or

sometimes armpit.
 Other beliefs:- Flatus, halitosis
 Organic syndromes:-cerebral
tumours, epilepsy, alcoholism and substance abuse
 T/t:- Psychotherapy, antidepressants and
antipsychotics.
 Morgellons syndrome:-Fibre-like filaments, granules

and crystals that appear on or under the skin lesions
Disorder of Body Image
 BODY DYSMORPHIC DISORDER –
 A patient is preoccupied and distressed with an imagined
defect in appearance or an excessive concern over a trivial
defect.
 BDD is defined in DSM-IV and classified as a somatoform
disorder.
 There is an underlying co-morbid mental disorder
including mood disorders such as depression, OCD, social
phobia, and/or avoidant personality disorder.
 Most patients are females in their 30's.
 These patients are rich in symptoms, while poor in signs of
organic skin disease.
 Complaints related to mainly face, breast, hair, nose, and
stomach, while men presented with concern related to
hair, nose, ear, genitals, and body build.
 Distress, poor self esteem, and impairment in
social, occupational, and domestic functioning.
 Repetitive compulsive behavior to hide their
imaginary/trivial defect.
 BDD patients are doctor shoppers, they repeatedly
undergo procedures to find solution for their flaws and
majority are dissatisfied with results and consultation.
 Suicidal ideation and suicide attempts are common in BDD
patients.
 Treatment: SSRIs:- 50% of patients may respond completely or

partially .
 clomipramine

 fluoxetine 50 mg/day and fluvoxamine260 mg/day for 2-

4 months
 Venlafaxine 37.5 mg/day for 1 year

 Cognitive behavioural therapy
Anorexia nervosa and bulimia
 Definitions:- Anorexia

nervosa must satisfy the
criteria for:1.

2.

3.

An inability to maintain
the normal or minimum
weight for age and height
coupled with an intense
fear of gaining weight; the
BMI is less than 17.5 kg/m2
A distorted perception of
weight, size and body
configuration- essential
features
Amenorrhoea

 Bulimia nervosa is defined

by the following:
1.

2.

3.

4.

Recurrent and compulsive
overeating episodes (binge
eating)
Recurrent and inappropriate
compensatory behaviour in
order to avoid gaining weight;
these include induced
vomiting and abuse of
diuretics and laxatives
Binge eating and weight
reduction behaviours
occurring at least twice per
week for 3 months
Self-esteem affected by weight
and body configuration.
Psycho cutaneous disorders
Harmful cutaneous habits
 Lichen simplex and neurodermatitis:-Lichenification








describes characteristic pattern of response of predisposed
skin to repeated rubbing.
Treatment:- antihistamines, TCA doxepin in doses as low
as 25–50 mg/day
thalidomide 50–100 mg/daily for up to 2 months
Pathological skin picking(Dermatotillomania):recurrent picking accompanied by visible tissue damage
and functional impairment.
Clinical features:-lesions are polymorphic, newer lesions
are angular excoriated erosions with a serosanguineous
crust.
 Healing with

erythematous, white and
atrophic centrally and
commonly hypertrophic
and hyperpigmented at the
periphery
 Site:-face, hair margins,
sides of neck, chin, upper
chest, shoulders, upper
arms and thighs.

 Management:-supportive






psychotherapy
Cognitive behavioural
therapy
Compulsive nature of
disorder:antidepressants:-SSRI
A-B-C model of habit
disorders, that is Affect
regulation, Behavioural
regulation and Cognitive
control
Lamotrigine
Acute excoriations and
chronic, scarred, atrophic lesions due to
pathological picking on face, neck and
shoulders

Acne excoriee
 Trichotillomania:-term was first used by Hallopeau in 1889
 derived from the Greek thrix hair, tillein pull out and mania
madness.
 Morbid craving to pull out hair.
 Revised DSM-IV diagnostic criteria:a.
b.
c.
d.
e.

Recurrent pulling out of one’s own hair resulting in hair loss
An increasing sense of tension immediately before pulling out
hair or when attempting to resist behaviour
Pleasure, gratification or relief when pulling out the hair
Disturbance is not better accounted for by another mental
disorder and
Disturbance provokes clinically marked distress and/or
impairment in occupational, social or other areas of functioning.
 C/F:-short, irregular, broken

and distorted hair.
 plucking activity are
centrifugal from a single
starting point or linear, in
wave-like activity.
 Trichobezoar and the
Rapunzel syndrome:-balllike aggregations of fibre-like
materials( hair) in stomach
and small intestine.
 Swallowed hair is retained
within folds of gastric
mucosa.

Trichotillomania
 Investigations: Scalp biopsy: normally hairs amongst empty hair follicles in a noninflamed dermis.
 Follicular plugging with keratin debris is evident.
 deep distortion and curling of hair bulb.
 Barium contrast and CT scan:-gastrointestinal bezoars
 Management:-cognitive behavioural therapy (CBT) is

effective alone and combined CBT and TCA or SSRIs.
 Clomipramine more useful than SSRI alone.
Psychogenic Pruritus
 Psychogenic pruritus (PP) is a poorly defined entity in








which the patient has intractable or persistant itch, not
ascribed to any physical or dermatological illness.
Pruritic episodes are unpredictable with abrupt onset and
termination, predominantly occurring at the time of
relaxation.
PP can be generalized or localized.
The commonest sites of predilection are legs, arms, back,
and genitals.
A significant number of patients have associated anxiety
and or depression.
Detailed cutaneous and systemic examination and routine
baseline investigation should be performed to rule out
cutaneous and systemic causes of pruritus before
diagnosing PP.
Psycho cutaneous disorders
Psycho cutaneous disorders
Psycho cutaneous disorders
Cutaneous phobias
Fear of contamination, e.g. dirt phobia, germ
phobia, wart phobia
2. Fear of malignancy, e.g. cancer phobia, mole phobia
3. Fear of emotional display, e.g. blushing, sweating
1.
Factitious skin disease
 DSM-IV-TR criteria:1. Intentional feigning of physical or psychological signs
or symptoms
2. Motivation is to assume the sick role
3. External incentives for behaviour (such as economic
gain, avoiding legal responsibility, or improving
physical well-being, as in malingering) are absent.
 Dermatitis factitia:- caused entirely by actions of fully

aware (i.e. not consciously impaired) patient on the skin,
hair, nails or mucosae.
 F>m, children, from age of 8 years, pre-pubertal children
having an equal sex ratio, rising to 3 : 1 female
predominance in early teens
 Etiology: psychosocial stress of a major life
 neurotic and react to adverse situations in an immature,

impulsive manner.
 Depression
 personality disorder:-borderline or hysterical in females and
paranoid in males
 C/F:- 2 characteristics:1. physical signs
2. fabricated story that accompanies it
 patient often describes :
 Sudden appearance of lesions with little or no
prodrome.
 No complete description of genesis of individual skin
lesions.
 Clinical signs: Commonest site are face (cheeks) in 50% children, Dorsa of






hands, forearms
most frequently of non-dominant limb, mostly on covered skin
lesions are polymorphic, bizarre, clearly demarcated from surrounding
normal skin and can resemble many inflammatory reactions in skin
crude, angulated, destructive processes with a tendency to a linear
configuration, Circular erosions or blisters of a uniform size, as result of
thermal, chemical or instrumental injury
Secretan’s syndrome:-Oedema of limbs from constricting bands and
hysterical dependent posture has been described.
 Drip-sign:- corrosive liquids.
 Excoriations:- nail files, sanding boards, cheese graters or wire






brushes
Punched out necrotic areas:- cigarettes, soldering irons
Dramatic dermal induration and necrosis occur from foreign
body injection of milk, oil, or grease into breasts, thighs,
abdomen and penis .
The other common presentation is chronic, non-healing infected
wounds.
A patient is unable to provide clear history of evolution of the
lesions and typically denies any role in the production of the
lesions.
Psycho cutaneous disorders
Psycho cutaneous disorders
 Witchcraft syndrome:- Artefact dermatitis can be

provoked on an unknowing and unsuspecting victim
by proxy.
 Dermatological pathomimicry:- patients may
intentionally aggravate an existing dermatosis using
explanation of its genesis given by their dermatologist
 Atopic patients reintroduced allergens
Factitious cheilitis due to
repeated lip sucking.

Factitious nail disease
Dermatitis passivata
 Young Diogenes syndrome; accretions of facial keratin and debris
Secondary Psychiatric Disorders
 Skin problems, especially chronic skin diseases, affecting

exposed body parts because of the visibility and resultant
disfigurement lead to embarrassment, depression, anxiety,
poor self image, low self esteem, and suicidal ideation in
the patients.
 Also, patients have to commonly face social isolation and
discrimination and, at times, have difficulty getting jobs.
 Many patients are able to cope up with the disease while
few develop secondary psychiatric morbidity.
 Dermatologist should look into this aspect of chronic

disfiguring dermatoses.
 If the dermatologist suspects significant secondary

psychological morbidity then interrogation, counseling,
psychiatric referral should b done.
Management of Psychocutaneous
Patients
 Most of the patients with psychocutaneous disorders

can be broadly categorized under four diagnoses:
(a) Anxiety,
(b) depression,
(c) psychosis,
(d) OCD.
 The choice of a psychotropic medication is based
primarily on the nature of the underlying
psychopathology.
Anxiety
 Therapeutic modalities for anxiety include BDZ, non-BDZ,

and CBT.
 Risk of dependence on BDZ is quite high; hence, they are
indicated only for short-term treatment (2-4 weeks) for
severe and disabling symptoms and should be avoided in
milder forms.
 Non-BDZ used in the treatment of anxiety are selective
SSRIs (citalopram escitalopram, paroxetine), serotoninnorepinephrine reuptake inhibitors (SNRIs) (venlafaxine
XL, duloxetine), antihistamines (hydroxyzine), betablockers (propranolol), and the antiepileptic pregabalin.
Depression
 In mild symptoms, watchful waiting or CBT is

recommended.
 Moderate symptoms can be managed with SSRI and CBT.

 In cases with severe symptoms and suicidal ideation

admission, antidepressants with possibly electroconvulsive
therapy (ECT) are recommended.
Antipsychotics
 Antipsychotics are used in the therapy of psychocutaneous

disorders such as delusions of parasitosis, dermatitis
artefacta, and monosymptomatic hypochondriasis.
 The goal of the dermatologist is not to relieve the patients

of their delusion, but to help them function better with the
delusion.
Obsessive Compulsive Disorder
 Disorders like BDD and impulse control disorder (acne

excoree, trichotillomania, onychotillomania,
neurodermatitis) are treated on the lines of OCD.
 Develop insight into the etiology of their problem, they are
more amenable to see a psychiatrist and engage in nonpharmacological management (CBT).
 For patients who are unwilling or unable to initiate
behavioral modification, pharmacological therapy can be
helpful.
 Currently, three SSRIs-fluoxetine, paroxetine, and
sertraline-are the first-line therapy for the management of
OCD.
Non-Pharmacological Treatments


There is a significant psychosomatic/behavioral
component in many dermatologic conditions hence
complementary non-pharmacological
psychotherapeutic interventions
1. biofeedback
2. CBT
3. hypnosis
4. placebo
 Have positive impacts on many dermatologic
disorders.
Biofeedback
 Biofeedback is a non-invasive conditioning technique

with wide applications in the field of medicine.
 Biofeedback training encompasses a wide variety of
progressive muscle-relaxing techniques, autogenic
training, imagery techniques, transcendental, and
other meditation techniques as well as other
relaxation-directed programs (i.e., breathing
techniques, self-talk, and others).
 Relaxation training is primarily directed at minimizing
sympathetic reactivity and enhancing parasympathetic
function.
Cognitive Behavioral Therapy
 CBT deals with dysfunctional thought patterns (cognitive)

or actions (behavioral) that damage the skin or interfere
with dermatologic therapy .

Hypnosis
 Hypnosis is an intentional induction, deepening,

maintenance, and termination of a trance state for a
specific purpose.
 Hypnotic trance can be defined as a heightened state of
focus that can be helpful in reducing unpleasant sensations
(i.e., pain, pruritus, dysesthesias), while simultaneously
inducing favorable physiologic changes.
Psycho cutaneous disorders
THANKS

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Dermatology 5th year, 3rd lecture (Dr. Kazhan)
Dermatology 5th year, 3rd lecture (Dr. Kazhan)Dermatology 5th year, 3rd lecture (Dr. Kazhan)
Dermatology 5th year, 3rd lecture (Dr. Kazhan)
 
Cutaneous manifestations of endocrine disease
Cutaneous manifestations of endocrine diseaseCutaneous manifestations of endocrine disease
Cutaneous manifestations of endocrine disease
 
Deceptive syndromes- factitious disorder & malingering
Deceptive syndromes- factitious disorder & malingeringDeceptive syndromes- factitious disorder & malingering
Deceptive syndromes- factitious disorder & malingering
 
Delusional Disorder
Delusional DisorderDelusional Disorder
Delusional Disorder
 
Common Skin Diseases
Common Skin DiseasesCommon Skin Diseases
Common Skin Diseases
 
Skin manifestations of systemic diseases
Skin manifestations of systemic diseasesSkin manifestations of systemic diseases
Skin manifestations of systemic diseases
 
Depressive disorder (Depression Made Easy!)
Depressive disorder (Depression Made Easy!)Depressive disorder (Depression Made Easy!)
Depressive disorder (Depression Made Easy!)
 
Psychiatry and skin disease
Psychiatry and skin diseasePsychiatry and skin disease
Psychiatry and skin disease
 
Vitiligo
VitiligoVitiligo
Vitiligo
 
Pruritus
PruritusPruritus
Pruritus
 
Neurobiology of OCD
Neurobiology of OCDNeurobiology of OCD
Neurobiology of OCD
 
Disorders of Emotion
Disorders of Emotion Disorders of Emotion
Disorders of Emotion
 
Morphea
MorpheaMorphea
Morphea
 
Contact dermatitis
Contact dermatitisContact dermatitis
Contact dermatitis
 
Psychiatric Manifestations In Dementia
Psychiatric Manifestations In DementiaPsychiatric Manifestations In Dementia
Psychiatric Manifestations In Dementia
 
Rosacea: Inflammatory condition in Dermatology
Rosacea: Inflammatory condition in DermatologyRosacea: Inflammatory condition in Dermatology
Rosacea: Inflammatory condition in Dermatology
 
Bullous diseases(group a)
Bullous diseases(group a)Bullous diseases(group a)
Bullous diseases(group a)
 
Tardive Dyskinesia
Tardive Dyskinesia Tardive Dyskinesia
Tardive Dyskinesia
 
Seborrheic dermatitis
Seborrheic dermatitisSeborrheic dermatitis
Seborrheic dermatitis
 
Seminar pruritus
Seminar  pruritusSeminar  pruritus
Seminar pruritus
 

Destacado

Georga Public health Morgellons powerpoint presentation
Georga Public health Morgellons powerpoint presentationGeorga Public health Morgellons powerpoint presentation
Georga Public health Morgellons powerpoint presentationguest4adeaa
 
Eczema dermatitis homeopathy treatment
Eczema dermatitis homeopathy treatmentEczema dermatitis homeopathy treatment
Eczema dermatitis homeopathy treatmentPranav Pandya
 
Neuropsychiatric manifestations of endocrine disorders
Neuropsychiatric manifestations of endocrine disordersNeuropsychiatric manifestations of endocrine disorders
Neuropsychiatric manifestations of endocrine disordersDheeraj kumar
 
MÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁC
MÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁCMÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁC
MÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁCSoM
 
Koch To Quantiferon
Koch To QuantiferonKoch To Quantiferon
Koch To Quantiferonjamieritchey
 
Urticaria y Prurigo Nodular de Hyde
Urticaria y Prurigo Nodular de HydeUrticaria y Prurigo Nodular de Hyde
Urticaria y Prurigo Nodular de HydeMariana Perez
 
Padden & Gerrits: Hair Decision Tree Presentation
Padden & Gerrits: Hair Decision Tree PresentationPadden & Gerrits: Hair Decision Tree Presentation
Padden & Gerrits: Hair Decision Tree Presentationdcgerrits
 
Can You Treat Trichotillomania ?
Can You Treat Trichotillomania ?Can You Treat Trichotillomania ?
Can You Treat Trichotillomania ?lweg14
 

Destacado (13)

Premature ejaculation
Premature ejaculation Premature ejaculation
Premature ejaculation
 
Georga Public health Morgellons powerpoint presentation
Georga Public health Morgellons powerpoint presentationGeorga Public health Morgellons powerpoint presentation
Georga Public health Morgellons powerpoint presentation
 
Eczema dermatitis homeopathy treatment
Eczema dermatitis homeopathy treatmentEczema dermatitis homeopathy treatment
Eczema dermatitis homeopathy treatment
 
Neuropsychiatric manifestations of endocrine disorders
Neuropsychiatric manifestations of endocrine disordersNeuropsychiatric manifestations of endocrine disorders
Neuropsychiatric manifestations of endocrine disorders
 
2015 IPM
2015 IPM2015 IPM
2015 IPM
 
MÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁC
MÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁCMÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁC
MÔ HỌC DA, CƠ QUAN THỊ GIÁC, THÍNH GIÁC
 
Koch To Quantiferon
Koch To QuantiferonKoch To Quantiferon
Koch To Quantiferon
 
Eczema
EczemaEczema
Eczema
 
Prurigo
PrurigoPrurigo
Prurigo
 
Urticaria y Prurigo Nodular de Hyde
Urticaria y Prurigo Nodular de HydeUrticaria y Prurigo Nodular de Hyde
Urticaria y Prurigo Nodular de Hyde
 
K Novia D Block
K Novia D BlockK Novia D Block
K Novia D Block
 
Padden & Gerrits: Hair Decision Tree Presentation
Padden & Gerrits: Hair Decision Tree PresentationPadden & Gerrits: Hair Decision Tree Presentation
Padden & Gerrits: Hair Decision Tree Presentation
 
Can You Treat Trichotillomania ?
Can You Treat Trichotillomania ?Can You Treat Trichotillomania ?
Can You Treat Trichotillomania ?
 

Similar a Psycho cutaneous disorders

1-Mood-Disorders ...pptx
1-Mood-Disorders ...pptx1-Mood-Disorders ...pptx
1-Mood-Disorders ...pptxssuserbf570f
 
Mood disorders [affective disorders]
Mood disorders [affective disorders]Mood disorders [affective disorders]
Mood disorders [affective disorders]By Ayush kumar
 
62063954 case-study-bipolar-disorder
62063954 case-study-bipolar-disorder62063954 case-study-bipolar-disorder
62063954 case-study-bipolar-disorderhomeworkping4
 
Abnormalpsychology 111004002706-phpapp02
Abnormalpsychology 111004002706-phpapp02Abnormalpsychology 111004002706-phpapp02
Abnormalpsychology 111004002706-phpapp02iL Rish
 
Abnormal psychology
Abnormal psychologyAbnormal psychology
Abnormal psychologyCinne GaciLo
 
Anxiety disorders.pptx
Anxiety disorders.pptxAnxiety disorders.pptx
Anxiety disorders.pptxShaliniN51
 
Psychocutaneous diseases kopie
Psychocutaneous diseases   kopiePsychocutaneous diseases   kopie
Psychocutaneous diseases kopieDanyalSHamid
 
New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)
New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)
New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)College of Medicine, Sulaymaniyah
 
Mood disorders samiyah aljohani
Mood disorders samiyah aljohaniMood disorders samiyah aljohani
Mood disorders samiyah aljohaniさ ん
 
psychiatric disorders 4-Mood Disorders.ppt
psychiatric disorders 4-Mood Disorders.pptpsychiatric disorders 4-Mood Disorders.ppt
psychiatric disorders 4-Mood Disorders.pptArun170190
 
Depression- Diagnosis, Causes, Treatments
Depression- Diagnosis, Causes, Treatments Depression- Diagnosis, Causes, Treatments
Depression- Diagnosis, Causes, Treatments Aaradhana Reddy
 
Bipolar disorder for undergraduates
Bipolar disorder for undergraduatesBipolar disorder for undergraduates
Bipolar disorder for undergraduatesMohamed Abdelghani
 

Similar a Psycho cutaneous disorders (20)

Bipolar affective disorder
Bipolar affective disorderBipolar affective disorder
Bipolar affective disorder
 
1-Mood-Disorders ...pptx
1-Mood-Disorders ...pptx1-Mood-Disorders ...pptx
1-Mood-Disorders ...pptx
 
Mood disorders [affective disorders]
Mood disorders [affective disorders]Mood disorders [affective disorders]
Mood disorders [affective disorders]
 
62063954 case-study-bipolar-disorder
62063954 case-study-bipolar-disorder62063954 case-study-bipolar-disorder
62063954 case-study-bipolar-disorder
 
Abnormalpsychology 111004002706-phpapp02
Abnormalpsychology 111004002706-phpapp02Abnormalpsychology 111004002706-phpapp02
Abnormalpsychology 111004002706-phpapp02
 
Complete Psychological Disorders List
Complete Psychological Disorders ListComplete Psychological Disorders List
Complete Psychological Disorders List
 
Delirium
DeliriumDelirium
Delirium
 
Mood disorders slide
Mood disorders slideMood disorders slide
Mood disorders slide
 
Abnormal psychology
Abnormal psychologyAbnormal psychology
Abnormal psychology
 
Abnormal psychology
Abnormal psychologyAbnormal psychology
Abnormal psychology
 
Psychiatry 5th year, 1st lecture (Dr. Rebwar Ghareeb Hama)
Psychiatry 5th year, 1st lecture (Dr. Rebwar Ghareeb Hama)Psychiatry 5th year, 1st lecture (Dr. Rebwar Ghareeb Hama)
Psychiatry 5th year, 1st lecture (Dr. Rebwar Ghareeb Hama)
 
Anxiety disorders.pptx
Anxiety disorders.pptxAnxiety disorders.pptx
Anxiety disorders.pptx
 
Psychocutaneous diseases kopie
Psychocutaneous diseases   kopiePsychocutaneous diseases   kopie
Psychocutaneous diseases kopie
 
New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)
New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)
New: Psychiatry 5th year, 4th & 5th lectures (Dr. Nazar M. Mohammad Amin)
 
Mood disorders samiyah aljohani
Mood disorders samiyah aljohaniMood disorders samiyah aljohani
Mood disorders samiyah aljohani
 
psychiatric disorders 4-Mood Disorders.ppt
psychiatric disorders 4-Mood Disorders.pptpsychiatric disorders 4-Mood Disorders.ppt
psychiatric disorders 4-Mood Disorders.ppt
 
Depression
Depression Depression
Depression
 
Bpd927
Bpd927Bpd927
Bpd927
 
Depression- Diagnosis, Causes, Treatments
Depression- Diagnosis, Causes, Treatments Depression- Diagnosis, Causes, Treatments
Depression- Diagnosis, Causes, Treatments
 
Bipolar disorder for undergraduates
Bipolar disorder for undergraduatesBipolar disorder for undergraduates
Bipolar disorder for undergraduates
 

Más de Dr Daulatram Dhaked (20)

Psoriasis evidence based treatment
Psoriasis evidence based treatmentPsoriasis evidence based treatment
Psoriasis evidence based treatment
 
Treponema pallidum tutorial
Treponema pallidum tutorial Treponema pallidum tutorial
Treponema pallidum tutorial
 
Resistant urticaria tutorial ppt.
Resistant urticaria tutorial ppt.Resistant urticaria tutorial ppt.
Resistant urticaria tutorial ppt.
 
Psoriatic arthropathy
Psoriatic arthropathyPsoriatic arthropathy
Psoriatic arthropathy
 
Physiotherapy in dermatology ppt
Physiotherapy in dermatology pptPhysiotherapy in dermatology ppt
Physiotherapy in dermatology ppt
 
Pruritus targated treatment- a look into future
Pruritus  targated treatment- a look into futurePruritus  targated treatment- a look into future
Pruritus targated treatment- a look into future
 
Ppt scar
Ppt scarPpt scar
Ppt scar
 
Methotrexate
MethotrexateMethotrexate
Methotrexate
 
Melasma treatment
Melasma treatmentMelasma treatment
Melasma treatment
 
Melanocyte culture technique
Melanocyte culture techniqueMelanocyte culture technique
Melanocyte culture technique
 
Leprosy nlep & currents trends
Leprosy nlep & currents trendsLeprosy nlep & currents trends
Leprosy nlep & currents trends
 
Isotretinoin in acne
Isotretinoin in acneIsotretinoin in acne
Isotretinoin in acne
 
Gonorrhoea
GonorrhoeaGonorrhoea
Gonorrhoea
 
Genital ulcer
Genital ulcerGenital ulcer
Genital ulcer
 
Female hair loss
Female hair lossFemale hair loss
Female hair loss
 
Dermal filler sminar
Dermal filler sminarDermal filler sminar
Dermal filler sminar
 
Dapsone, colchicine
Dapsone, colchicineDapsone, colchicine
Dapsone, colchicine
 
Cutaneous features of endocrine diseases
Cutaneous features of endocrine diseasesCutaneous features of endocrine diseases
Cutaneous features of endocrine diseases
 
Cutaneous pseudolymphoma
Cutaneous pseudolymphomaCutaneous pseudolymphoma
Cutaneous pseudolymphoma
 
Clinicl aproch to blistering dissorder
Clinicl aproch to blistering dissorderClinicl aproch to blistering dissorder
Clinicl aproch to blistering dissorder
 

Último

BBA 205 BE UNIT 2 economic systems prof dr kanchan.pptx
BBA 205 BE UNIT 2 economic systems prof dr kanchan.pptxBBA 205 BE UNIT 2 economic systems prof dr kanchan.pptx
BBA 205 BE UNIT 2 economic systems prof dr kanchan.pptxProf. Kanchan Kumari
 
How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17
How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17
How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17Celine George
 
The First National K12 TUG March 6 2024.pdf
The First National K12 TUG March 6 2024.pdfThe First National K12 TUG March 6 2024.pdf
The First National K12 TUG March 6 2024.pdfdogden2
 
AI Uses and Misuses: Academic and Workplace Applications
AI Uses and Misuses: Academic and Workplace ApplicationsAI Uses and Misuses: Academic and Workplace Applications
AI Uses and Misuses: Academic and Workplace ApplicationsStella Lee
 
Research Methodology and Tips on Better Research
Research Methodology and Tips on Better ResearchResearch Methodology and Tips on Better Research
Research Methodology and Tips on Better ResearchRushdi Shams
 
PHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdf
PHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdfPHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdf
PHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdfSumit Tiwari
 
The OERs: Transforming Education for Sustainable Future by Dr. Sarita Anand
The OERs: Transforming Education for Sustainable Future by Dr. Sarita AnandThe OERs: Transforming Education for Sustainable Future by Dr. Sarita Anand
The OERs: Transforming Education for Sustainable Future by Dr. Sarita AnandDr. Sarita Anand
 
3.14.24 Gender Discrimination and Gender Inequity.pptx
3.14.24 Gender Discrimination and Gender Inequity.pptx3.14.24 Gender Discrimination and Gender Inequity.pptx
3.14.24 Gender Discrimination and Gender Inequity.pptxmary850239
 
Dhavni Theory by Anandvardhana Indian Poetics
Dhavni Theory by Anandvardhana Indian PoeticsDhavni Theory by Anandvardhana Indian Poetics
Dhavni Theory by Anandvardhana Indian PoeticsDhatriParmar
 
UNIT I Design Thinking and Explore.pptx
UNIT I  Design Thinking and Explore.pptxUNIT I  Design Thinking and Explore.pptx
UNIT I Design Thinking and Explore.pptxGOWSIKRAJA PALANISAMY
 
HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...
HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...
HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...Nguyen Thanh Tu Collection
 
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...Nguyen Thanh Tu Collection
 
THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...
THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...
THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...Subham Panja
 
ASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in Pharmacy
ASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in PharmacyASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in Pharmacy
ASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in PharmacySumit Tiwari
 
Quantitative research methodology and survey design
Quantitative research methodology and survey designQuantitative research methodology and survey design
Quantitative research methodology and survey designBalelaBoru
 
Alamkara theory by Bhamaha Indian Poetics (1).pptx
Alamkara theory by Bhamaha Indian Poetics (1).pptxAlamkara theory by Bhamaha Indian Poetics (1).pptx
Alamkara theory by Bhamaha Indian Poetics (1).pptxDhatriParmar
 
LEAD6001 - Introduction to Advanced Stud
LEAD6001 - Introduction to Advanced StudLEAD6001 - Introduction to Advanced Stud
LEAD6001 - Introduction to Advanced StudDr. Bruce A. Johnson
 

Último (20)

BBA 205 BE UNIT 2 economic systems prof dr kanchan.pptx
BBA 205 BE UNIT 2 economic systems prof dr kanchan.pptxBBA 205 BE UNIT 2 economic systems prof dr kanchan.pptx
BBA 205 BE UNIT 2 economic systems prof dr kanchan.pptx
 
How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17
How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17
How to Customise Quotation's Appearance Using PDF Quote Builder in Odoo 17
 
The First National K12 TUG March 6 2024.pdf
The First National K12 TUG March 6 2024.pdfThe First National K12 TUG March 6 2024.pdf
The First National K12 TUG March 6 2024.pdf
 
AI Uses and Misuses: Academic and Workplace Applications
AI Uses and Misuses: Academic and Workplace ApplicationsAI Uses and Misuses: Academic and Workplace Applications
AI Uses and Misuses: Academic and Workplace Applications
 
Research Methodology and Tips on Better Research
Research Methodology and Tips on Better ResearchResearch Methodology and Tips on Better Research
Research Methodology and Tips on Better Research
 
PHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdf
PHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdfPHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdf
PHARMACOGNOSY CHAPTER NO 5 CARMINATIVES AND G.pdf
 
Problems on Mean,Mode,Median Standard Deviation
Problems on Mean,Mode,Median Standard DeviationProblems on Mean,Mode,Median Standard Deviation
Problems on Mean,Mode,Median Standard Deviation
 
t-test Parametric test Biostatics and Research Methodology
t-test Parametric test Biostatics and Research Methodologyt-test Parametric test Biostatics and Research Methodology
t-test Parametric test Biostatics and Research Methodology
 
ANOVA Parametric test: Biostatics and Research Methodology
ANOVA Parametric test: Biostatics and Research MethodologyANOVA Parametric test: Biostatics and Research Methodology
ANOVA Parametric test: Biostatics and Research Methodology
 
The OERs: Transforming Education for Sustainable Future by Dr. Sarita Anand
The OERs: Transforming Education for Sustainable Future by Dr. Sarita AnandThe OERs: Transforming Education for Sustainable Future by Dr. Sarita Anand
The OERs: Transforming Education for Sustainable Future by Dr. Sarita Anand
 
3.14.24 Gender Discrimination and Gender Inequity.pptx
3.14.24 Gender Discrimination and Gender Inequity.pptx3.14.24 Gender Discrimination and Gender Inequity.pptx
3.14.24 Gender Discrimination and Gender Inequity.pptx
 
Dhavni Theory by Anandvardhana Indian Poetics
Dhavni Theory by Anandvardhana Indian PoeticsDhavni Theory by Anandvardhana Indian Poetics
Dhavni Theory by Anandvardhana Indian Poetics
 
UNIT I Design Thinking and Explore.pptx
UNIT I  Design Thinking and Explore.pptxUNIT I  Design Thinking and Explore.pptx
UNIT I Design Thinking and Explore.pptx
 
HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...
HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...
HỌC TỐT TIẾNG ANH 11 THEO CHƯƠNG TRÌNH GLOBAL SUCCESS ĐÁP ÁN CHI TIẾT - HK2 (...
 
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
BÀI TẬP BỔ TRỢ TIẾNG ANH 11 THEO ĐƠN VỊ BÀI HỌC - CẢ NĂM - CÓ FILE NGHE (GLOB...
 
THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...
THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...
THYROID HORMONE.pptx by Subham Panja,Asst. Professor, Department of B.Sc MLT,...
 
ASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in Pharmacy
ASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in PharmacyASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in Pharmacy
ASTRINGENTS.pdf Pharmacognosy chapter 5 diploma in Pharmacy
 
Quantitative research methodology and survey design
Quantitative research methodology and survey designQuantitative research methodology and survey design
Quantitative research methodology and survey design
 
Alamkara theory by Bhamaha Indian Poetics (1).pptx
Alamkara theory by Bhamaha Indian Poetics (1).pptxAlamkara theory by Bhamaha Indian Poetics (1).pptx
Alamkara theory by Bhamaha Indian Poetics (1).pptx
 
LEAD6001 - Introduction to Advanced Stud
LEAD6001 - Introduction to Advanced StudLEAD6001 - Introduction to Advanced Stud
LEAD6001 - Introduction to Advanced Stud
 

Psycho cutaneous disorders

  • 2. INTRODUCTION  Psychodermatology or psychocutaneous medicine encompasses disorders prevailing on the boundary between psychiatry and dermatology.  Approximately 30-40% patients seeking treatment for skin disorders have an underlying psychiatric or a psychological problem that either causes or exacerbates a skin complaint.
  • 3.  Skin–psyche interactions:- An essential component of dermatological illness is relationship that somatic dermatology has to psychological status of sufferer at time.  The influence that these psychological, psychosocial and sometimes psychiatric factors play can be conveniently assessed as: 1. 2. 3. 4. Multifactorial dermatological disorders which can be substantially influenced by psychological factors, e.g. psoriasis Dermatological disorders as a result of psychiatric illness, e.g. factitious dermatoses, body dysmorphic disorder Psychiatric illness developing as a result of skin disease, e.g. depression, adjustment disorder Co-morbidity with another psychiatric disorder, e.g. alcoholism
  • 4. Stigma  Term describes situation of an individual who is disqualified from full social acceptance.  Commonest dermatological situations where stigma is encountered may be:1. Physical deformities:Congenital naevae, e.g. port-wine stain II. Acquired deformities from developmental disorders, e.g. tuberose sclerosis III. Widespread inflammatory skin disease. IV. Surgical or post-traumatic deformities I.
  • 5. Implications of inferred character deficiencies:- 2. I. II. III. IV. V. VI. VII. Psychiatric disorder, i.e. their views on the skin disease are disqualified because they also have a psychiatric diagnosis Learning disability, i.e. they have limited emotional capacity to respond to their dermatosis, e.g. Down’s syndrome Persistent treatment non–compliance, i.e. an assumption of a fickleness of character, e.g. depressive illness Alcoholism and drug addiction, e.g. the cutaneous signs of substance abuse are a labelling of character weakness Unemployment Imprisonment HIV status
  • 6. 3. Stigma of: Race, e.g. implications of vitiligo for marriage  Religion, e.g. allowing the naked body to be seen by a stranger
  • 7. Classification A. Psychiatric disorders without significant dermatological disease:Delusional syndromes:- 1. i. ii. iii. iv. v. Parasitosis Smell Impregnation and contamination Folie à deux Other hypochondriasis, e.g. so-called Morgellons
  • 8. B. Disorders of awareness of the body:1. Phobias and obsessive compulsive disorders:i. ii. iii. iv. v. vi. vii. Disorders of body image:- body dysmorphic disorder (BDD) (synonyms dysmorphophobia, dermatological non-disease) Disturbance of body size and eating:- e.g. anorexia nervosa, bulimia Phobias:- mole phobia, venereophobia, wart phobia, erythrophobia, electrophobia and steroid phobia Obsessive–compulsive behaviours:- hand washing, hair plucking Atypical pain disorders:- glossodynia, vulvodynia and scrotodynia, anodynia Pruritis sine materia Other dermatologic hypochondriases:- botoxophilia, tanorexia
  • 9. Mental disorders and dermatological disorders:- B. Classical psychosomatic disorders:-Dermatoses in which emotional precipitating or perpetuating factors may be important:- 1. i. ii. iii. iv. v. vi. vii. viii. ix. x. Vesicular eczema of palms and soles AD Seborrhoeic dermatitis Psoriasis Some cases of localized or generalized pruritus AA Aphthosis Flushing reactions and rosacea Hyperhidrosis Urticarias. 2. Dermatoses primarily factitious in origin:Dermatitis factitia Artefact by proxy Witchcraft syndrome Dermatological pathomimicry v. Dermatitis simulata vi. Malingering vii. Compensation neurosis viii. Münchausen’s syndrome ix. Fabricated and induced illness (Münchausen’s syndrome by proxy) x. Deliberate self-cutting xi. Self-mutilation i. ii. iii. iv.
  • 10. 3. Dermatoses in association with harmful habits and compulsions:i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. Lichen simplex Neurotic excoriations Prurigo nodularis Acne excoriée Hair plucking Trichotillomania Trichophagia Nail destruction Onychotillomania Lip-licking cheilitis Knuckle biting The psychogenic purpura syndromes 4 i. ii. iii. iv. 5. 6. Autoerythrocyte sensitization (Gardner–Diamond syndrome) Autosensitivity to DNA Psychogenic purpura (idiopathic) Stigmata Disorders of neglect of selfcare (synonym Diogenes syndrome) Drug-dependence syndromes i. ii. Alcohol-related syndromes Substance abuse
  • 11. 7. Mental disorders due to dermatological treatment i. ii. 8. Cortisone psychosis Interferon depression iii. Lithium-induced psoriasis Tranquillizer hyperpigmentation Anti-depressant hyperhidrosis Dual non-associated disease, dermatological and psychiatric i. ii. disorders Skin cancer in patients with major psychosis Dermatological patients with psychic symptoms not amounting to a disorder:i. ii. iii. Dermatological disorders due to psychopharmacological treatment:i. ii. 9. C. D. ‘Troublesome patients’ Dysthymic responses to illness Cosmetology associated worries Group and mass population reactions:i. ii. Sick building syndrome Epidemic hysteria
  • 12. Delusions of parasitosis:- unshakeable conviction that his or her skin is infested by parasites.  Causes: Neurological: Cerebrovascular disease, Dementia and neurodegenerative diseases, Parkinson’s disease, Huntingdon’s disease, CNS tumours, Head injury, Encephalitis, Meningitis, Multiple sclerosis, Learning disability,  Cardiovascular disorders: Arrhythmias, Heart failure, Coronary artery bypass  Renal disease:- CRF, Dialysis  Liver disease:- Hepatitis  Endocrine disease: Diabetes mellitus, Hyperthyroidism, Hypothyroidism, Panhypopituitarism, Hypoparathyroidism, Acromgaly,  Nutritional disorders:  Pellagra ,Folate deficiency, Vitamin B12 deficiency, Anorexia nervosa
  • 13.  Infectious diseases:- Syphilis, AIDS, Tuberculosis (pulmonary), Leprosy  Malignancy:- Breast cancer, Colon cancer, Lung cancer, Lymphoma, CLL.  Substance abuse:- Amphetamines, Cannabis, Cocaine, Ecstasy, Opiates.  Medicines:- Corticosteroids, Ciprofloxacin, Mefloquine.
  • 14.  Monosymptomatic hypochondriacal psychosis.  Middle aged/elderly females .  Visual and tactile hallucinations of parasites crawling, burrowing, and biting all over their body.  Excoriations are usual and, sometimes, extensively produced in an attempt to extricate organism.
  • 15. Management  Patients with anxiety, social isolation or depression:-      psychotherapy, or antidepressants such as doxepin, citalopram or venlafaxine. Pimozide:- initial dose 2 mg, is increased weekly by 2 to a maximum of 12 mg daily. Sulpiride:- 200–400 mg/day Amisulpride:Respiridone:-1–8 mg/day Olanzapine in small doses
  • 16.  Bromidrosiphobia:- A/K Delusions of smell  M:F= 4-5: 1  Most patients complain that smell comes from groin or sometimes armpit.  Other beliefs:- Flatus, halitosis  Organic syndromes:-cerebral tumours, epilepsy, alcoholism and substance abuse  T/t:- Psychotherapy, antidepressants and antipsychotics.
  • 17.  Morgellons syndrome:-Fibre-like filaments, granules and crystals that appear on or under the skin lesions
  • 18. Disorder of Body Image  BODY DYSMORPHIC DISORDER –  A patient is preoccupied and distressed with an imagined defect in appearance or an excessive concern over a trivial defect.  BDD is defined in DSM-IV and classified as a somatoform disorder.  There is an underlying co-morbid mental disorder including mood disorders such as depression, OCD, social phobia, and/or avoidant personality disorder.  Most patients are females in their 30's.  These patients are rich in symptoms, while poor in signs of organic skin disease.
  • 19.  Complaints related to mainly face, breast, hair, nose, and stomach, while men presented with concern related to hair, nose, ear, genitals, and body build.  Distress, poor self esteem, and impairment in social, occupational, and domestic functioning.  Repetitive compulsive behavior to hide their imaginary/trivial defect.  BDD patients are doctor shoppers, they repeatedly undergo procedures to find solution for their flaws and majority are dissatisfied with results and consultation.  Suicidal ideation and suicide attempts are common in BDD patients.
  • 20.  Treatment: SSRIs:- 50% of patients may respond completely or partially .  clomipramine  fluoxetine 50 mg/day and fluvoxamine260 mg/day for 2- 4 months  Venlafaxine 37.5 mg/day for 1 year  Cognitive behavioural therapy
  • 21. Anorexia nervosa and bulimia  Definitions:- Anorexia nervosa must satisfy the criteria for:1. 2. 3. An inability to maintain the normal or minimum weight for age and height coupled with an intense fear of gaining weight; the BMI is less than 17.5 kg/m2 A distorted perception of weight, size and body configuration- essential features Amenorrhoea  Bulimia nervosa is defined by the following: 1. 2. 3. 4. Recurrent and compulsive overeating episodes (binge eating) Recurrent and inappropriate compensatory behaviour in order to avoid gaining weight; these include induced vomiting and abuse of diuretics and laxatives Binge eating and weight reduction behaviours occurring at least twice per week for 3 months Self-esteem affected by weight and body configuration.
  • 23. Harmful cutaneous habits  Lichen simplex and neurodermatitis:-Lichenification     describes characteristic pattern of response of predisposed skin to repeated rubbing. Treatment:- antihistamines, TCA doxepin in doses as low as 25–50 mg/day thalidomide 50–100 mg/daily for up to 2 months Pathological skin picking(Dermatotillomania):recurrent picking accompanied by visible tissue damage and functional impairment. Clinical features:-lesions are polymorphic, newer lesions are angular excoriated erosions with a serosanguineous crust.
  • 24.  Healing with erythematous, white and atrophic centrally and commonly hypertrophic and hyperpigmented at the periphery  Site:-face, hair margins, sides of neck, chin, upper chest, shoulders, upper arms and thighs.  Management:-supportive     psychotherapy Cognitive behavioural therapy Compulsive nature of disorder:antidepressants:-SSRI A-B-C model of habit disorders, that is Affect regulation, Behavioural regulation and Cognitive control Lamotrigine
  • 25. Acute excoriations and chronic, scarred, atrophic lesions due to pathological picking on face, neck and shoulders Acne excoriee
  • 26.  Trichotillomania:-term was first used by Hallopeau in 1889  derived from the Greek thrix hair, tillein pull out and mania madness.  Morbid craving to pull out hair.  Revised DSM-IV diagnostic criteria:a. b. c. d. e. Recurrent pulling out of one’s own hair resulting in hair loss An increasing sense of tension immediately before pulling out hair or when attempting to resist behaviour Pleasure, gratification or relief when pulling out the hair Disturbance is not better accounted for by another mental disorder and Disturbance provokes clinically marked distress and/or impairment in occupational, social or other areas of functioning.
  • 27.  C/F:-short, irregular, broken and distorted hair.  plucking activity are centrifugal from a single starting point or linear, in wave-like activity.  Trichobezoar and the Rapunzel syndrome:-balllike aggregations of fibre-like materials( hair) in stomach and small intestine.  Swallowed hair is retained within folds of gastric mucosa. Trichotillomania
  • 28.  Investigations: Scalp biopsy: normally hairs amongst empty hair follicles in a noninflamed dermis.  Follicular plugging with keratin debris is evident.  deep distortion and curling of hair bulb.  Barium contrast and CT scan:-gastrointestinal bezoars  Management:-cognitive behavioural therapy (CBT) is effective alone and combined CBT and TCA or SSRIs.  Clomipramine more useful than SSRI alone.
  • 29. Psychogenic Pruritus  Psychogenic pruritus (PP) is a poorly defined entity in      which the patient has intractable or persistant itch, not ascribed to any physical or dermatological illness. Pruritic episodes are unpredictable with abrupt onset and termination, predominantly occurring at the time of relaxation. PP can be generalized or localized. The commonest sites of predilection are legs, arms, back, and genitals. A significant number of patients have associated anxiety and or depression. Detailed cutaneous and systemic examination and routine baseline investigation should be performed to rule out cutaneous and systemic causes of pruritus before diagnosing PP.
  • 33. Cutaneous phobias Fear of contamination, e.g. dirt phobia, germ phobia, wart phobia 2. Fear of malignancy, e.g. cancer phobia, mole phobia 3. Fear of emotional display, e.g. blushing, sweating 1.
  • 34. Factitious skin disease  DSM-IV-TR criteria:1. Intentional feigning of physical or psychological signs or symptoms 2. Motivation is to assume the sick role 3. External incentives for behaviour (such as economic gain, avoiding legal responsibility, or improving physical well-being, as in malingering) are absent.
  • 35.  Dermatitis factitia:- caused entirely by actions of fully aware (i.e. not consciously impaired) patient on the skin, hair, nails or mucosae.  F>m, children, from age of 8 years, pre-pubertal children having an equal sex ratio, rising to 3 : 1 female predominance in early teens  Etiology: psychosocial stress of a major life  neurotic and react to adverse situations in an immature, impulsive manner.  Depression  personality disorder:-borderline or hysterical in females and paranoid in males
  • 36.  C/F:- 2 characteristics:1. physical signs 2. fabricated story that accompanies it  patient often describes :  Sudden appearance of lesions with little or no prodrome.  No complete description of genesis of individual skin lesions.
  • 37.  Clinical signs: Commonest site are face (cheeks) in 50% children, Dorsa of     hands, forearms most frequently of non-dominant limb, mostly on covered skin lesions are polymorphic, bizarre, clearly demarcated from surrounding normal skin and can resemble many inflammatory reactions in skin crude, angulated, destructive processes with a tendency to a linear configuration, Circular erosions or blisters of a uniform size, as result of thermal, chemical or instrumental injury Secretan’s syndrome:-Oedema of limbs from constricting bands and hysterical dependent posture has been described.
  • 38.  Drip-sign:- corrosive liquids.  Excoriations:- nail files, sanding boards, cheese graters or wire     brushes Punched out necrotic areas:- cigarettes, soldering irons Dramatic dermal induration and necrosis occur from foreign body injection of milk, oil, or grease into breasts, thighs, abdomen and penis . The other common presentation is chronic, non-healing infected wounds. A patient is unable to provide clear history of evolution of the lesions and typically denies any role in the production of the lesions.
  • 41.  Witchcraft syndrome:- Artefact dermatitis can be provoked on an unknowing and unsuspecting victim by proxy.  Dermatological pathomimicry:- patients may intentionally aggravate an existing dermatosis using explanation of its genesis given by their dermatologist  Atopic patients reintroduced allergens
  • 42. Factitious cheilitis due to repeated lip sucking. Factitious nail disease
  • 43. Dermatitis passivata  Young Diogenes syndrome; accretions of facial keratin and debris
  • 44. Secondary Psychiatric Disorders  Skin problems, especially chronic skin diseases, affecting exposed body parts because of the visibility and resultant disfigurement lead to embarrassment, depression, anxiety, poor self image, low self esteem, and suicidal ideation in the patients.  Also, patients have to commonly face social isolation and discrimination and, at times, have difficulty getting jobs.  Many patients are able to cope up with the disease while few develop secondary psychiatric morbidity.
  • 45.  Dermatologist should look into this aspect of chronic disfiguring dermatoses.  If the dermatologist suspects significant secondary psychological morbidity then interrogation, counseling, psychiatric referral should b done.
  • 46. Management of Psychocutaneous Patients  Most of the patients with psychocutaneous disorders can be broadly categorized under four diagnoses: (a) Anxiety, (b) depression, (c) psychosis, (d) OCD.  The choice of a psychotropic medication is based primarily on the nature of the underlying psychopathology.
  • 47. Anxiety  Therapeutic modalities for anxiety include BDZ, non-BDZ, and CBT.  Risk of dependence on BDZ is quite high; hence, they are indicated only for short-term treatment (2-4 weeks) for severe and disabling symptoms and should be avoided in milder forms.  Non-BDZ used in the treatment of anxiety are selective SSRIs (citalopram escitalopram, paroxetine), serotoninnorepinephrine reuptake inhibitors (SNRIs) (venlafaxine XL, duloxetine), antihistamines (hydroxyzine), betablockers (propranolol), and the antiepileptic pregabalin.
  • 48. Depression  In mild symptoms, watchful waiting or CBT is recommended.  Moderate symptoms can be managed with SSRI and CBT.  In cases with severe symptoms and suicidal ideation admission, antidepressants with possibly electroconvulsive therapy (ECT) are recommended.
  • 49. Antipsychotics  Antipsychotics are used in the therapy of psychocutaneous disorders such as delusions of parasitosis, dermatitis artefacta, and monosymptomatic hypochondriasis.  The goal of the dermatologist is not to relieve the patients of their delusion, but to help them function better with the delusion.
  • 50. Obsessive Compulsive Disorder  Disorders like BDD and impulse control disorder (acne excoree, trichotillomania, onychotillomania, neurodermatitis) are treated on the lines of OCD.  Develop insight into the etiology of their problem, they are more amenable to see a psychiatrist and engage in nonpharmacological management (CBT).  For patients who are unwilling or unable to initiate behavioral modification, pharmacological therapy can be helpful.  Currently, three SSRIs-fluoxetine, paroxetine, and sertraline-are the first-line therapy for the management of OCD.
  • 51. Non-Pharmacological Treatments  There is a significant psychosomatic/behavioral component in many dermatologic conditions hence complementary non-pharmacological psychotherapeutic interventions 1. biofeedback 2. CBT 3. hypnosis 4. placebo  Have positive impacts on many dermatologic disorders.
  • 52. Biofeedback  Biofeedback is a non-invasive conditioning technique with wide applications in the field of medicine.  Biofeedback training encompasses a wide variety of progressive muscle-relaxing techniques, autogenic training, imagery techniques, transcendental, and other meditation techniques as well as other relaxation-directed programs (i.e., breathing techniques, self-talk, and others).  Relaxation training is primarily directed at minimizing sympathetic reactivity and enhancing parasympathetic function.
  • 53. Cognitive Behavioral Therapy  CBT deals with dysfunctional thought patterns (cognitive) or actions (behavioral) that damage the skin or interfere with dermatologic therapy . Hypnosis  Hypnosis is an intentional induction, deepening, maintenance, and termination of a trance state for a specific purpose.  Hypnotic trance can be defined as a heightened state of focus that can be helpful in reducing unpleasant sensations (i.e., pain, pruritus, dysesthesias), while simultaneously inducing favorable physiologic changes.