Kenkare Varsha L, Madke Bhushan, Choudhary Ankita, Bose Shiti
From the Department of Dermatology, Venereology and Leprosy, Dr. Surya's Skin Clinic, Sainikpuri, Secunderabad, Telangana, India.
Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi Meghe, Wardha, Maharashtra, India.
Indian J Dermatol. 2025 Jan-Feb;70(1):23-37. doi: 10.4103/ijd.ijd_792_23. Epub 2024 Dec 30.
Psycho-dermatology is an evolving speciality of psychosomatic medicine where psychological factors play a role in initiating and/or exacerbating the dermatological conditions. Dermatologists should be well versed with the basic pharmacotherapy of psycho-cutaneous disorders and work in close liaison with the psychiatrists when it comes to the holistic management of the same. The review has been divided into two parts, with part 1 consisting of anti-depressants and mood stabilisers and part 2 consisting of anti-psychotics, anxiolytics, and sedative-hypnotic agents used in psycho-dermatology. This comprehensive review focusses on the various psychotropic drugs which are of paramount significance to the dermatologists. The knowledge of these drugs will lead to the pertinent treatment of the psychiatric dermatoses, which has been a less explored territory in the arena of dermatology. Within the realm of psycho-dermatology, a diverse array of anti-depressants is utilised to address psychiatric dermatoses. These include selective serotonin reuptake inhibitors like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline, alongside selective serotonin norepinephrine reuptake inhibitors such as venlafaxine, desvenlafaxine, and duloxetine. Additionally, norepinephrine dopamine reuptake inhibitors like bupropion; tricyclic antidepressants including doxepin, amitriptyline, imipramine, and clomipramine; and tetracyclic antidepressants like mirtazapine are commonly employed. Supplementary medications like anti-convulsants (e.g., gabapentin and pregabalin) further enrich the therapeutic landscape in psycho-dermatology. The approach to treatment in psycho-dermatology is meticulous, starting with a precise psychiatric diagnosis and followed by tailored drug interventions. Factors such as individual response, side-effect profiles, potential drug interactions, and concurrent medical conditions guide the selection and titration of medications. Typically, treatment initiates at conservative doses, with adjustments made based on patient progress and tolerability. This comprehensive review not only illuminates the psycho-cutaneous indications of these medications including in patients with co-morbidties but also underscores the imperative of vigilant monitoring for adverse effects and its management. This systematic review aimed to evaluate the use of psychotropic medications, including antidepressants and mood stabilizers, in dermatology. A comprehensive search of PubMed Central was conducted for studies published between 1986 and 2023, focusing on meta-analyses, reviews, and systematic reviews. After screening 2287 records, 26 studies met the inclusion criteria. The findings underscore the potential role of psychotropic drugs in managing dermatological conditions, highlighting the need for further research to strengthen the evidence base in psycho-dermatology.
心理皮肤病学是身心医学中一个不断发展的专业领域，其中心理因素在引发和/或加重皮肤病方面发挥作用。皮肤科医生应精通心理皮肤疾病的基本药物治疗，在对其进行整体管理时，应与精神科医生密切合作。本综述分为两部分，第1部分包括抗抑郁药和情绪稳定剂，第2部分包括用于心理皮肤病学的抗精神病药、抗焦虑药和镇静催眠药。这一全面综述聚焦于对皮肤科医生至关重要的各种精神药物。了解这些药物将有助于对精神性皮肤病进行恰当治疗，而精神性皮肤病在皮肤科领域一直是一个较少被探索的领域。在心理皮肤病学领域，各种各样的抗抑郁药被用于治疗精神性皮肤病。这些药物包括选择性5-羟色胺再摄取抑制剂，如西酞普兰、艾司西酞普兰、氟西汀、氟伏沙明、帕罗西汀和舍曲林，以及选择性5-羟色胺去甲肾上腺素再摄取抑制剂，如文拉法辛、去甲文拉法辛和度洛西汀。此外，去甲肾上腺素多巴胺再摄取抑制剂，如安非他酮；三环类抗抑郁药，包括多塞平、阿米替林、丙咪嗪和氯米帕明；以及四环类抗抑郁药，如米氮平，也经常被使用。补充药物，如抗惊厥药（如加巴喷丁和普瑞巴林），进一步丰富了心理皮肤病学的治疗手段。心理皮肤病学的治疗方法细致入微，首先要进行精确的精神科诊断，然后进行针对性的药物干预。个体反应、副作用情况、潜在药物相互作用以及并发疾病等因素指导药物的选择和滴定。通常，治疗从保守剂量开始，根据患者的进展和耐受性进行调整。这一全面综述不仅阐明了这些药物在包括合并症患者在内的心理皮肤疾病方面的适应证，还强调了对不良反应进行密切监测及其管理的必要性。本系统综述旨在评估精神药物，包括抗抑郁药和情绪稳定剂，在皮肤科的应用。对1986年至2023年期间发表在《美国国立医学图书馆医学期刊数据库》上的研究进行了全面检索，重点是荟萃分析、综述和系统评价。在筛选了2287条记录后，有26项研究符合纳入标准。研究结果强调了精神药物在管理皮肤病方面的潜在作用，突出了进一步研究以加强心理皮肤病学证据基础的必要性。
