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Pediatric Psychocutaneous Disorders

A Review of Primary Psychiatric Disorders with Dermatologic Manifestations

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Abstract

Psychocutaneous disorders (PCDs) are conditions that are characterized by psychiatric and skin manifestations. Classifications of PCDs and their nomenclature are matters of debate. For the purpose of this review, we adopted the classification that distinguishes primary dermatologic disorders with psychiatric comorbidity (PDDPC) from primary psychiatric disorders with dermatologic manifestations (PPDDM). PDDPC includes the psychophysiologic disorders such as atopic eczema, psoriasis, vitiligo, and alopecia areata. PPDDM includes impulse control disorders, obsessive-compulsive disorders, factitious disorder, factitious disorder by proxy, self-mutilation, delusions of parasitosis, psychogenic purpura/Gardner- Diamond syndrome, and cutaneous sensory disorders. Diagnosis and treatment of PCDs are challenging and require that the underlying psychopathology be addressed. A specific PCD may have different underlying psychopathologies and, at times, multiple overlapping psychopathologies may coexist. Most often, both non-pharmacologic management and psychopharmacologic treatment are necessary. The choice of psychopharmacologic agent depends on the nature of the underlying psychopathology (e.g. anxiety, depression, obsessive-compulsive disorder, psychosis). This article reviews the spectrum of PPDDM in children.

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References

  1. Lee CS, Accordino R, Howard J, et al. Psychopharmacology in dermatology. Dermatol Ther 2008; 21 (1): 69–82

    Article  PubMed  Google Scholar 

  2. Gupta MA, Gupta AK, Ellis CN. Psychiatric evaluation of the dermatology patient. Dermatol Clin 2005; 23: 591–9

    Article  PubMed  CAS  Google Scholar 

  3. Folks DG, Warnock JK. Psychocutaneous disorders. Curr Psychiatry Rep 2001; 3: 219–25

    Article  PubMed  CAS  Google Scholar 

  4. Jafferany M. Psychodermatology: a guide to understanding common psychocutaneous disorders. Prim Care Companion J Clin Psychiatry 2007; 9 (3): 203–13

    Article  PubMed  Google Scholar 

  5. Pacan P, Grzesiak M, Reich A, et al. Onychophagia as a spectrum of obsessivecompulsive disorder. Acta Derm Venereol 2009; 89 (3): 278–80

    Article  PubMed  Google Scholar 

  6. Grant JE, Mancebo MC, Eisen JL, et al. Impulse-control disorders in children and adolescentswith obsessive-compulsive disorder. Psychiatry Res 2010; 175: 109–13

    Article  PubMed  Google Scholar 

  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000: 674–7

  8. Tay YK, Levy ML, Metry DW. Trichotillomania in childhood: case series and review. Pediatrics 2004; 113: e494–8

    Article  Google Scholar 

  9. Grant JE, Odlaug BL. Updates on pathological skin picking. Curr Psychiatry Rep 2009; 11 (4): 283–8

    Article  PubMed  Google Scholar 

  10. Monti M, Sambvani N, Sacrini F. Obsessive-compulsive disorders in dermatology. J Eur Acad Dermatol Venereol 1998; 11: 103–8

    Article  PubMed  CAS  Google Scholar 

  11. Stein DJ, Hollander E. Dermatology and conditions related to obsessivecompulsive disorder. J Am Acad Dermatol 1992; 26: 237–42

    Article  PubMed  CAS  Google Scholar 

  12. Leonard HL, Swedo SE, Lenane MC, et al. A 2- to 7-year follow-up study of 54 obsessive-compulsive children and adolescents. Arch Gen Psychiatry 1993; 50 (6): 429–39

    Article  PubMed  CAS  Google Scholar 

  13. Grados MA. The genetics of obsessive-compulsive disorder and Tourette syndrome: an epidemiological and pathway-based approach for gene discovery. J Am Acad Child Adolesc Psychiatry 2010 Aug; 49 (8): 810–9, 819.e1-2

  14. Philips KA, Taub SL. Skin picking as a symptom of body dysmorphic disorder. Psychopharmacol Bull 1995; 31: 279–88

    Google Scholar 

  15. Phillips KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry 1991; 148: 1138–49

    PubMed  CAS  Google Scholar 

  16. Jafferany M, Feng Y, Hornung RL. Trichodaganomania: the compulsive habit of biting one’s own skin. J Am Acad Dermatol 2009; 60 (4): 689–91

    Article  PubMed  Google Scholar 

  17. King RA, Scahill L, Vitulano LA, et al. Childhood trichotillomania: clinical phenomenology, comorbidity, and family genetics. J Am Acad Child Adolesc Psychiatry 1995; 34: 1451–9

    Article  PubMed  CAS  Google Scholar 

  18. Christenson GA. Trichotillomania: from prevalence to comorbidity. Psychiatr Times 1995; 12 (9): 44–8

    Google Scholar 

  19. Hautmann G, Hercogova J, Lotti T. Tricotillomania. J Am Acad Dermatol 2002; 46 (6): 807–21

    Article  PubMed  Google Scholar 

  20. Duke DC, Keeley ML, Geffken GR, et al. Trichotillomania: a current review. Clin Psychol Rev 2010; 30 (2): 181–93

    Article  PubMed  Google Scholar 

  21. Trueb RM, Cavegn B. Trichotillomania in connection with alopecia areata. Cutis 1996; 58 (1): 67–70

    PubMed  CAS  Google Scholar 

  22. van Minnen A, Hoogduin KA, Keijsers GP, et al. Treatment of trichotillomania with behavioral therapy or fluoxetine: a randomized, waiting-list controlled study. Arch Gen Psychiatry 2003; 60: 517–22

    Article  PubMed  Google Scholar 

  23. Ninan PT, Rothbaum BO, Marsteller FA, et al. A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry 2000; 61: 47–50

    Article  PubMed  CAS  Google Scholar 

  24. Ashton AK. Olanzapine augmentation for trichotillomania. Am J Psychiatry 2001; 158: 1929–30

    Article  PubMed  CAS  Google Scholar 

  25. Carrion VG. Naltrexone for the treatment of trichotillomania: a case report. J Clin Psychopharmacol 1995; 15: 444–5

    Article  PubMed  CAS  Google Scholar 

  26. Seedat S, Stein DJ, Harvey BH. Inositol in the treatment of trichotillomania and compulsive skin picking. J Clin Psychiatry 2001; 62: 60–1

    Article  PubMed  CAS  Google Scholar 

  27. Arnold LM, Auchenbach MB, McElroy SL. Psychogenic excoriation: clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs 2001; 15 (5): 351–9

    Article  PubMed  CAS  Google Scholar 

  28. Keuthen NJ, Deckersbach T, Wilhelm S, et al. Repetitive skin-picking in a student population and comparison with sample of self-injurious skin pickers. Psychosomatics 2000; 41 (3): 210–5

    Article  PubMed  CAS  Google Scholar 

  29. Sandoz A, Koenig T, Kusnir D, et al. Psychocutaneous disorders. In: Wolff K, Goldsmith LA, Katz SI, et al. Fitzpatrick’s dermatology in general medicine. 7th ed. New York: McGraw Hill, 2008: 912–21

    Google Scholar 

  30. Gupta MA, Gupta AK, Haberman HF. Neurotic excoriations: a review and some new perspectives. Compr Psychiatry 1986; 27: 381–6

    Article  PubMed  CAS  Google Scholar 

  31. Mitropoulos P, Norton SA. Dermatophagia or dermatodaxia [letter]. J Am Acad Dermatol 2005; 53 (2): 365

    Article  PubMed  Google Scholar 

  32. Scott Jr MJ, Scott 3rd MJ. Dermatophagia ‘wolf-biter’. Cutis 1997; 59 (1): 19–20

    PubMed  Google Scholar 

  33. Ressmann AC, Butterworth T. Localized acquired hypertrichosis. AMA Arch Derm Syphilol 1952; 65 (4): 458–63

    Article  PubMed  CAS  Google Scholar 

  34. Tanaka OM, Vitral RW, Tanaka GY, et al. Nailbiting, or onychophagia: a special habit. Am J Orthod Dentofacial Orthop 2008; 134 (2): 305–8

    Article  PubMed  Google Scholar 

  35. Leung AK, Robson WL. Nailbiting. Clin Pediatr (Phila) 1990; 29: 690–2

    Article  CAS  Google Scholar 

  36. Heaton KW, Mountford RA. Nail-biting in the population and its relationship to irritable bowel syndrome. J R Soc Med 1992; 85: 457

    PubMed  CAS  Google Scholar 

  37. Williams TI, Rose R, Chisholm S. What is the function of nail biting: an analog assessment study. Behav Res Ther 2006; 45: 989–95

    Article  PubMed  Google Scholar 

  38. Penzel F. Skin picking and nail biting: related habits [online]. Available from URL: (http://westsuffolkpsych.homestead.Com/SkinPicking.html) [Accessed 2008 May 11]

  39. Luker J. Diseases of the oral mucosa and tongue. In: Harper J, Oranje A, Prose N. Textbook of pediatric dermatology. 2nd ed. Boston (MA): Blackwell Scientific Publication, 2006: 1725–49

    Google Scholar 

  40. Gattu S, Rashid RM, Khachemoune A. Self-inflicted skin lesions: a review of dermatitis artefacta. Cutis 2009; 84 (5): 247–51

    PubMed  Google Scholar 

  41. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000: 513–7

  42. Nielsen K, Jeppesen M, Simmelsgaard L, et al. Self-inflicted skin diseases: a retrospective analysis of 57 patients with dermatitis aretefacta seen in dermatology department. Acta Derm Venereol 2005; 85: 512–5

    PubMed  Google Scholar 

  43. Schulze UM, Pettke-Rank CV, Kreienkamp M, et al. Dermatologic findings in anorexia and bulimia nervosa of childhood and adolescence. Pediatr Dermatol 1999; 16: 90–4

    Article  PubMed  CAS  Google Scholar 

  44. Koblenzer CS. Neurotic excoriations and dermatitis artefacta. Dermatol Clin 1996; 14 (3): 447–55

    Google Scholar 

  45. Sneddon I, Sneddon J. Self-inflicted injury: a follow up study of 43 patients. Br Med J 1975; 3: 527–30

    Article  PubMed  CAS  Google Scholar 

  46. Alcolado JC, Ray K, Baxter M, et al. Malignant change in dermatitis artefacta. Postgrad Med J 1993; 69: 648–50

    Article  PubMed  CAS  Google Scholar 

  47. Koblenzer CS. Dermatitis artefacta: clinical features and approaches to treatment. Am J Clin Dermatol 2000; 1: 47–55

    Article  PubMed  CAS  Google Scholar 

  48. Meadow R. Munchausen syndrome by proxy: the hinterland of child abuse. Lancet 1977; 2: 343–5

    Article  PubMed  CAS  Google Scholar 

  49. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000: 781–3

  50. Hall DE, Eubanks L, Meyyazhagan LS, et al. Evaluation of covert video surveillance in the diagnosis of Munchausen syndrome by proxy: lessons from 41 cases. Pediatrics 2000; 105 (6): 1305–12

    Article  PubMed  CAS  Google Scholar 

  51. Fabisch W. What is dermatitis artefacta? Int J Dermatol 1981; 20: 427–8

    Article  PubMed  CAS  Google Scholar 

  52. Gupta MA, Gupta AK. The use of antidepressant drugs in dermatology. J Eur Acad Dermatol Venereol 2001; 15: 512–8

    Article  PubMed  CAS  Google Scholar 

  53. Rodham K, Hawton K, Evans E. Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescence. J Am Acad Child Adolesc Psychiatry 2004; 43: 80–7

    Article  PubMed  Google Scholar 

  54. Lesch M, Nyhan WL. A familial disorder of uric acid metabolism and central nervous system function. Am J Med 1964; 36: 561–70

    Article  PubMed  CAS  Google Scholar 

  55. Bilo RA, Oranje AP. Physiological habits, self-mutilation and factitious disorders. In: Harper J, Oranje A, Prose N. Textbook of pediatric dermatology. 2nd ed. Boston (MA): Blackwell Scientific Publication, 2006: 2096–109

    Google Scholar 

  56. Gadoth ME. Oro-dental self-mutilation in familial dysautonomia. J Oral Pathol Med 1994; 23: 273–6

    Google Scholar 

  57. Trabert W. 100 years of delusions of parasitosis: meta-analysis of 1223 case reports. Psychopathology 1995; 28: 238–46

    Article  PubMed  CAS  Google Scholar 

  58. Wilson J, Miller HE. Delusions of parasitosis (acarophobia). Arch Derm Syphilol 1946; 54: 39–56

    Article  PubMed  CAS  Google Scholar 

  59. Edlich RF, Cross CL, Wack CA, et al. Delusions of parasitosis. Am J Emerg Med 2009; 27 (8): 997–9

    Article  PubMed  Google Scholar 

  60. Gardner FH, Diamond LK. Autoerythrocyte sensitization: a form of purpura producing painful bruising following autosensitization to red cells in certain women. Blood 1955; 10: 675–90

    PubMed  CAS  Google Scholar 

  61. Hansen RC. Pediatric psychocutaneous disorders. Curr Opin Pediatr 1997; 9 (4): 367–71

    Article  PubMed  CAS  Google Scholar 

  62. Croch GS, Finch SC, Rogoway W, et al. Studies in the pathogenesis of autoerythrocyte sensitization syndrome. Blood 1966; 28 (1): 19–33

    Google Scholar 

  63. Elpern DJ. Toward a better understanding of “psychocutaneous disorders”. Int J Dermatol 2009; 48 (12): 1395–6

    Article  PubMed  Google Scholar 

  64. Shenefelt PD. Therapeutic management of psychodermatological disorders. Expert Opin Pharmacother 2008; 9 (6): 973–85

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

No sources of funding were used to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Section of Dermatology, The Hospital for Sick Children, University of Toronto, 555, University Ave, Toronto, Ontario, Canada

    Khalid Al Hawsawi &  Elena Pope

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  1. Khalid Al Hawsawi
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  2. Elena Pope
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Correspondence to Elena Pope.

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Al Hawsawi, K., Pope, E. Pediatric Psychocutaneous Disorders. Am J Clin Dermatol 12, 247–257 (2011). https://doi.org/10.2165/11589040-000000000-00000

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