Šitum M, Kolić M, Buljan M
Acta Med Croatica. 2016;70 Suppl 1:35-8.
Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. Correlation between psychiatric and dermatological disorders is a highly complex relation considering etiology, diagnostic procedures and treatment. There are three major groups of psychodermatological disorders: psychosomatic (psychophysiologic) disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychosomatic disorders are dermatological diseases which can be exacerbated or worsened by emotional stress, but are not caused directly by stress. Emotional stress can exacerbate many chronic dermatoses like urticaria, eczema, psoriasis, acne, seborrheic dermatitis, atopic dermatitis, alopecia areata, psychogenic purpura, rosacea, atypical pain syndromes and hyperhidrosis. The treatment of patients with the resistant chronic dermatosis can be difficult when stress is not recognized as a provoking factor. Primary psychiatric disorders are psychiatric conditions which induce development of various skin changes, e.g trichotillomania, factitial dermatitis, neurotic excoriations, delusions of parasitosis and dysmorphophobia. They include psychiatric disorders with anxiety, compulsive- opsessive and depressive symptoms and pathologic delusional ideas or hallucinations regarding the skin. Secondary psychiatric disorders appear as a result of a certain disfiguring skin disease that induces psychologic suffering such as loss of self-confidence, anxiety and social phobia. This category includes diseases like psoriasis, chronic eczema, various ichthyosiform syndromes, rhinophyma, multiple neurofibromas, severe acne, and other cosmetically disfiguring cutaneous lesions. The therapeutic approach of psychodermatological disorders should be multidisciplinary including primary care physicians, dermatologist, psychiatrist and psychologist. It is very important to educate dermatologists in the diagnostic procedures and therapy of psychiatric disorders which sometimes coexist with the skin disease. Majority of psychodermatological disorders can be treated with cognitive-bihevioral psychotherapy, psychotherapeutic stress-and-anxiety-management techniques and psychotropic drugs. Psychopharmacologic treatment includes anxiolytics, antidepressants, antipsychotics and mood stabilizer.
心理皮肤病学疾病是涉及心理与皮肤相互作用的病症。考虑到病因、诊断程序和治疗，精神疾病与皮肤病之间的关联是一种高度复杂的关系。心理皮肤病学疾病主要分为三大类：心身（心理生理）疾病、原发性精神疾病和继发性精神疾病。心身疾病是指那些可因情绪压力而加重或恶化，但并非直接由压力引起的皮肤病。情绪压力可加重许多慢性皮肤病，如荨麻疹、湿疹、银屑病、痤疮、脂溢性皮炎、特应性皮炎、斑秃、心理性紫癜、酒渣鼻、非典型疼痛综合征和多汗症。当压力未被视为诱发因素时，治疗难治性慢性皮肤病患者可能会很困难。原发性精神疾病是指那些可引发各种皮肤变化的精神病症，例如拔毛癖、人工皮炎、神经性擦伤、寄生虫妄想症和畸形恐惧症。它们包括伴有焦虑、强迫和抑郁症状以及关于皮肤的病理性妄想观念或幻觉的精神疾病。继发性精神疾病是由某种毁容性皮肤病导致心理痛苦（如自信心丧失、焦虑和社交恐惧症）而出现的。这一类别包括银屑病、慢性湿疹、各种鱼鳞病样综合征、肥大性酒渣鼻、多发性神经纤维瘤、重度痤疮以及其他美容方面毁容性的皮肤损害。心理皮肤病学疾病的治疗方法应是多学科的，包括初级保健医生、皮肤科医生、精神科医生和心理学家。对皮肤科医生进行有时与皮肤病共存的精神疾病的诊断程序和治疗方面的教育非常重要。大多数心理皮肤病学疾病可用认知行为心理治疗、心理治疗性压力和焦虑管理技术以及精神药物进行治疗。精神药物治疗包括抗焦虑药、抗抑郁药、抗精神病药和心境稳定剂。
