CAGE Questionnaire and Self-Harm Quiz

Psychocutaneous Disorders - II

• Psychodermatology is a branch of dermatology focusing on the complex interaction between the brain, cutaneous nerves, cutaneous immune system, and skin.
• Table 82.1 classifies psychodermatological disorders:

i) Psychophysiological Disorders

• Includes conditions like psoriasis, atopic dermatitis, acne excoriee, hyperhidrosis, urticaria, recurrent herpes simplex infection, seborrheic dermatitis, oral aphthosis, and rosacea.
• Also includes pruritus.

ii) Psychiatric Disorders with Dermatologic Manifestations

• Includes dermatitis artefacta, delusions of parasitosis, obsessive-compulsive disorder, disorders of obsession (dysmorphophobia, acarophobia), and disorders of compulsion such as trichotillomania, neurotic excoriations, onychotillomania, lip-licking, cheek biting.
• Also includes eating disorders and psychogenic pruritus.

iii) Dermatologic Disorders with Psychiatric Symptoms

• This category includes alopecia areata, vitiligo, psoriasis, chronic eczema, ichthyosiform syndromes, rhinophyma, neurofibroma, albinism, cutaneous sensory syndromes (glossodynia, vulvodynia, scalp pruritus), psychogenic purpura syndrome, and pseudopsychodermatologic disease.
• Also includes suicide in dermatology patients and psychiatric side effects of dermatological and psychotropic drugs.

iv) Miscellaneous

• Includes disorders like cutaneous sensory syndromes, vitiligo, psoriasis, and chronic eczema.

Factitious Skin Disease

• Clinical deception involves a spectrum of intentional deception regarding the motivation and level of inducing illness.

• DSM-5 criteria include: falsification of physical or psychological signs/symptoms or injury, presenting as ill/impaired/injured, deceptive behavior evident without external rewards, and behavior not better explained by another mental disorder.

• Dermatitis Artefacta is a skin disease entirely caused by the patient's actions.

• In adults, female patients are more prevalent than male patients. In prepubescent children, there is an equal sex ratio for this condition.

• Patients often create a 'hollow history', providing fabricated lies, or appearing to not know how the lesions developed.

• Lesions commonly appear suddenly and symmetrically.

• Patients may display a detached attitude or an apparent indifference, often described with a "Mona Lisa smile"nonchalance and innocence.

• Common areas of involvement are the face (particularly cheeks), dorsum of the hands (in children), and forearms (usually on the non-dominant side).

Factitious Cheilitis

• Less common in young girls, typically involving the simulation of the condition through application of substances like paper, glue and colorants.
• Lesions appear as inflammation and crusting with variable hemorrhaging.

Factitious Nail Disease

• This involves traumatic or chemical damage to the nails and nail fold.
• Children often show chronic paronychia, caused by inserting nails, pins or splinters.

Hair Artefact

• A distinctive pattern of hair loss occurs after cutting or shaving, resulting in rough or patterned shaved alopecia.

Witchcraft Syndrome

• Artefact dermatitis may be provoked on an unknowing victim.

Constriction Artefact

• Edema in one limb is constricted at a time.

Purpura Artefact

• Purpura and bruising result from suction, friction, or blunt trauma.

Dermal Artefact

• Skin lesions may show manifestations that mimic panniculitis-type lesions and boggy swellings.
• Needle tracks, presence of injected substances, may be present.

Post Surgical Artefact

• Non-healing wounds are a common sign of this condition, often following minor procedures like breast biopsies or laparoscopies, followed by recurrence or infection by microbes such as MRSA.