Connor Cody J
Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA.
Clin Cosmet Investig Dermatol. 2017 Apr 20;10:117-132. doi: 10.2147/CCID.S111041. eCollection 2017.
Dermatological disease can be devastating for patients, and although dermatologists are focused on remedying the cutaneous manifestations of these conditions, it is easy to miss the psychological suffering lurking below. Studies reveal that psychiatric comorbidity in dermatology is highly prevalent. Undetected psychopathology can greatly decrease a patient's quality of life and even contribute significantly to the clinical severity of their skin disease. For these reasons, it is vital that practitioners learn to detect psychological distress when it is present, and it is equally essential that they understand the treatment options available for effective intervention. Without training in psychiatric diagnosis and psychopharmacology, dermatologists can easily feel overwhelmed or out of their comfort zone when faced with the need to manage such conditions, but with the negative stigma associated with psychiatric disease in general, a psychiatric referral is often refused by patients, and the dermatologist is thus left with the responsibility. Uncertainty abounds in such situations, but this review seeks to alleviate the discomfort with psychodermatological disease and share practical and impactful recommendations to assist in diagnosis and treatment. In a busy dermatology clinic, the key is effective and efficient screening, combined with a repertoire of pharmacological and non-pharmacological treatment options that can be dispersed through an algorithmic approach according to the specific findings of that screening. By implementing these recommendations into practice, dermatologists may begin to gain comfort with the management of psychocutaneous disease and, as a specialty, may expand to fill a hole in patient care that is truly significant for patients, their families, and our communities as a whole.
皮肤病对患者来说可能是毁灭性的，尽管皮肤科医生专注于治疗这些疾病的皮肤表现，但很容易忽略潜藏在表面之下的心理痛苦。研究表明，皮肤病中的精神疾病共病非常普遍。未被发现的精神病理学问题会极大地降低患者的生活质量，甚至对其皮肤病的临床严重程度有显著影响。出于这些原因，从业者学会在心理痛苦出现时进行检测至关重要，同样重要的是，他们要了解可用于有效干预的治疗选择。由于缺乏精神病诊断和精神药理学方面的培训，皮肤科医生在面对需要处理此类情况时很容易感到不知所措或超出自己的舒适区，但由于一般精神疾病存在负面 stigma，患者往往会拒绝转介至精神科，因此皮肤科医生就肩负起了责任。在这种情况下存在诸多不确定性，但本综述旨在减轻对心理皮肤病的不适感，并分享实用且有影响力的建议以协助诊断和治疗。在繁忙的皮肤科诊所，关键是要进行有效且高效的筛查，并结合一系列药物和非药物治疗选择，这些治疗选择可以根据筛查的具体结果通过算法方法进行分配。通过将这些建议付诸实践，皮肤科医生可能会开始对心理皮肤疾病的管理感到得心应手，并且作为一个专业领域，可能会扩展以填补患者护理中对患者、其家庭以及整个社区都真正重要的一个空白。
