A study of dermatological disorders with primary psychiatric illness from South India

INTRODUCTION

Central nervous system and skin evolves together alongside in fetus and stays interconnected always.¹ Many psychiatric illnesses are linked with dermatological manifestations.² Many factors such as stress, anxiety which is mediated by the hypothalamus pituitary axis contribute to the development of dermatosis by releasing neuropeptides and neurohormones which should be treated properly, so there is always a connection between dermatology and psychiatry.³ Rates of psychiatric patients having skin disease differ with authors, but they all had accepted the fact that skin and psychiatry go hand in hand and management requires a dual approach, so they created a new subspecialty known as psychodermatology.⁴ Certain primary psychiatric conditions itself has skin manifestations such as delusion of parasitosis, trichotillomania, acne excoria.⁵ Various dermatosis such as psoriasis, atopic dermatitis, acne were caused and aggravated by stress.⁶ Usually dermatologists forget to rule out the psychological history of their patient’s skin disorders, and psychiatric patients try to cover their psychological condition and seek the help of dermatologists for their skin manifestations.⁷ However there are very little study done to find the incidence of dermatosis in patients with primary psychiatric disorder and to highlight the importance of dermatology consultation in psychiatric patients.

METHODS

In this cross-sectional study, patients attending psychiatry OPD of Meenakshi institute of medical sciences and research hospital, Kancheepuram, were selected after taking informed consent. The sample size is 200 taken over a period of 6 months from March to August 2019. A detailed history was taken; complete dermatological examination was carried out by visual inspection and clinical examination. Underlying psychiatric disorders were confirmed with the help of psychiatrists. Inclusion criteria were psychiatric patients of age 10 to 70; both male and female patients. Exclusion criteria were patients not willing for the study.

RESULTS

Out of 200 people, 110 (55%) were female and 90 (45%) were male (Table 1). The majority of patients were in the age group 30-40 (Table 2). Out of 200 patients, 65 were diagnosed with major depressive disorder, 42 with bipolar disorder, 40 with schizophrenia, 30 with obsessive compulsion disorder and 23 with an anxiety disorder (Table 3). Out of 153 (76.5%) patients had dermatological findings (Table 4) in which 84 (55%) had infectious disease; 35 (22.9%) had parasitic infections, 26 (17%) had fungal infections, 15 (9.8%) had bacterial infections and 8 (5.23%) had viral infections. 56 (36.6%) of patients had non-infectious skin findings; 22 (14.4%) had acne, 15 (9.8%) had pruritis, 12 (7.84%) had eczema, 5 (3.3%) had psoriasis and 2 (1.3%) had vitiligo. 13 (8.4%) patients had psychodermatological problems; 10 (6.53%) had neurotic excoriation, 2 (1.3%) had delusion of parasitosis and 1 (0.6%) had trichotillomania (Table 5 and Table 6).

DISCUSSION

In current study, females patients were more compared to male patients and major depressive disorder (32.5%) was found to be the major primary psychiatric disease. 153 (76.5%) patients had dermatological manifestations, this prevalence correlates with the national study done by Moftah et al, in which 200 patients with primary psychiatry disorder were studied and dermatological manifestations were reported in 71.5% patients.⁸ In study conducted by Mookhoek et al with 90 patients, skin manifestations in 77% of patients were reported.⁹

In present study, infections were found to be the major dermatological manifestation, parasitic infections were found in 22.8% such as scabies, pediculosis, this may be due to poor self care, poor hygiene and negligence. Dermatophytic infections were found to be 16.9%, due to excessive sweating because of the humid climate in south India. Bacterial infections seen are secondary infections caused by frequent scratching, furuncles. Viral infections such as herpes simplex, wart, molluscum contagiosum were seen in patients. This correlates with the study done by Kuruvilla et al, where 68.7% of psychiatric patients were reported with infectious skin disease.¹⁰

Acne may be due to antipsychotics, female preponderance, age factor, depression. In papulosquamous disorder, psoriasis was seen in 3.2% of the patients, this may be due to stress factors. Mookhoek et al in his study observed 2.2% of patients having psoriasis.⁹ Pruritis was seen mostly in depressive patients, Gupta et al in his study gave a positive correlation between pruritis and depression.¹¹ Neurotic excoriations were seen in depressive and anxiety patients. Delusional parasitosis was seen mostly in schizophrenia patients. Seborrheic dermatitis and atopic dermatitis were the common eczemas seen in patients. Trichotillomania was seen mostly with obsessive compulsion disorder and depression patients.

CONCLUSION

This study shows the importance of dermatology consultation of psychiatric patients and a mutual approach of both dermatologists and psychiatrists is needed in treating psychiatric patients so that higher prevalence of skin manifestations in psychiatric patients may be lowered.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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