Deshpande Sharmishtha Shailesh, Khatu Swapna S, Pardeshi Geeta S, Gokhale Neeta R
Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.
Department of Dermatology, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.
Indian J Psychiatry. 2018 Jul-Sep;60(3):324-328. doi: 10.4103/psychiatry.IndianJPsychiatry_115_16.
Patients with dermatological problems have higher prevalence of psychiatric illnesses than the general population. Melasma, hyperpigmentation of skin over sun-exposed areas, has bidirectional cause-effect relationship with depression and stress through psycho-neuro-endocrine pathways.
The aim of this study is to study the psychiatric morbidity and perceived stress in patients with melasma and statistically compare objective study parameters with those without melasma.
This cross-sectional descriptive study was carried out in Tertiary hospital in urban setting, jointly by psychiatrist and dermatologist.
The study involved 50 consecutive patients with melasma and 30 relatives of patients coming to dermatology clinic not having any skin disorder. Cases were assessed by psychiatrist as per the International Classification of Diseases-10 Diagnostic Criteria for Research, Cohen's 4 item perceived stress scale, Disability Assessment Scale 2.0 by WHO and Hospital Anxiety Depression Scale (HADS) and Dermatologist calculated melasma area severity index score (MASI).
Majority patients were females (88%) in the reproductive age group. The most common psychiatric morbidity seen in 42% cases was major depressive disorder. Adjustment disorder (26%) was the second most common diagnosis. Nonparametric analysis using Mann-Whitney U test revealed significantly more perceived stress ( = 0.001), more disability ( = 0.000) and anxiety-depression on HADS ( = 0.0 16) in cases than in their relatives.
This was a hospital-based study and thus melasma patients in the community are not represented. Small sample size, less number of controls, lack of structured diagnostic interview are other limitations of this study.
There is high psychiatric comorbidity (76%) of depressive and stress disorders, higher functional disability and perceived stress in patients with melasma compared to controls.
皮肤病患者中精神疾病的患病率高于普通人群。黄褐斑是阳光暴露部位皮肤色素沉着过度，通过心理-神经-内分泌途径与抑郁和压力存在双向因果关系。
本研究旨在探讨黄褐斑患者的精神疾病发病率和感知压力，并对有黄褐斑和无黄褐斑患者的客观研究参数进行统计学比较。
本横断面描述性研究在城市环境中的三级医院由精神科医生和皮肤科医生联合开展。
本研究纳入了50例连续的黄褐斑患者以及30名到皮肤科门诊就诊且无任何皮肤疾病的患者亲属。精神科医生根据《国际疾病分类第10版研究用诊断标准》、科恩4项感知压力量表、世界卫生组织残疾评估量表2.0以及医院焦虑抑郁量表（HADS）对病例进行评估，皮肤科医生计算黄褐斑面积严重程度指数评分（MASI）。
大多数患者为育龄期女性（88%）。42%的病例中最常见的精神疾病是重度抑郁症。适应障碍（26%）是第二常见的诊断。使用曼-惠特尼U检验的非参数分析显示，病例组的感知压力（P = 0.001）、残疾程度（P = 0.000）以及HADS焦虑抑郁评分（P = 0.016）均显著高于其亲属。
这是一项基于医院的研究，因此未纳入社区中的黄褐斑患者。样本量小、对照组数量少、缺乏结构化诊断访谈是本研究的其他局限性。
与对照组相比，黄褐斑患者中抑郁和应激障碍的精神共病率较高（76%），功能残疾和感知压力也更高。
