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PubMed1987

The self-inflicted dermatoses: a critical review.

The self-inflicted dermatoses, namely dermatitis artefacta, neurotic excoriations, and trichotillomania, have been reported to be associated with various degrees of psychopathology in the dermatologic literature, but have received surprisingly little emphasis in the psychiatric literature. This probably reflects, firstly the fact that most of these patients initially deny any psychologic problems and hence may not receive psychiatric interventions, and secondly a lack of adequate collaboration between the psychiatrist and dermatologist. These disorders may be associated with serious sequelae, such as suicide and repeated major surgical procedures. Their treatment is also primarily psychiatric. This article critically reviews the literature and comments upon the salient clinical features and treatments for these disorders, which are relevant for the psychiatrist doing consultation-liaison work. Knowledge of these disorders is important in the evaluation of any psychiatric patient, as these disorders are essentially a cutaneous sign of psychopathology.

Dermatitis↗
PubMed1991

A double-blind, multicenter trial of 0.05% halobetasol propionate ointment and 0.05% clobetasol 17-propionate ointment in the treatment of patients with chronic, localized atopic dermatitis or lichen simplex chronicus.

In a double-blind, parallel-group, multicenter comparative trial in 127 evaluable patients with chronic, localized atopic dermatitis or lichen simplex chronicus, healing was reported in a higher percentage of patients treated with halobetasol propionate ointment than in those in the clobetasol propionate treatment group (65.1% versus 54.7%). The success rates (described as "healed" and "marked improvement") were practically identical in the two treatment groups (93.7% versus 92.2%). Early onset of therapeutic effect, that is, within 3 days of the start of treatment, was similar in the two treatment groups (24% versus 28%). Both preparations were well tolerated. Adverse effects were reported in 5% and 2% of the patients treated with halobetasol propionate and clobetasol propionate ointments, respectively.

Adolescent↗
PubMed1991

A double-blind, multicenter, parallel-group trial with 0.05% halobetasol propionate ointment versus 0.1% diflucortolone valerate ointment in patients with severe, chronic atopic dermatitis or lichen simplex chronicus.

In a double-blind, parallel-group, multicenter, comparative trial in 120 evaluable patients with chronic, localized atopic dermatitis or lichen simplex chronicus, the success rate (described as "healed" and "marked improvement") was 91.5% in patients treated with halobetasol propionate ointment and 83.6% in those in the diflucortolone valerate treatment group. Of patients treated with halobetasol propionate ointment, 40.7% reported healing within 17 days, whereas of those in the diflucortolone valerate treatment group, 32.8% reported healing within that time. Early onset of therapeutic effect, that is, within 3 days of the start of treatment, was reported in a higher percentage of patients treated with halobetasol propionate ointment than in those treated with diflucortolone valerate ointment (70% versus 59%). Adverse effects at the site of application were less frequently reported in patients belonging to the halobetasol propionate treatment group than in those treated with diflucortolone valerate ointment (3% versus 8%).

Adolescent↗
PubMed1991

A review of two controlled multicenter trials comparing 0.05% halobetasol propionate ointment to its vehicle in the treatment of chronic eczematous dermatoses.

The efficacy and safety of 0.05% halobetasol propionate ointment were evaluated in patients with chronic atopic or other eczematous dermatoses in two vehicle-controlled, double-blind studies: a paired-comparison study in 124 patients (study A) and a parallel-group study in 100 patients (study B). In study A, patients applied both treatments twice daily for 2 weeks and were evaluated by investigators on days 0, 7, and 14 with 0 to 3 severity scales and by self-assessment with two 5-step end-of-treatment rating scales. In study B, patients applied treatments twice daily for 2 weeks, and investigators made evaluations on days 0, 3, 7, and 14 with 0 to 6 scales and also made a 5-step end-of-treatment physician's global assessment. In study A, both severity scores and patient ratings favored halobetasol propionate significantly on days 7 (p less than or equal to 0.0013) and 14 (p less than 0.0001); in study B, severity scores on days 3 (p less than or equal to 0.045, pruritus, erythema, and overall lesion severity), 7, and 14 (p less than 0.001, all comparisons) also favored halobetasol propionate significantly, and global assessments showed complete resolution or marked improvement for 83% of patients using halobetasol propionate versus 28% of those using vehicle (p less than 0.0001). No instances of systemic effects or skin atrophy were reported in either study. We conclude that 0.05% halobetasol propionate ointment is highly effective and well tolerated in the treatment of the conditions studied, with the rapid action and high degree of clearing associated with superpotent corticosteroid formulations.

Adolescent↗
PubMed1991

Double-blind bilateral paired comparison of 0.05% halobetasol propionate cream and its vehicle in patients with chronic atopic dermatitis and other eczematous dermatoses.

Six investigators evaluated 0.05% halobetasol propionate cream and its vehicle in 111 patients with chronic atopic dermatitis and several other eczematous dermatoses. Patients applied treatment twice daily to bilateral lesions for 14 days. Investigators graded pruritus, erythema, scaling, papulation, and lichenification using 4-point severity scales on days 0, 7, and 14. On day 14 patients provided an assessment of efficacy for both treatments. Statistically significant differences favoring halobetasol propionate over the vehicle were seen for all signs and symptoms (p less than 0.001). Substantial improvements were achieved by the active treatment by day 7 (p less than 0.001). Patients assessments of efficacy were significantly higher for halobetasol cream than for vehicle (p less than 0.001). No instances of systemic effects or skin atrophy were reported and adverse experiences were limited to burning or stinging and other minor, nonspecific complaints distributed uniformly between active treatment and vehicle. These results demonstrate that 0.05% halobetasol propionate cream is highly effective in the treatment of atopic dermatitis and other eczematous dermatoses.

Administration, Cutaneous↗
PubMed2006

Homoeopathy for the treatment of lichen simplex chronicus: a case series.

Twenty-seven patients with chronic lichen simplex involving various parts of the body were treated. Hydrocotyle was prescribed to 21 patients in different potencies (6c, 30c, 200c, 1 M, 10 M), Thuja to three patients (1 M, 10 M), Graphites (6c), Kali bich (30c) and Sulphur (200c) to one patient each during 1 year study period. Only two patients showed complete improvement with Thuja and one with Graphites. In other cases, the response was limited to partial relief of [corrected] itching.

Administration, Cutaneous↗
PubMed2006

Medically unexplained cutaneous sensory symptoms may represent somatoform dissociation: an empirical study.

OBJECTIVE: We examined the relation between medically unexplained cutaneous symptoms and dissociation [measured by the Dissociative Experiences Scale, or DES; Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986;174:727-35] among participants with no history of primary dermatologic disorders. METHODS: Three hundred sixty consenting participants (44 psychiatric outpatients and 316 nonclinical participants from the community at large) rated the severity of nine medically unexplained cutaneous symptoms (sum of all ratings comprised the Cutaneous9 variable) and completed the DES. RESULTS: The Cutaneous9 variable correlated significantly (Pearson r=.56, P<.001) with DES scores. Stepwise multiple regression analysis using the nine cutaneous symptoms as independent variables revealed that Pain, Itching, and Numbness were the best predictors of the DES scores (adjusted R2=.34, P<.001). CONCLUSION: Our findings have empirically shown that itching, like pain and numbness, may be a symptom of somatoform dissociation. Second, even milder degrees of dissociation in the nonclinical range may play a role in the genesis of unexplained cutaneous sensory symptoms.

Adolescent↗
PubMed1997

Psychiatric illness in patients referred to a dermatology-psychiatry clinic.

There is a recognized psychiatric morbidity among those who attend dermatology clinics. We aimed to determine the pattern of psychological and social problems among patients referred to a liaison psychiatrist within a dermatology clinic. Notes from 149 patients were reviewed and more detailed assessments performed in a subgroup of 32 consecutive referrals. All but 5% merited a psychiatric diagnosis. Of these, depressive illness accounted for 44% and anxiety disorders, 35%. Less common general psychiatric disorders included social phobia, somatization disorder, alcohol dependence syndrome, obsessive-convulsive disorder, posttraumatic stress disorder, anorexia nervosa, and schizophrenia. Classical disorders such as dermatitis artefacta and delusional hypochondriasis were uncommon. Commonly, patients presented with longstanding psychological problems in the context of ongoing social difficulties rather than following discrete precipitants. Psychiatric intervention resulted in clinical improvement in most of those followed up. Of the dermatological categories 1) exacerbation of preexisting chronic skin disease; 2) symptoms out of proportion to the skin lesion; 3) dermatological nondisease; 4) scratching without physical signs, the commonest were dermatological nondisease and exacerbation of chronic skin disease. Anxiety was common in those from all dermatological categories. Patients with dermatological nondisease had the highest prevalence of depression. Skin patients with significant psychopathology may go untreated unless referred to a psychiatrist. The presence of dermatological nondisease or symptoms out of proportion to the skin disease should particularly alert the physician to the possibility of underlying psychological problems.

Adolescent↗
PubMed1988

Nonatopic eczemas.

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Bibliographies as Topic↗
PubMed1996

Mycobacteria in prurigo nodularis: the cause or a consequence?

BACKGROUND: Prurigo nodularis (PN) is a chronic skin disorder; its cause remains unknown. OBJECTIVE: We evaluated mycobacteria as a possible cause of PN. METHODS: Forty-three patients with PN were examined. Skin biopsy specimens were obtained for microbiologic and histopathologic studies. The patients were tested for intracutaneous reactivity to 12 mycobacterial antigens with the Mantoux technique. RESULTS: Six specimens (14%) grew mycobacteria in culture: M. avium-intracellulare (3), M. malmoense (1), and Mycobacterium sp. (2). Histopathologically, 12 samples (28%) were positive for acid-fast bacilli, and granulomatous changes were present in one sample. Patients whose cultures were positive for mycobacteria had significantly larger skin reactions to mycobacterial antigens. Two patients underwent 2 years of antituberculous chemotherapy; one had an excellent response and the other a partial response. CONCLUSION: Detection of mycobacteria by culture or staining, combined with elevated skin reactivity to mycobacteria in a high proportion of patients with PN, suggests a mycobacterial cause.

Adult↗
PubMed1996

Detection of circulating T cells with CD4+CD7- immunophenotype in patients with benign and malignant lymphoproliferative dermatoses.

BACKGROUND: Cutaneous T-cell lymphomas (CTCLs) are malignancies of CD4+ T cells that involve the skin. CD4+CD7- cells may represent a malignant population in CTCL. OBJECTIVE: Our purpose was to compare the percentage of CD4+CD7- cells and the expression of pan-T-cell antigens in blood lymphocytes from 31 patients with benign dermatoses with 35 patients who had CTCL. METHODS: The patients with CTCL were classified as follows: 10 with mycosis fungoides (MF), seven with pre-Sézary syndrome (pre-SS), and 18 with Sézary syndrome (SS). Flow cytometry was used to determine the percentage of CD4+CD7- cells and the CD4/CD8 ratio and to detect aberrant expression of the pan-T-cell antigens CD2, CD3, and CD5. RESULTS: We found a mean of 5.8% CD4+CD7- cells for the 16 normal control subjects and 9.3% for the benign cases (p = 0.13). The patients with pre-SS and SS had a higher percentage of CD4+CD7- cells (22.4% and 35.5%, respectively) than patients with benign dermatoses (p < 0.01); no difference was found between patients with benign dermatoses and those with MF (p = 0.80). The mean CD4/CD8 ratio was 3.1 for the normal control subjects compared with 7.4 for the patients with benign dermatoses (p < 0.01). Patients with SS had a ratio of 49, which was higher than the ratio for those with benign dermatoses (p < 0.01); however, the ratio for patients with MF and pre-SS did not differ from that of the group with benign dermatoses (p = 0.71 and 0.55, respectively). Aberrant CD2, CD3, or CD5 expression was observed in 66% of patients with SS, 29% with pre-SS, 30% with MF, but in none of the patients with a benign dermatosis. CONCLUSION: Small numbers of CD4+CD7- cells can be found by flow cytometry in patients with a benign dermatosis and in normal control subjects. This T-cell subset is expanded in pre-SS and SS but not in MF. Aberrant pan-T-cell antigen expression is commonly observed in patients with SS but not in patients with a benign dermatosis.

Antigens, CD7↗
PubMed1997

Lichen amyloidosus: a consequence of scratching.

BACKGROUND: Lichen amyloidosus (LA) is generally said to be a pruritic type of amyloidosis of unknown cause. Histopathologically, it is characterized by epidermal changes of lichen simplex chronicus and by deposits of amyloid in the papillary dermis that are derived from keratin peptides of necrotic keratinocytes. Chronic scratching is responsible for the development of lichen simplex chronicus and may lead to necrosis of individual keratinocytes. OBJECTIVE: Our purpose was to evaluate whether chronic scratching may also be responsible for the formation of amyloid in LA. METHODS: We studied patients with LA in regard to histopathologic findings, onset of pruritus, associated diseases, and response to treatment. RESULTS: In most cases, pruritus had preceded the skin lesions. Eight of nine patients suffered from diseases other than LA that may be associated with pruritus. Histopathologically, amyloid was confined to areas that also showed signs of lichen simplex chronicus. Systemic treatment with sedating antihistamines and intense local treatment with corticosteroids were found to be effective. CONCLUSION: LA is considered to be a variant of lichen simplex chronicus in which scratching leads to necrosis of keratinocytes and eventually to the formation of amyloid in the papillary dermis. Because chronic scratching seems to be the cause and not the result of the deposits of amyloid, treatment should be directed at the amelioration of pruritus.

Administration, Cutaneous↗