Pediatric Psychodermatology (eBook)

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Ruqiya Shama Tareen, Donald E. Greydanus,Mohammad Jafferany, and Dilip R. Patel, Michigan State University,East Lansing, Michigan, USA;Joav Merrick,Ministry of Social Affairs and Social Services, Jerusalem, Israel.

Foreword I 23
Foreword II 27
Preface 29
Author index 37
Abbreviations 41
Part I: INTERFACE OF DERMATOLOGY AND PSYCHIATRY 47
1 Perspectives on management of pediatric dermatologie disorders 49
1.1 Introduction 49
1.2 Skin infections and infestations 49
1.2.1 Bacterial infections 49
1.2.2 Viral infections 61
1.3 HIV/AIDS 65
1.3.1 Non-infectious skin lesions 65
1.3.2 Bacterial infections in HIV 65
1.3.3 Viral infections in HIV 66
1.3.4 Fungal infections in HIV 66
1.3.5 Fungal infections 67
1.3.6 Topical antifungals 71
1.3.7 Infestations 72
1.4 Dermatitis 75
1.4.1 Irritant dermatitis 75
1.4.2 Dry-skin dermatitis 75
1.4.3 Seborrheic dermatitis 75
1.4.4 Allergic dermatitides 76
1.4.5 Idiopathic dermatitides 79
1.5 Hypersensitivity 79
1.5.1 Urticaria 79
1.5.2 Drug eruptions 81
1.6 Miscellaneous skin conditions 83
1.6.1 Acne vulgaris 83
1.6.2 Nevi 87
1.6.3 Papulosquamous disorders 90
1.6.4 Lichens 92
1.6.5 Psoriasis 95
1.7 Dermatologic manifestations of systematic disorders 98
1.7.1 Pruritus without rash 98
1.7.2 Inflammatory bowel disease (IBD) 99
1.7.3 Erythema nodosum 99
1.7.4 Pyoderma gangrenosum 99
1.7.5 Less common skin manifestations 99
1.7.6 Management 99
1.8 Collagen vascular disease 100
1.8.1 Lupus erythematosus (SLE) 100
1.8.2 Dermatomyositis 100
1.8.3 Juvenile idiopathic arthritis 100
1.8.4 Management 100
1.9 Endocrinologic disorders 101
1.9.1 Thyroid disorders 101
1.9.2 Diabetes mellitus 101
1.9.3 Adrenal disorders 101
1.9.4 Management 102
1.10 Hair and nails 102
1.10.1 Alopecia areata 102
1.10.2 Telogen effluvium 104
1.10.3 Androgenic alopecia 104
1.10.4 Trichotillomania 105
1.10.5 Traction alopecia 105
1.10.6 Hirsutism and hypertrichosis 105
1.10.7 Hair changes with systemic disease 106
1.10.8 Infection 106
1.10.9 Bacterial 108
1.10.10 Fungal 109
1.10.11 Onychodystrophy 110
1.10.12 Nail changes with systemic and nutritional disorders 111
2 Psychoneuroimmunology and other interactions between skin and psyche 115
2.1 Introduction 115
2.1.1 History of psychodermatology 116
2.1.2 Classification of psychodermatologic disorders 118
2.1.3 Psychological perspective of skin 118
2.1.4 Skin, mind, and the embryological embrace 120
2.2 Psychoneuroimmunology 121
2.2.1 Neuroendocrine response to stress 121
2.2.2 Immune response and central nervous system 122
2.2.3 Immune response and peripheral nervous system 123
2.2.4 Immune response and skin disease 123
2.2.5 Immune response and psychiatric disease 125
2.3 Conclusion 126
3 A clinician’s approach to psychocutaneous diseases in adolescents: Untying the Gordian knot 129
3.1 Introduction 129
3.1.1 History taking skills in adolescent patients 129
3.2 Interviewing the adolescent patient 131
3.2.1 Confidentiality 133
3.2.2 Parental confidentiality 133
3.2.3 Health questionnaires 133
3.2.4 Interview techniques 134
3.2.5 Active listening skills 135
3.3 Concepts of the physical examination 136
3.4 Successful management of the adolescent patient 136
3.4.1 Informed consent 136
3.4.2 Shared decision makings 137
3.4.3 Improving compliance 138
3.5 Conclusion 138
4 Quality of life issues in children and adolescents with dermatological conditions and their wider impact on the family and society 141
4.1 Introduction 141
4.2 Pediatric quality of life and its assessment 142
4.3 Skin disease and quality of life 143
4.3.1 Impact of skin diseases on children’s quality of life 143
4.3.2 Quality of life assessment in children with dermatological conditions 145
4.3.3 Children’s Dermatology Life Quality Index (CDLQI) 146
4.3.4 Infant’s Dermatitis Quality of Life Index (IDQoL) 146
4.3.5 Impact of skin disease on the quality of life of adolescents 147
4.4 Assessment of adolescents’ quality of life in dermatology 148
4.4.1 Teenager’s QoL questionnaire (T-QoL) 148
4.4.2 Skindex-Teen 149
4.4.3 Impact of skin disease on family quality of life: The “greater patient” concept 150
4.5 Assessment of family quality in dermatology 152
4.5.1 Family Dermatology Life Quality Index (FDLQI) 152
4.5.2 Dermatitis Family Impact questionnaire (DFI) 153
4.5.3 Parents’ Index of Quality of Life in Atopic Dermatitis (PIQoL-AD) 154
4.5.4 Childhood Atopic Dermatitis Impact Scale (CADIS) 154
4.5.5 Psoriasis Family Index (PFI) 155
4.6 Societal impact of childhood dermatological conditions 155
4.7 Conclusions 156
Part II: PSYCHOPHYSIOLOGIC DISORDERS 163
5 Atopic dermatitis: a psychocutaneous review 165
5.1 Introduction 165
5.1.1 Epidemiology 165
5.2 Pathophysiologic factors in atopic dermatitis 166
5.2.1 Genetic predisposition 166
5.2.2 Socio-economic status 166
5.2.3 Family size 166
5.2.4 Food allergens 166
5.3 Psychoneuroimmunologic factors 167
5.3.1 Breast feeding 167
5.3.2 Environmental allergens 167
5.4 Psychophysiological aspects of atopic dermatitis 168
5.4.1 Impact of stress on the immunological system 168
5.4.2 Psychoanalytic hypothesis 169
5.4.3 Biopsychosocial model 170
5.4.4 Psychological dysregulation due to atopic dermatitis 170
5.5 Clinical features 171
5.6 Diagnosis 171
5.6.1 Allergy Testing 173
5.6.2 Differential Diagnosis 174
5.7 Management 174
5.7.1 Prevention of relapse 174
5.7.2 Food allergens 175
5.7.3 Aeroallergens 175
5.7.4 Optimizing the epidermal barrier (EB) 175
5.7.5 Hydration therapy 176
5.7.6 Management of pruritus 176
5.7.7 Topical corticosteroids 177
5.7.8 Topical immunomodulators 180
5.8 Systematic treatment of atopic dermatits 180
5.8.1 Antihistamines 180
5.8.2 Phototherapy 181
5.8.3 Antibiotics 181
5.8.4 Systemic corticosteroids 182
5.8.5 Immunomodulators 182
5.8.6 Cyclosporine 183
5.8.7 Azathioprine 183
5.8.8 Infliximab 183
5.8.9 Interferon-. 184
5.8.10 Leukotriene inhibitors 184
5.9 Psychiatric comorbidities 184
5.9.1 Family dynamics 185
5.9.2 Internalizing and externalizing behaviors 185
5.9.3 Anxiety and depression 186
5.9.4 Personality traits 186
5.10 Management of psychiatric comorbidities 187
5.10.1 Multidisciplinary approach 187
5.10.2 Psychoeducation 187
5.10.3 Psychosocial assessment 187
5.10.4 Psychiatric symptoms review 188
5.10.5 Quality of life assessment 188
5.10.6 Psychodynamic therapy 188
5.10.7 Cognitive behavioral therapy 189
5.10.8 Behavioral modifications 189
5.10.9 Psychotropic medications 189
5.11 Conclusion 190
6 Psoriasis and children: A psychological approach 193
6.1 Introduction 193
6.1.1 Epidemiology 194
6.2 Dermatological clinical features 194
6.2.1 Plaque psoriasis 195
6.2.2 Guttate psoriasis 195
6.2.3 Erythrodermic psoriasis 195
6.2.4 Pustular psoriasis 196
6.2.5 Psoriatic arthritis 197
6.2.6 Inverse psoriasis 197
6.3 Psychological clinical features 198
6.3.1 Differential diagnosis 200
6.3.2 Psychotherapeutic intervention 201
6.3.3 Psychotherapy 202
6.4 Conclusions 205
7 The acnes: Acne vulgaris, acne rosacea, and acne excoriée 209
7.1 Acne Vulgaris 209
7.1.1 Introduction 209
7.1.2 Epidemiology 209
7.1.3 Pathogenesis 213
7.1.4 Classification 214
7.1.5 Management 214
7.1.6 Teratogenicity and isotretinoin 225
7.1.7 Depression, suicidality, and isotretinoin 226
7.2 Acne Rosacea 230
7.2.1 Pathophysiology 231
7.2.2 Management of acne rosacea 232
7.3 Acne Variants 233
7.4 Conclusion 233
8 Psychogenic purpura (Gardner-Diamond syndrome) 239
8.1 Introduction 239
8.2 History 239
8.3 Etiology and pathogenesis 240
8.4 Clinical features 241
8.5 Differential diagnosis 241
8.5.1 Disease course 241
8.5.2 Histopathology 241
8.5.3 Laboratory testings 242
8.5.4 Psychological disturbances 242
8.6 Treatment approaches and recommendations 242
8.7 Conclusion 243
Part III: PSYCHIATRIC DISORDERS WITH DERMATOLOGIC MANIFESTATIONS 245
9 Body dysmorphic disorder in adolescents 247
9.1 Introduction 247
9.2 Definition 248
9.2.1 Epidemiology 249
9.2.2 Clinical features 249
9.2.3 Differential diagnosis 250
9.3 Management 251
9.3.1 Preliminary considerations 251
9.3.2 The clinical interview 252
9.3.3 Assessment 252
9.3.4 Patient education 254
9.3.5 Treatment 254
9.4 Other treatment techniques 256
9.4.1 Anxiety management training (AMT) 256
9.4.2 Eye movement desensitization and reprocessing (EMDR) 257
9.4.3 Family therapy 257
9.4.4 Group therapy 257
9.4.5 Metaphors 257
9.4.6 Mindfulness 258
9.4.7 Intervention 258
9.4.8 Nonpsychiatric medical treatment 258
9.4.9 Final management considerations 259
9.5 Conclusions 259
10 Delusional infestation in childhood, adolescence, and adulthood 263
10.1 Introduction 263
10.2 How to diagnose a delusion 264
10.3 Primary and secondary delusional infestation 265
10.4 The context of children and adolescence 266
10.5 Clinical pictures 267
10.5.1 Case one 267
10.5.2 Case two 268
10.5.3 Case Three 269
10.5.4 Commentary on these three cases 270
10.6 Delusional elaboration (“Wahnarbeit”) 270
10.7 Prevalence of delusional infestation 272
10.7.1 Treatment 273
10.7.2 Which antipsychotic in DI? 274
10.8 Antipsychotics 276
10.9 Conclusion 278
11 Dermatitis artefacta, skin picking, and other self-injurious behaviors: A psychological perspective 283
11.1 Introduction 283
11.2 Epidemiology 285
11.3 Etiology 287
11.4 Clinical features 289
11.4.1 Dermatitis Artefacta 291
11.4.2 Skin picking 292
11.4.3 Self-mutilation behavior 292
11.5 Differential diagnosis 294
11.6 Management 294
11.6.1 Pharmacological Treatment 297
11.6.2 Psychotherapy 297
11.6.3 Issues with Treatment 301
11.7 Conclusions 303
12 Trichotillomania 307
12.1 Introduction 307
12.2 Definition 307
12.3 Differential diagnosis 308
12.4 Assessment 310
12.5 Management 312
12.5.1 Psychotherapy 313
12.5.2 Medication 313
12.6 Conclusions: Future directions 314
13 Psychogenic pruritus with particular emphasis on children and adolescents 317
13.1 Introduction 317
13.2 Epidemiology 318
13.3 Clinical features 319
13.4 Differential diagnosis 320
13.5 Management 321
13.6 Conclusion 323
Part IV: DERMATOLOGIC DISORDERS PREDISPOSING TO PSYCHIATRIC DISORDERS 327
14 Disorders of hair loss 329
14.1 Introduction 329
14.2 Causes of hair loss 329
14.3 Diagnostic approach to hair loss 331
14.3.1 History 331
14.3.2 Examination 331
14.3.3 Laboratory investigation 332
14.4 Tinea capitis 332
14.5 Telogen effluvium 333
14.6 Alopecia areata 333
14.7 Male pattern hair loss 334
14.8 Hair Loss due to Chemotherapy 334
14.9 Psychiatric aspects 334
14.9.1 Psychological treatment approaches 336
14.10 Conclusion 337
15 Disorders of skin pigmentation 341
15.1 Introduction 341
15.2 Disorders of hypopigmentation 342
15.2.1 Vitiligo 342
15.2.2 Albinism 344
15.2.3 Postinflammatory hypopigmentation 344
15.2.4 Pityriasis alba 345
15.2.5 Tinea versicolor 345
15.3 Disorders of hyperpigmentation 346
15.3.1 Postinflammatory hyperpigmentation 346
15.3.2 Melasma 346
15.3.3 Hyperpigmentation associated with medical disorders 346
15.3.4 Café-au-lait spots 347
15.3.5 Lentigines 347
15.4 Psychological aspects of disorders of pigmentations 347
15.4.1 Psychosocial management of disorders of pigmentation 349
15.5 Conclusion 350
16 Skin adnexal disorders 353
16.1 Hidradenitis suppurativa (HS) 353
16.1.1 Introduction 353
16.1.2 Diagnosis 353
16.1.3 Etiology 354
16.1.4 Clinical features 355
16.1.5 Differential Diagnosis 356
16.2 Hyperhidrosis 357
16.2.1 Definition 357
16.2.2 Epidemiology 358
16.2.3 Etiology 358
16.2.4 Clinical features 359
16.2.5 Differential diagnosis 359
16.2.6 Management 360
16.3 Anhidrotic ectodermal dysplasia 362
16.3.1 Definition 362
16.3.2 Epidemiology 362
16.3.3 Clinical features 362
16.3.4 Differential diagnosis 362
16.3.5 Management 363
16.4 Nevus sebaceous 363
16.4.1 Definition 363
16.4.2 Epidemiology 363
16.4.3 Clinical features 363
16.4.4 Differential diagnosis 364
16.4.5 Management 364
16.5 Conclusion 364
Part V: SYSTEMATIC DISEASES WITH PSYCHODERMATOLOGIC MANIFESTATIONS 367
17 Neurocutaneous disorders 369
17.1 Introduction 369
17.2 Neurofibromatosis 369
17.2.1 Clinical features 371
17.2.2 Neuropsychiatric aspects of neurofibromatosis type 1 371
17.2.3 Management 372
17.2.4 NF1 summary 374
17.3 Tuberous Sclerosis Complex (TSC) 374
17.3.1 Introduction 374
17.3.2 Clinical features of TSC 375
17.3.3 Neurologic lesions 375
17.3.4 Psychiatric symptoms 375
17.3.5 Management 376
17.3.6 Treatment of neuropsychiatric problems 376
17.4 Conclusion 378
18 Collagen vascular disorders: Psychiatric and dermatologic manifestations 381
18.1 Lupus erythematosus (LE) 381
18.1.1 Epidemiology 381
18.1.2 Clinical features 381
18.1.3 Cutaneous manifestations 382
18.1.4 Neuropsychiatric systemic lupus erythematosus (NPSLE) 383
18.1.5 Differential diagnosis 386
18.1.6 Clinical diagnosis 386
18.1.7 Diagnostic workup 388
18.1.8 Management 388
18.1.9 Treatment of cutaneous lupus lesions 389
18.1.10 Treatment of NPSLE 389
18.2 Dermatomyositis 390
18.2.1 Epidemiology 390
18.2.2 Clinical features 391
18.2.3 Cutaneous manifestations 391
18.2.4 Psychiatric manifestations 392
18.2.5 Management 393
18.3 Rheumatoid Arthritis 394
18.3.1 Epidemiology 394
18.3.2 Etiopathogenesis 395
18.3.3 Clinical features 395
18.3.4 Cutaneous manifestations 395
18.3.5 Psychiatric manifestations 397
18.3.6 Laboratory findings 399
18.3.7 Management 400
18.3.8 Management of psychiatric issues 402
19 Psychocutaneous manifestations of endocrine disorders 407
19.1 Introduction 407
19.2 Diabetes Mellitus 407
19.2.1 Clinical features 408
19.2.2 Dermatological manifestations 409
19.2.3 Psychiatric manifestations 411
19.2.4 Management of psychiatric conditions 412
19.3 Disorders of growth hormone 413
19.3.1 Acromegaly 413
19.3.2 Dermatological manifestations 413
19.3.3 Psychiatric manifestations 414
19.3.4 Diagnostic workup 415
19.3.5 Clinical management 415
19.3.6 Management of dermatological manifestations 416
19.3.7 Management of psychiatric manifestations 416
19.4 Thyroid hormone disorders 416
19.4.1 Hypothyroidism 416
19.4.2 Hyperthyroidism 417
19.4.3 Clinical features of thyroid disorders 417
19.4.4 Dermatological manifestations of hypothyroidism 418
19.4.5 Dermatological manifestations of hyperthyroidism 419
19.4.6 Psychiatric manifestations 419
19.4.7 Diagnostic workup 421
19.4.8 Management of hypothyroidism 421
19.4.9 Management of hyperthyroidism 421
19.4.10 Management of psychiatric disorders 423
19.5 Adrenal gland disorders 424
19.5.1 Hypoadrenocorticism (adrenal insufficiency [AI] or Addison disease [AD]) 424
19.5.2 Hyperadrenocorticism (Cushing syndrome) 426
19.6 Disorders of parathyroid glands 430
19.6.1 Hypoparathyroidism 430
19.6.2 Hyperparathyroidism 434
19.7 Disorders of hormones of the reproductive system 436
19.8 Androgen disorders 436
19.8.1 Hypogonadism in males 436
19.8.2 Androgen disorders in Females 437
19.9 Estrogen disorders 440
19.9.1 Estrogen disorders in males 440
19.9.2 Estrogen disorders in females 440
19.9.3 Psychiatric manifestations of disorders of androgen and estrogens 441
19.10 Conclusion 442
20 Inborn errors of metabolism with psychiatric and dermatologic features 449
20.1 Introduction 449
20.2 Phenylketonuria [PKU] 449
20.2.1 Genetics and pathophysiology 450
20.2.2 Clinical features 451
20.2.3 Cutaneous manifestations 452
20.2.4 Psychiatric manifestations 452
20.2.5 Laboratory diagnosis 453
20.2.6 Management 453
20.3 Hartnup disease 455
20.3.1 Genetics and pathophysiology 455
20.3.2 Cutaneous manifestations 455
20.3.3 Psychiatric manifestations 455
20.3.4 Laboratory findings 456
20.3.5 Management 456
20.4 Homocystinuria 456
20.4.1 Genetics and pathophysiology 456
20.4.2 Clinical features 456
20.4.3 Cutaneous manifestations 457
20.4.4 Psychiatric Manifestations 457
20.4.5 Management 458
20.5 Porphyrias 458
20.5.1 Genetics and prevalence 458
20.5.2 Clinical features 459
20.5.3 Cutaneous manifestations 459
20.5.4 Psychiatric manifestations 460
20.5.5 Laboratory diagnosis 461
20.5.6 Management 461
20.6 Conclusion 462
Part VI: SPECIAL ISSUES IN MANAGEMENT OF PSYCHOCUTANEOUS DISORDERS 467
21 Psychiatric complications of dermatological treatments 469
21.1 Introduction 469
21.2 Epidemiology 469
21.3 Clinical features by medication category 470
21.3.1 Antibacterial agents 470
21.3.2 Antiviral agents 471
21.3.3 Corticosteroids 472
21.3.4 Dapsone 472
21.3.5 Antimalarial agents 472
21.3.6 Retinoids 473
21.3.7 Interferons 474
21.3.8 Other agents 474
21.4 Differential diagnosis 474
21.5 Management 474
21.5.1 Drug-drug interactions 475
21.5.2 Non-pharmacologic interventions 475
21.6 Conclusion 476
22 Dermatologic manifestations of psychotropic medications 479
22.1 Introduction 479
22.1.1 Epidemiology 479
22.2 Diagnosis 480
22.3 Pathogenesis 481
22.4 Categories 482
22.5 Common adverse cutaneous reactions 482
22.5.1 Pruritus 482
22.5.2 Exanthematous eruptions 482
22.5.3 Urticaria and angioedema 496
22.5.4 Fixed drug eruptions 497
22.5.5 Photosensitivity 497
22.5.6 Pigmentation 498
22.5.7 Diaphoresis 498
22.5.8 Alopecia 498
22.6 Serious and life-threatening cutaneous reactions 499
22.6.1 Erythema multiforme 499
22.6.2 Stevens-Johnson Syndrome and Toxic Epidermolysis Necrolysis 499
22.6.3 Drug hypersensitivity syndrome 500
22.6.4 Vasculitis 501
22.6.5 Exfoliative dermatitis 501
22.6.6 Anaphylactoid reactions 502
22.7 General dermatologic conditions 502
22.7.1 Acneiform eruptions 502
22.7.2 Psoriasiform eruption 503
22.7.3 Seborrheic eruption 503
22.7.4 Lichenoid eruption 503
22.8 Conclusion 504
23 Non-pharmacological approaches to treat psychocutaneous disorders 507
23.1 Introduction 507
23.2 Non-pharmacological modalities 508
23.2.1 Acupuncture 508
23.2.2 Aromatherapy 508
23.2.3 Biofeedback 509
23.2.4 Brief dynamic psychotherapy 510
23.2.5 Cognitive behavioral therapy methods 510
23.2.6 Emotional freedom techniques (EFT) 510
23.2.7 Eye Movement Desensitizing and Reprocessing (EMDR) 511
23.2.8 Hypnosis 511
23.2.9 Music 512
23.2.10 Placebo 513
23.2.11 Suggestion 513
23.3 Conclusion 513
24 Psychiatric disorders frequently encountered in dermatology practices 517
24.1 Introduction 517
24.1.1 Epidemiology 518
24.2 Mood disorders 518
24.2.1 Epidemiology 518
24.2.2 Diagnosis of depressive disorders 521
24.2.3 Differential diagnosis of depressive disorders 522
24.2.4 Management of depressive disorders 522
24.3 Bipolar spectrum disorders 523
24.3.1 Types of bipolar disorders 524
24.3.2 Diagnosis of bipolar disorders 526
24.3.3 Differential diagnosis of bipolar disorders 527
24.4 Anxiety spectrum disorders 531
24.4.1 Obsessive compulsive disorder 532
24.4.2 Social anxiety disorder (SAD) 534
24.4.3 Eating disorders 537
24.5 Personality disorders (PDs) 540
24.5.1 Introduction 540
24.5.2 Clinical diagnosis 541
24.6 Conclusion 544
APPENDIX 547
25 About the editors 549
26 FDA approved psychotropic medication indications for children and adolescents 553
27 Common psychiatric terms 555
28 Common dermatotologic lesions 559
Index 565
Plate section 573