Psychocutaneous Diseases

Psychocutaneous disorders represent one of the most challenging problems in clinical medicine. Recent studies have shown that 35–40% of dermatological patients have psychiatric/psychological comorbidities that impact the outcome of their skin disease. The skin and central nervous system arise from the same embryonal tissue, the ectoderm, which is the reason for the continual two-way interaction between the skin and the psyche. Adopting a highly simplified model, the diseases that involve skin and psyche can be grouped as follows: “somatopsychic” disorders (when the body is primarily involved, and mental disturbances are a consequence of the psychical damage) and “psychosomatic” disorders (when psychological or psychiatric disorders lie at the origin of the problem, while the somatic disturbances are the secondary effect). Undoubtedly, psychocutaneous diseases are in the great majority of cases correlated to mental disorders, and so they are generally included among psychiatric disorders. This is also because the treatment primarily targets the mental rather than the dermatological problem. Despite these valid reasons, in this work we have preferred to adopt a classification that highlights the dermatological aspect of the problem, starting from the various skin pictures that can, in turn, be induced by or else induce psychiatric or psychological disturbances. The management of patients with psychocutaneous disorders is quite challenging: a joint liaison between psychiatry and dermatology (that has led to the origin of psychodermatology), however, has proven very helpful to patients. The purpose of this work, resulting in decades of field experience and of the joint efforts of both dermatologists and psychiatrists, is to clarify the terminology of these disorders and, above all, to analyze their clinical characteristics in detail, the first and pivotal sign of suspicion and diagnosis. The topic is completed by the addition of chapters by psychiatric specialists, in order to address pathogenetic problems and therapeutic guidelines, as well as contributions that integrate the approach with medico-legal expertise. It is hoped that this manual will offer a helpful tool for dermatologists, psychologists, psychiatrists and forensic doctors, will provide a handy update on this complex medical area, and in particular, an in-depth analysis of the clinical aspects of this important field of psychodermatology