Dermatologists and patients have long known that skin diseases affect the
physical and emotional well-being of a person’s existence. Conversely, the
psychological state of a person can also affect his/her skin. In this chapter, we set out
the nature and basis of some of the dermatological conditions linked to obsessive
compulsive disorders [SPD and Acne excoriee] and also take a look at Dermatitis
Artefacta, a poorly understood factitious disorder. We present the process of evaluation
and care of this vulnerable group of patients, whilst also highlighting the importance of
a holistic approach in a multidisciplinary setting.
The skin is well placed to be the focus of tension reducing and emotion regulating
behaviours [1]. High levels of anxiety, in dissociative and obsessive compulsive states
is perhaps one of the most significant influences in conditions such as Skin picking
disorders [SPD] and Dermatitis Artefacta [DA]. Anxiety can also exacerbate primary
skin disorders such as Acne with the development of Acne excoriee.
We know that psychological, psychiatric and psychosocial stress affect over 30% of
dermatological patients. Assessment of these co-morbidities is therefore imperative in
the overall clinical evaluation of the patient. Therefore an integrated multidisciplinary
team approach to manage this group of patients leads to better outcomes.
Keywords: Acne excoriee, Artefactual, Compulsive, Dermatitis artefacta,
Dermatology, Dissociation, DSM-5, Excoriation, Multidisciplinary team,
Neurotic, Obsessive, Picking, Psychiatric, Psychodermatology, Psychosomatic,
Skin.
