Psihodermatologija je interdisciplinarno područje koje pokriva sve aspekte međuodnosa psihološkog statusa i kože u pogledu uzroka, početka, razvoja, dijagnostike i liječenja različitih kožnih bolesti. Kožne bolesti povezane su s depresijom, anksioznošću, poremećajem doživljaja tjelesnog izgleda (dizmorfofobija), seksualnim poremećajima, sniženim samopoštovanjem i kvalitetom života. Smatra se da 40 % do 80 % bolesnika koji traže pomoć dermatovenerologa imaju određene psihičke probleme. Psihodermatološki poremećaji se dijele na psihosomatske, primarno psihijatrijske ili psihogene i sekundarno psihijatrijske. Psihosomatski poremećaji su dermatološke bolesti na čije pogoršanje i težinu utječe emocionalni stres. Stres ne uzrokuje bolest već ju potiče i pogoršava. Primarni psihijatrijski poremećaji s kožnim manifestacijama znatno su rjeđi od psihosomatskih poremećaja, a radi se o anksioznom, obuzeto-prisilnom, depresivnom ili psihotičnom psihijatrijskom poremećaju sa sekundarnim induciranjem kožnih promjena. Sekundarni psihijatrijski poremećaji javljaju se kod kroničnih nagrđujućih kožnih bolesti poput alopecije, akne konglobata, multiplih neurofi broma, psorijaze, vitiliga, ihtioze, gigantskih kongenitalnih nevusa, sindroma displastičnih nevusa i rinofi me. Kožne bolesti rijetko su životno ugrožavajuće, ali zbog njihove izloženosti tuđim pogledima uvelike utječu na kvalitetu života. Pristup psihodermatološkom bolesniku mora biti individualan, interdisciplinaran i holistički. Interdisciplinarni pristup liječenju podrazumijeva standardno dermatološko liječenje uz psihoterapiju i po potrebi, psihofarmakoterapiju.Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. Correlation between psychiatric and dermatological disorders is a highly complex relation considering etiology, diagnostic procedures and treatment. There are three major groups of psychodermatological disorders: psychosomatic (psychophysiologic) disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychosomatic disorders are dermatological diseases which can be exacerbated or worsened by emotional stress, but are not caused directly by stress. Emotional stress can exacerbate many chronic dermatoses like urticaria, eczema, psoriasis, acne, seborrheic dermatitis, atopic dermatitis, alopecia areata, psychogenic purpura, rosacea, atypical pain syndromes and hyperhidrosis. The treatment of patients with the
resistant chronic dermatosis can be diffi cult when stress is not recognized as a provoking factor. Primary psychiatric disorders are psychiatric conditions which induce development of various skin changes, e.g trichotillomania, factitial dermatitis, neurotic excoriations, delusions of parasitosis and dysmorphophobia. They include psychiatric disorders with anxiety, compulsive-opsessive and depressive symptoms and pathologic delusional ideas or hallucinations regarding the skin. Secondary psychiatric disorders appear as a result of a certain disfiguring skin disease that induces psychologic suffering such as loss of self-confi dence, anxiety and social phobia. This category includes diseases like psoriasis, chronic eczema, various ichthyosiform syndromes, rhinophyma, multiple neurofi bromas, severe acne, and other cosmetically disfi guring cutaneous lesions. The therapeutic approach of psychodermatological disorders should be multidisciplinary including primary care physicians, dermatologist, psychiatrist and psychologist. It is very important to educate dermatologists in the diagnostic procedures and
therapy of psychiatric disorders which sometimes coexist with the skin disease. Majority of psychodermatological disorders can be treated with cognitive-bihevioral psychotherapy, psychotherapeutic stress-and-anxiety-management techniques and psychotropic drugs. Psychopharmacologic treatment includes anxiolytics, antidepressants, antipsychotics and mood stabilizer
