Printer Friendly

The psychiatric burden of chronic dermatological diseases/ Aspectele psihiatrice ale afectiunilor dermatologice cronice.

INTRODUCTION

Skin, the largest organ of our body, is one of the major paths through we perceive the world and has a major effect on our body image. The interface of dermatology and psychiatry has many long-recognized conditions recently rediscovered and have lead to the appearance of a new term in the medical field--psychodermatology. The term addresses to the interaction between mind and skin, connecting internal, psychiatric disorders with external, dermatological disorders.

The association between chronic dermatological disorders and psychiatry runs both ways and the scientific advances help us to understand these pathologies as well as manage them from a different point of view. It is estimated that between 20% and 40% of patients seeking treatment for different skin lesions have some psychiatric or psychological problems that are closely linked with the skin issue (1).

We all react differently to stressful situations, and some patients develop tics that make them pinch their skin, especially the hands, forearms and face, tics that help them overcome a certain situation easier.

Women are especially prone to these manifestations, representing two thirds of the patients that present to the dermatologist with self-inflicted skin lesions, such as excoriations and pinches (2).

The predominant symptom in dermatology, pruritus, is one of the issues that have a significant effect on patients' quality of life and correlates negatively with sleep, attention and sexual function. It is defined as an unpleasant cutaneous sensation which leads to an imperious urge to scratch, all human beings experiencing this sensation in the course of their life time (3).

Pruritus can be divided into two types: acute and chronic. According to the International Forum of the Study of Itch, pruritus chronicus is defined as "an itch that lasts for six weeks or more and it is known to have strong psychogenic elements".

The relationship between skin and the central nervous system can be divided into two important pathways:

* primary psychiatric disorders associated with skin lesions;

* primary dermatologic disorders that are associated to psychological changes.

The first category is the best represented and includes many well defined psychiatric conditions, such as: delusion of parasitosis (DOP), body dysmorphic disorder (BDD) or factitious disorders (dermatitis artefacta, trichotillomania, neurotic excoriations) (4).

Anxiety, depression and certain personality types have been also shown to be associated with skin symptoms, such as: hyperhidrosis, pruritus, picking or excoriations disorders. It is believed that about 90% of these psychiatric patients are first seen by the dermatologist (5, 6).

DOP is the most frequent monosymptomatic hypochondriacal psychosis encountered by dermatologists. It is also known as acarophobia, delusional infestation, psychogenic parasitosis or Ekbom syndrome.

The patients suffering from DOP have a false fixated belief of being infested with parasites, the female/male ratio is about 2/1 and their symptoms go back months or even years before consulting a doctor.

DOP occurs more often in patients over 50 years old and the prevalence is higher in less-educated patients or in those with a lower socioeconomic status. Regarding the cutaneous findings, they range from none to pruritus with excoriation or lichenification, prurigo nodularis or real ulcerations post scratching. It is important to consider the differential diagnosis for DOP. The first differential diagnosis is formication. Formication is a tactile hallucination described as "something creeping on or under the skin". It is often associated with cocaine abuse, but, unlike DOP patients, those with formication do not believe that their symptoms are due to a parasite infestation.

The second differential diagnosis for DOP is represented by delusions, secondary to substance abuse (amphetamines). The third and the fourth differential diagnosis is a real skin disorder--scabies incognito or Groover disease. Conditions such as: liver failure, renal failure, obstructive jaundice, HIV/AIDS must also be considered.

BDD, also known as body dysmorphia, is a relatively common psychiatric condition, characterized by an excessive preoccupation with a presumed flaw regarding the physical appearance. Such patients often come to a cosmetic dermatologist in order to solve "the problem", in fact, the dermatologist appears to be the physician most likely to be seen by people with BDD (7).

Other problems in BDD are: compulsive skin picking with labels--"dermatilomania" and "neurotic excoriation", hair concerns--"hair loss and fear of going bald", "excessive facial hair", "too much or too little body hair".

Schizophrenia may exhibit tactile hallucinations, leading to skin problems. Many patients experience so-called "pleasurable-pain"--term used to describe the process of scratching an itch which by themselves, which produces an immediate relief and reduces the inner tension.

If we look for the term "psychogenic pruritus" in DSMIV, we will not find it, but we could integrate the term into disorders, such as: unspecified or undifferentiated somatoform disorder, pain disorder associated with psychological factors, or conversion disorder.

Patients with schizophrenia, for example, which may believe that they are attacked by insects as a consequence of their paranoid delusions, can suffer from itching and present themselves with post scratching injuries.

Factitious disorders are defined as self-injuring acts which lead to clinical damage of the organism. There is no intention of suicide, the main goal is hospital admission or medical/surgical measures.

Trichotillomania, a mental illness, is characterized by repetitive pulling of hair. The most commonly affected body areas include: the scalp, resulting alopecia, the eyebrows or the pubic hair.

Dermatitis artefacta is a form of factitious disorder, an intentional self-inflicted dermatitis difficult to diagnose. The patient, intentionally, feigns symptoms and produces signs of disease in attempt to assume a role in a specific disease. The skin lesions may vary from superficial erosions or excoriations to deep necrosis, ulceration and scars.

Neurotic excoriations are also a condition in which the patients induce cutaneous lesions through repetitive, compulsive excoriations of their skin. Such patients describe significant itching leading to persistent scratching. On clinical examination, the lesions are distributed in areas that he/she can reach, namely the face and extremities.

A Greek study presented at the European Association of Dermatology and Venerology (EADV) Congress in Istanbul concluded that patients with neurodermatitis showed higher scores on the Hospital Anxiety and Depression Scale on the Leyton-Trait Scale for compulsive behaviours.

In the second category we find chronic dermatological diseases, such as: psoriasis, acne excoriee, alopecia, atopic dermatitis, chronic forms of urticaria, endogenous eczema, prurigo nodularis, Darier's disease, lichen simplex chronicus, recidivant herpes simplex infection etc.

Both laboratory and clinical studies have revealed a close connection among these dermatological conditions and the severity of depression or anxiety (8). It has been reported that up to 30% of people with psoriasis develop depression at some point (9).

Acne excoriee is frequently found in young women and is a habitual act of picking the skin lesions. It is driven by compulsion and psychological factors independent of acne severity.

Physical appearance is an important link that connects people in society, and alopecia may negatively affect the patients' self-confidence as well as their social or private life.

In approximate 70% of atopic dermatitis patients was found that stressful live events had preceded the onset of the disease (10).

Patients with hyperhidrosis have social phobic and avoidance symptoms because of excessive sweating when emotional stimuli are present.

Emotional stress may also exacerbate chronic urticaria and the severity of pruritus appears to intensify as the depression becomes more severe (11).

Herpes zoster and herpes simplex infections are strongly connected with stress. Buske et al. demonstrated that experimentally induced stress leads to herpes simplex virus reactivation. Patients with chronic child abuse and severe psychological stress are also strongly related to herpes zoster diseases.

The psychogenic pruritus incidence among dermatologic clinics is estimated to be about 2%. It is usually a diagnosis of exclusion and is frequently considered as idiopathic pruritus (12).

It is more common in women and the main sites affected are the scalp and the face (13).

Regarding the clinical classification of pruritus, it includes four major categories, noting that in many patients more that one category can coexist (14):

* pruritus generated in the skin (urticaria, atopic dermatitis, scabies)

* pruritus generated in the central nervous system as a response to circulating pruritogens (chronic renal failure, cholestatic jaundice)

* neuropathic pruritus as a result of anatomic lesions of the central or peripheral nervous system (notalgia paraesthetica, herpes zoster, brachioradial pruritus)

* pshychogenic pruritus which is considered psychiatric in origin (delusional parasitosis).

For the first time in 2007, The French Psychodermatology Group proposed three main criteria for psyhcogenic pruritus: the absence of somatic cause, pruritus sine materia and pruritus that lasts for more than six weeks.

Chronic pruritus has many similarities to chronic pain: both can seriously affect the quality of life and both are accompanied by unpleasant sensations (15).

The traditional choice of treatment is antipsychotic medication. Ideally, these patients should be treated by two specialists: a dermatologist and a psychiatrist. Unfortunately, most of them refuse to receive a mental health professional treatment, because they do not consider having a cause of psychiatric nature.

Body dismorphic disorder is a relatively common disorder, with an incidence in general population between 0.7 and 2.4%.

Scratching, an acute reaction to pruritus, allows penetration of allergens and microbial antigens which can lead to infection and micronial eczema.

In many cases, general aspects of therapy used in dermatological problems include psychiatric medication such as anxiolytics, antidepressants, antipsychotics.

Anxiolytics (lorazepam, clonazepam, buspirone) and antidepressants (serotonin reuptakeinhibitors or tricyclic antidepressants) have an antipruritic effect and have been well documented in many controlled studies (16, 17).

Other classes of drugs, opiate receptor antagonists and anticonvulsivants (carbamazepine, pregabalin, gabapentin) have also been suggested as possible therapy in dermatological symptoms as pruritus (18).

It is necessary that the dermatologists ensure their colleagues, the psychiatrists, about the psychological burdens imposed by chronic skin diseases and work together in order to choose the right therapy.

CONCLUSIONS

The interface between psychiatry and dermatology has recently experienced major changes and has introduced a new term used in literature, namely psychodermatology. The purpose of this paper is to provide a background involving the psychosomatic aspects of chronic skin disorders and to highlight the constant interaction between psychological aspects and clinical manifestation, of skin diseases.

ACKNOWLEDGMENTS AND DISCLOSURE

This study was financially supported by the "Program of excellence in multidisciplinary doctoral and postdoctoral research regarding chronic diseases" (POSDRU 159/1.5/S/133377), "Grigore T. Popa" University of Medicine and Pharmacy, Iasi.

REFERENCES

(1.) Gupta, M. A., Psychocutaneous disease, Dermatol Clin 4:591, 2005

(2.) American PA, Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Washington D. C., American Psychiatric Association; 2013

(3.) Stander, S., Weisshaar, E., Mettang, T. et al, Classification of itch: a position paper of the International Forum for the Study of Itch, Acta Derm Venerol, 2007, 87: 291-294

(4.) Wolf, Klaus, Goldsmith, Lowell A., Katz, Stephen I., Gilchrest, Barbara A., Paler, Amy S., Leffell, David J., Fitzpatrick's Dermatology in General Medicine, 7th edition, 2010, vol. 1: 912-921

(5.) Freudenmann, R. W., Lepping, P., Delusional infestation, Clin Microbiol Rev 2009; 22:690-732

(6.) Buske-Kirschbaum, A., Ebrecht, M., Kern, S. et al., Personality characteristics and their association with biological stress responses in patients with atopic dermatitis, Dermatol Psychosom, 2004; 22:12-16

(7.) Phillips, K. A., Dufresne, R. G., Jr, Wilkel, C., Vittorio, C., Rate of body dysmorphic disorder in dermatology patients, J Am Acad Dermatol., 2000; 42:436-41

(8.) Uhlenhake, E., Yentzer, B. A., Feldman, S. R., Acne vulgaris and depression: a retrospective examination, J Cosmet Dermatol, 2010, 9:59-63

(9.) Moon, H.--S., Mizara, A., McBride, S., Psoriasis and psycho-dermatology, Dermatol Ther., 2013; 3:117-130

(10.) Faulstich, M. E., Williamson, D. A., An overview of atopic dermatitis: towards bio-behavioral integration, J Psychosom Res 1985; 29:415-417

(11.) Hashiro, M., Okumara, M., Anxiety, depression, psychosomatic symptoms and autonomic nervous function in patients with chronic urticaria, J Dermatol Sci., 1994; 8:129-135

(12.) Arnold, L. M., Auchenbach, M. B., Mc Elroy, S. L., Psychogenic excoriation. Clinicalfeatures, proposed diagnostic criteria, epidemiology and approaches to treatment, CNS Drugs, 2001; 15(5): 351-359

(13.) Mazeh, D., Melamed, Y., Cholostoy, Y., Aharonovitzch, B., Weizman, A., Yosipovitch, G., Itching in the psychiatric ward, Acta Derm-Venerol., 2008; 88(2):128-131

(14.) Greaves, M. W., Khalifa, N., Itch--more than skin deep, Itch Arch Allergy Immunol., 2004, 135:166-172

(15.) Yosipovitch, G., Greaves, M. W., Schmelz, M., Itch, Lancet, 2003; 361:690-694

(16.) Zylicz, Z., Krajnik, M., Sorge, A. A. et al., Paroxetine in the treatment of severe non-dermatologicalpruritus: a randomized, controlled trial, Journal of Pain and Symptom Management, 2003; 26:1105-1112

(17.) Shaw, R. J., Dayal, S., Good, J., Bruckner, A., Joshi, S., Psychiatric Medications of the Treatment of Pruritus, Psychosomatic Medicine, 2007; 69 (9): 970-978

(18.) Zylicz, Z., Krajnik, M., Sorge, A. A., Costantini, M., Paroxetine in the treatment of severe non-dermatological pruritus: a randomized, controlled trial, J Pain Symptom Manage, 2003; 26 (6):1105-1112

Laura Gheuca-Solovastru--M. D., Ph. D., Associated Professor, Department of Dematology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania

Dan Vata--M. D., Ph. D., Assistant Professor, Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania

Laura Statescu--M. D., Ph. D., Assistant Professor, Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania

Elena Andrese--Ph. D. Student, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania

Correspondence:

DAN VATA

"Sf. Spiridon" University Hospital Iasi, Department of Dermatology Str. Ciurchi no. Ill, Iasi, Romania

Tel.: +40 741 084 264

E-mail: dan.vata@umfiasi.ro

Date of Submission: May, 30, 2014/ Acceptance: August, 22, 2014

INTRODUCERE

Pielea, cel mai mare organ al corpului nostru, este una dintre caile principale prin care noi percepem lumea inconjuratoare si are un efect major asupra imaginii noastre corporale. Interfata dintre dermatologie si psihiatrie are conturate multe afectiuni, recent redescoperite si care au contribuit la aparitia unui nou termen in limbajul medical--psihodermatologia. Termenul se adreseaza interactiunii dintre minte si piele, conectand afectiuni de tip psihiatric, fara manifestari somatice cu afectiuni dermatologice care prezinta leziuni externe tegumentare.

Asocierea dintre afectiuni cronice dermatologice si psihiatrie se desfasoara in ambele sensuri, iar noutatile stiintifice din domeniul medical ne ajuta atat in intelegerea acestor procese patologice, cat si in managementul lor privind lucrurile dintr-o alta perspectiva. Se estimeaza ca intre 20 si 40% dintre pacientii care necesita tratament pentru diverse leziuni cutanate au si probleme de ordin psihiatric sau psihologic care sunt intr-o stransa conexiune cu problema de pe piele (1).

Cu totii reactionam diferit in situatii stresante, iar unii dintre noi dezvolta ticuri, ce ii determina fie sa isi lezeze pielea, in special la nivelul mainilor, antebratelor si fetei, ticuri ce ii ajuta sa depaseasca o situatie mai speciala intr-un mod mai usor.

Femeile sunt in mod special mai predispuse sa dezvolte astfel de manifestari, atingand aproximativ doua treimi dintre pacientii care ajung la dermatolog cu leziuni auto-induse la nivelul pielii, cum ar fi excoriatiile sau piscaturile (2).

Simptomul predominat in dermatologie, pruritul, reprezinta o problema cu un efect important asupra calitatii vietii pacientilor si care se coreleaza negativ cu somnul, atentia sau desfasurarea activitatii sexuale. Este definit ca o senzatie neplacuta cutanata, care creeaza nevoia imperioasa de a se scarpina, fiecare om experimentand aceasta senzatie pe parcursul vietii sale (3).

Pruritul poate fi divizat in doua tipuri: acut si cronic. Conform International Forum of the Study of Itch, pruritul cronic este definit ca "senzatia de mancarime care dureaza sase saptamani sau mai mult si are in componenta sa elemente psihogenice puternice".

Relatia dintre piele si sistemul nervos central poate fi conturata pe doua cai importante:

* afectiuni psihiatrice primare asociate cu leziuni la nivel cutanat;

* afectiuni dermatologice primare ce se asociaza cu modificari de ordin psihic.

Prima categorie este cea mai bine reprezentata si include afectiuni psihiatrice bine definite, precum: delirul parazitozei (DOP), body dysmorphic disorder sau dismorfofobia (BDD) sau afectiunile false, pe care bolnavii cu afectiuni psihiatrice si le produc singuri--factitious disorders (dermatitis artefacta, tricotilomania, excoriatiile neurotice) (4).

Anxietatea, depresia si anumite tipuri de personalitate s-au dovedit, de asemenea, a fi asociate cu o simptomatologie cutanata, precum: hiperhidroza, pruritul, piscaturile din cadrul ticurilor crede ca aproximativ 90% dintre acesti pacienti psihiatrici sunt vazuti pentru prima data nervoase sau leziunile de tipul excoriatiilor. Se de catre dermatolog (5, 6).

DOP este cea mai frecventa psihoza monosimptomatica de tip hipocondrial intalnita de dermatologi. Este, de asemenea, cunoscuta si sub denumirea de acarofobie, infestatie deliranta, paraftozapsihogena sau sindrom Ekbom.

Pacientii suferinzi de DOP au falsa senzatie ca sunt infestati cu diversi paraziti, raportul femei/barbati fiind de aproximativ 2/1, iar simptomatologia acestora, de multe ori, aparand cu luni sau chiar ani inainte de a se consulta un medic. DOP apare, cel mai adesea, la persoanele de peste 50 de ani, iar prevalenta este mai mare printre cei mai putin educati sau printre cei cu un statut socio-economic mai scazut. In ceea ce priveste simptomatologia cutanata, aceasta poate varia de la asimptomatic pana la prezenta excoriatiilor post-grataj sau lichenificare, prurigo nodularis sau chiar ulceratii postgrataj. Ca urmare a acestei largi manifestari, este foarte important sa diferentiem diagnosticul de DOP de alte afectiuni. Primul diagnostic diferential trebuie facut cu o halucinatie de tip tactil, descrisa ca "ceva care se misca sub sau pe piele" si cunoscuta sub termenul englezesc de formication. Adesea acest tip de halucinatie se asociaza consumului de cocaina, dar, spre deosebire de DOP, pacientii nu au convingerea ca sufera de o infestare cu diversi paraziti.

Al doilea diagnostic diferential care trebuie facut pentru DOP este cel al halucinatiilor secundare abuzului de diverse substante (amfetamine).

Al treilea si al patrulea diagnostic diferential ar trebui sa fie o adevarata afectiune cutanata--scabia incognito sau boala Grover. Afectiuni precum insuficienta hepatica, insuficienta renala, icterul obstructiv, HIV-SIDA ar trebui, de asemenea, sa fie considerate.

BDD, cunoscuta si sub numele de dismorfie corporala, este o afectiune psihiatrica relativ comuna, caracterizata prin preocuparea excesiva legata de un presupus defect corporal. Astfel de pacienti ajung, adesea, la medicul dermatolog specializat pe cosmetologie pentru a le rezolva asa-zisa "problema"; de fapt, dermatologul se pare ca este medicul care vede majoritatea pacientilor suferinzi de BDD (7).

Alte probleme intalnite in BDD sunt: piscaturile pielii de tip compulsiv cu asocieri de tipul dermatilomania si excoriatiile de tip neurotic, afectiuni la firului de par--"pierderea parului si frica de a dezvolta chelie", "exces de par facial", "prea mult sau prea putin par corporal".

Pacientii cu schizofrenie pot dezvolta halucinatii de tip tactil, ce conduc, in cele din urma, la probleme de ordin cutanat. Multi pacienti experimenteaza asa-zisa "placuta placere", termen utilizat pentru a descrie procesul de scarpinare ce urmeaza senzatiei de mancarime si care ii produce pacientului o senzatie de usurare imediata si reducere a tensiunii interioare.

Daca suntem mai atenti la termenul de "prurit psihogenic", in DSM-IV nu-l putem gasi, dar am putea oare sa il integram in afectiuni precum cele somatoforme nediferentiate, afectiuni dureroase asociate cu factori psihologici sau afectiuni disociative de conversie.

Spre exemplu, pacientii cu schizofrenie, care cred ca sunt atacati de insecte, ca o consecinta a halucinatiilor, pot experimenta senzatia de mancarime si se pot prezenta cu leziuni de tip post-grataj.

Patomimia este definita ca o afectiune in care bolnavul isi produce singur leziuni cu scopul de a simula o anumita afectiune. Nu exista intentia de suicid, scopul primordial fiind internarea intr-o institutie medicala sau accesul la diverse manevre medicale/chirurgicale.

Tricotilomania este o afectiune psihica caracterizata prin smulgerea repetitiva a parului. Cele mai afectate parti ale corpului sunt scalpul, rezultand alopecie, sprancenele sau parul pubian.

Dermatitis artefacta este o forma de patomimie, o afectiune auto-indusa, dificil de diagnosticat. Pacientul, in mod intentionat, mimeaza anumite simptome si isi produce leziuni cu scopul de a mima o anumita boala. Leziunile de la nivel tegumentar variaza de la eroziuni superficiale sau excoriatii pana la necroza cutanata, ulceratii si cicatrici reziduale.

Excoriatiile neurotice sunt, de asemenea, o afectiune in cadrul careia pacientii isi induc leziuni de tip cutanat prin piscarea sistematica a tegumentului. Astfel de pacienti descriu senzatia de prurit asociata cu nevoia imperioasa de a se scarpina. La examinarea clinica, leziunile sunt distribuite la nivelul zonelor accesibile, respectiv la nivelul fetei si extremitatilor.

Un studiu grecesc, prezentat la Congresul European al Asociatiei de Dermatologie si Venerologie din Istanbul a concluzionat ca pacientii cu neurodermatita prezinta un scor mai mare in Hospital Anxiety and Depression Scale de la nivelul Leyton--Trait Scale pentru afectiunile de tip compulsiv.

In cea de a doua categorie se gasesc afectiuni dermatologice cronice, precum psoriazisul, acneea excoriatica, alopecia, dermatita atopica, formele cronice de urticarie, eczema endogena, prurigo nodularis, boala Darier, lichen simplex chronicus, infectiile herpetice recidivante etc.

Atat studiile de laborator, cat si cele clinice au aratat o conexiune stransa intre afectiunile dermatologice si severitatea depresiei sau a anxietatii (8). S-a raportat ca pana la 30% din populatia ce sufera de psoriazis va dezvolta, la un anumit punct, depresie (9). Acneea excoriatica este frecvent intalnita la femeile tinere si se prezinta ca o afectiune in care persoana isi traumatizeaza, in mod repetitiv, leziunile cutanate. Este dominata de factori psihologici si tendinte compulsive, fara a avea o legatura directa cu severitatea leziunilor de acnee.

S-a demonstrat ca aproximativ 70% dintre pacientii suferinzi de dermatita atopica au trait un eveniment stresant inainte de exacerbarea bolii (10).

Pacientii cu hiperhidroza prezinta fobii de tip social si tendinte de evitare a interactiunii cu alte persoane din cauza transpiratiei in exces, atunci cand experimenteaza diverse trairi emotionale.

Stresul de tip emotional exacerbeaza, de asemenea, si urticaria cronica, iar severitatea pruritului se pare ca se intensifica odata cu accentuarea depresiei (11).

Zona zoster si herpesul simplex sunt strans conectate cu nivelul de stres. Buske et al. au demonstrat ca stresul indus experimental duce la reactivarea infectiei de tip herpetic. Pacientii care au suferit diverse abuzuri in copilarie si stari de stres psihologic sunt asociati cu zona zoster.

Incidenta pruritului psihogenic printre cazurile din clinicile dermatologice se estimeaza a fi aproximativ de 2%. In mod obisnuit este un diagnostic de excludere si de multe ori este considerat ca prurit idiopatic (12). Este mai frecvent intalnit la femei, iar localizarea principala este la nivelul scalpului si fetei (13).

In ceea ce priveste clasificarea din punct de vedere clinic a pruritului, aceasta contine patru mari categorii, cu mentiunea ca, la un singur pacient, putem intalni mai mult de o categorie (14):

* pruritul cu punct de plecare la nivelul pielii (urticaria, dermatita atopica, scabia);

* pruritul generat la nivelul sistemului nervos central, ca raspuns la circularea in sange a diverselor substante de tip pruritogen (insuficienta renala cronica, icterul colestatic);

* pruritul neuropatic ce apare ca raspuns la diferite leziuni ale sistemului nervos central sau periferic (notalgia paraesthetica, zona zoster, pruritul brachioradial);

* pruritul psihogenic, considerat a fi de origine psihiatrica (delirul parazitozei).

Pentru prima data in anul 2007, The French Psychodermatology Group a propus trei criterii majore pentru diagnosticarea pruritului psihogenic: absenta unei cauze somatice, pruritus sine materia si durata de peste sase saptamani.

Pruritul cronic are multe asemanari cu durerea de tip cronic: ambele au efecte puternice asupra calitatii vietii pacientului si sunt acompaniate de senzatii neplacute (15).

Alegerea conventionala a tratamentului este reprezentata de medicatia antipsihotica. Ideal, acesti pacienti ar trebui tratati de ambii specialisti: dermatolog si psihiatru. Din pacate insa, cei mai multi dintre ei refuza tratamentul profesional, deoarece considera ca nu sufera de o afectiune de natura psihica.

Scarpinatul, o reactie acuta la senzatia de mancarime, permite penetrarea alergenilor si a microbilor, fapt ce poate duce la aparitia eczemei microbiene.

In multe cazuri, variante ale terapiei dermatologice includ medicamente utilizate in psihiatrie, ca anxioliticele, antidepresivele sau antipsihoticele.

Anxioliticele (lorazepamul, clonazepamul, buspirona) si antidepresivele (inhibitorii recaptarii secretiei de serotonina sau antidepresivele triciclice) au un efect impotriva senzatiei de mancarime, efect documentat in multe studii clinice (16, 17).

Alte clase de medicamente, antagonistii receptorilor de opioizi si anticonvulsivantele (Carbamazepin, Pregabalin, Gabapentin) au fost propuse ca terapie dermatologica in cazurile asociate cu prurit (18).

Este necesara informarea de catre dermatolog a colegilor sai psihiatri despre efectele psihiatrice pe care le pot avea afectiunile cronice der matologice si colaborarea in cadrul celor doua specialitati in alegerea terapiei adecvate in astfel de cazuri.

CONCLUZII

Interfata dintre psihiatrie si dermatologie a experimentat recent schimbari majore care au condus la introducerea unui nou termen in literatura de specialitate, psihodermatologia. Scopul acestui articol este sa aduca un fundal nou pentru aspectele psihosomatice ale bolilor dermatologice si sa evidentieze interactiunea constanta dintre aspectele psihologice si manifestarile de la nivel tegumentar.

MULTUMIRI SI DEVOALARI

Aceasta lucrare a beneficiat de suport financiar prin proiectul "Program de excelenta in cercetare doctorala sipostdoctorala multidisciplinara in bolile cronice", contract nr. POSDRU/159/1.5/S/133377, beneficiar: Universitatea de Medicina si Farmacie "Grigore T. Popa" din Iasi, proiect cofinantat din Fondul Social European prin Programul Operational Sectorial Dezvoltarea Resurselor Umane 2007-2013.

BIBLIOGRAFIE

(1.) Gupta, M. A., Psychocutaneous disease, Dermatol Clin 4:591, 2005

(2.) American PA, Diagnostic and Statistical Manual of Mental Disorders, 5 th edition, Washington D. C., American Psychiatric Association; 2013

(3.) Stander, S., Weisshaar, E., Mettang, T. et al, Classification of itch: a position paper of the International Forum for the Study of Itch, Acta Derm Venerol, 2007, 87: 291-294

(4.) Wolf, Klaus, Goldsmith, Lowell A., Katz, Stephen I., Gilchrest, Barbara A., Paler, Amy S., Leffell, David J., Fitzpatrick's Dermatology in General Medicine, 7th edition, 2010, vol 1: 912-921

(5.) Freudenmann, R. W., Lepping, P., Delusional infestation, Clin Microbiol Rev 2009; 22:690-732

(6.) Buske-Kirschbaum, A., Ebrecht, M., Kern, S. et al., Personality characteristics and their association with biological stress responses in patients with atopic dermatitis, Dermatol Psychosom, 2004; 22:12-16

(7.) Phillips, K. A., Dufresne, R. G., Jr, Wilkel, C., Vittorio, C., Rate of body dysmorphic disorder in dermatology patients, J Am Acad Dermatol., 2000; 42:436-41

(8.) Uhlenhake, E., Yentzer, B. A., Feldman, S. R., Acne vulgaris and depression: a retrospective examination, J Cosmet Dermatol, 2010, 9:59-63

(9.) Moon, H.--S., Mizara, A., McBride, S., Psoriasis and psycho-dermatology, Dermatol Ther., 2013; 3:117-130

(10.) Faulstich, M. E., Williamson, D. A., An overview of atopic dermatitis: towards bio-behavioral integration, J Psychosom Res 1985; 29: 415-417

(11.) Hashiro, M., Okumara, M., Anxiety, depression, psychosomatic symptoms and autonomic nervous function in patients with chronic urticaria, J Dermatol Sci., 1994; 8:129-135

(12.) Arnold, L. M., Auchenbach, M. B., Mc Elroy, S. L., Psychogenic excoriation. Clinicalfeatures, proposed diagnostic criteria, epidemiology and approaches to treatment, CNS Drugs, 2001; 15(5): 351-359

(13.) Mazeh, D., Melamed, Y., Cholostoy, Y., Aharonovitzch, B., Weizman, A., Yosipovitch, G., Itching in thepsychiatric ward, Acta DermVenerol., 2008; 88(2):128-131

(14.) Greaves, M. W., Khalifa, N., Itch--more than skin deep, Itch Arch Allergy Immunol., 2004, 135:166-172

(15.) Yosipovitch, G., Greaves, M. W., Schmelz, M., Itch, Lancet, 2003; 361:690-694

(16.) Zylicz, Z., Krajnik, M., Sorge, A. A. et al, Paroxetine in the treatment of severe non-dermatologicalpruritus: a randomized, controlled trial, Journal of Pain and Symptom Management, 2003; 26:1105-1112

(17.) Shaw, R. J., Dayal, S., Good, J., Bruckner, A., Joshi, S., Psychiatric Medications of the Treatment of Pruritus, Psychosomatic Medicine, 2007; 69 (9): 970-978

(18.) Zylicz, Z., Krajnik, M., Sorge, A. A., Costantini, M., Paroxetine in the treatment of severe non-dermatological pruritus: a randomised, controlled trial, J Pain Symptom Manage, 2003; 26 (6):1105-1112

Laura Gheuca-Solovastru--Profesor asociat, Departamentul de Dermatologie, Universitatea de Medicina si Farmacie "Grigore T. Popa", Iasi, Romania

Dan Vata--M. D., Ph. D., Asistent universitar, Departamentul de Dermatologie, Universitatea de Medicina si Farmacie "Grigore T. Popa", Iasi, Romania

Laura Statescu--M. D., Ph. D., Conferentiar, Departamentul de Dermatologie, Universitatea de Medicina si Farmacie "Grigore T. Popa", Iasi, Romania

Elena Andrese--M. D., Doctorand, Universitatea de Medicina si Farmacie "Grigore T. Popa", Iasi, Romania

Corespondenta:

DAN VATA

Spitalul Clinic Judetean de Urgente "Sf. Spiridon", Clinica Dermatologie, Str. Ciurchi nr. III, Iasi, Romania

Tel.: +40 74I 084 264

E-mail: dan.vata@umfiasi.ro

Primit: 30 mai 2014 / Acceptat: 22 august 2014
COPYRIGHT 2014 Institute of Psychiatry Socola, Iasi
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2014 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Gheuca-Solovastru, Laura; Vata, Dan; Statescu, Laura; Andrese, Elena
Publication:Bulletin of Integrative Psychiatry
Article Type:Report
Date:Sep 1, 2014
Words:4602
Previous Article:Cognitive evaluation in patients with schizophrenia and persecutory delusion/ Evaluarea cognitiei la pacientii cu schizofrenie si ideatie deliranta...
Next Article:Psychological and psychiatric manifestations in cancer patients/Manifestari de natura psihologica si psihiatrica la pacientii cu cancer.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |