BACKGROUND:Self-inflicted skin injury is a significant yet often underrecognized contributor to acne progression, particularly in postadolescent populations. It not only perpetuates lesions but also triggers inflammatory cascades, including sebaceous gland epithelialization and cystic transformation. Postadolescent acne excoriée poses unique therapeutic challenges due to the interplay of dermatological and psychological factors. AIMS:To evaluate the effectiveness of a combined psychodermatological treatment-CO2 laser ablation and cognitive-behavioral therapy (CBT)-in managing chronic, treatment-resistant postadolescent acne excoriée. METHODS:A case series of three patients with refractory postadolescent acne excoriée was conducted. Treatment involved CO2 laser ablation to remove obstructed sebaceous glands, combined with CBT targeting maladaptive excoriation behaviors. RESULTS:All patients achieved rapid and sustained clinical improvement. The combined approach disrupted the pathomimetic cycle, eliminated visible obstructed sebaceous glands, and reduced compulsive skin manipulation. CONCLUSION:Integrating CO2 laser ablation with CBT offers a dual benefit of addressing both the physical lesions and psychological drivers of acne excoriée. Multidisciplinary collaboration is essential for effective management of complex psychocutaneous disorders.

Psychogenic pruritus (PP) is a chronic itch disorder associated with psychological conditions lacking any dermatological or systemic cause. Diagnosis relies on excluding other aetiologies and identifying psychological stressors. Treatments include dermatological and psychiatric interventions such as topical steroids, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, antihistamines, antipsychotics and psychotherapy. However, efficacy remains inconsistent, necessitating a systematic review of current and emerging pharmacological options. This study reviews pharmacological treatments for PP published in the past decade, evaluating efficacy and therapeutic potential. A systematic literature search was conducted using PubMed, Embase and Google Scholar (November 2014 to November 2024) following the PRISMA guidelines (PROSPERO: 1000201). In total, 1034 articles were screened by two independent reviewers. Inclusion criteria focused on human studies evaluating pharmacological treatments for PP. Seven studies met the inclusion criteria. Levels of evidence were assessed using the Joanna Briggs Institute critical appraisal checklist. SSRIs, particularly escitalopram, showed symptom improvement in case reports. Naltrexone (an opioid antagonist) led to complete itch resolution in a patient refractory to SSRIs. Gabapentin reduced pruritus severity. A neurokinin-1 receptor (NK-1R) antagonist (serlopitant) demonstrated significant efficacy in a phase II trial. Biologics such as dupilumab showed promise in chronic pruritus. Targeted therapies, including SSRIs, naltrexone, opioid pathway modulators, NK-1R antagonists and biologics, show promise in the clinical management of PP, but further research through randomized controlled trials is necessary to establish their efficacy and optimize treatment strategies.

Abstract Trichotillomania is an impulse control hair-pulling disorder resulting in hair loss. Trichotillomania is often disabling, leading to significant distress, impaired functioning and significantly low quality of life. It is associated with a high degree of comorbidity, particularly psychiatric conditions such as anxiety disorders, depression and attention deficit/hyperactivity disorder. The objective of this systematic review is to critically review all currently available data to understand the psychosocial burden in patients with trichotillomania. Furthermore, this study will provide sufficient information to dermatologists and physicians to recognize and raise awareness on the psychosocial impact of trichotillomania. A comprehensive literature search was conducted using PubMed, employing the search terms ‘trichotillomania’ AND ‘hair pulling disorder’ AND ‘depression’ OR ‘psychological’ OR ‘psychosocial’ OR ‘self-esteem’. Studies published from January 2014 to June 2024, in English, over the last 10 years were included based on predefined inclusion and exclusion criteria. In total 23 studies were included in the final analysis after the initial process. Research indicates that individuals with trichotillomania frequently experience functional impairments across various domains, including social interactions, academic performance and overall quality of life. The presence of comorbid conditions exacerbates the severity of trichotillomania symptoms, creating a complex interplay that complicates treatment. Trichotillomania is a multifaceted disorder requiring holistic management strategies, addressing both the psychological and physical aspects of the disorder. Given the high levels of comorbidity and the significant impact on quality of life, there is a critical need for increased awareness, early intervention and tailored treatment plans that incorporate both therapeutic and supportive measures.

Psychocutaneous disorders (PCDs) in children and adolescents lie at the intersection of dermatology and psychiatry and include primary psychiatric conditions with cutaneous manifestations, dermatologic diseases with psychiatric sequelae, and functional or overlap syndromes. Despite substantial psychosocial burden and chronic morbidity, pediatric PCDs remain under-recognized and inconsistently managed. We conducted a narrative review of PubMed, Embase, PsycINFO, Scopus, and Web of Science (2000–2025), including epidemiologic studies, clinical trials, meta-analyses, and consensus statements addressing prevalence, risk factors, diagnostic tools, and management strategies in pediatric psychodermatology. Available data suggest that 20–30

ABSTRACT:Psychodermatology encompasses the complex relationship between psychiatric disorders and dermatologic conditions, focusing on their bidirectional effects. This review delves into the role of psychopharmacology in managing dermatologic diseases and their associated psychiatric comorbidities, specifically investigating how psychotropic medications, such as antidepressants, anxiolytics, and antipsychotics, are used to treat dermatologic conditions with psychiatric comorbidities and their impact on both skin health and psychiatric symptoms. A narrative review was conducted, synthesizing studies published between 2019 and 2024 that included studies focused on psychopharmacological interventions in psychocutaneous disorders. Relevant literature was analyzed to evaluate the efficacy of psychotropic medications in improving both dermatologic and psychiatric symptoms. The present review highlighted that psychotropic medications, particularly antidepressants, anxiolytics, and antipsychotics, offer significant benefits in managing psychodermatologic conditions. Across the literature, antidepressants were shown to reduce inflammation and immune dysregulation in conditions such as psoriasis and hidradenitis suppurativa. Furthermore, psychotropic drugs were shown to alleviate psychiatric symptoms associated with dermatologic diseases, such as anxiety, compulsive behaviors, and delusional thoughts. Although the literature has demonstrated the efficacy of psychotropic medication in treating dermatologic diseases, psychiatric referrals and psychopharmacological treatments remain underutilized in clinical practice. Psychopharmacology plays a crucial role in managing psychodermatologic conditions by addressing both skin and psychiatric symptoms. Despite growing evidence of the importance and utility of psychodermatology, there is a need for greater awareness and incorporation of multidisciplinary psychiatric evaluation and treatment in dermatologic care. Future research should focus on larger, longitudinal studies to assess the long-term efficacy and safety of psychotropic medications in dermatology.

Tinea capitis is a fungal infection of the scalp in which trichoscopy plays an important role by allowing early identification of characteristic hair shaft alterations before mycological confirmation. We describe two adult women who are immunosuppressed with endothrix tinea capitis caused by Trichophyton violaceum. Both patients presented with diffuse scalp alopecia and scaling. Trichoscopic examination revealed unusually elongated corkscrew hairs, and fungal cultures confirmed the diagnosis. Elongated corkscrew hairs represent a previously unreported trichoscopic pattern in chronic endothrix tinea capitis. Awareness of this finding may facilitate earlier diagnostic suspicion and prompt targeted mycological investigation in patients who are immunosuppressed.

Geriatric psychodermatology encompasses conditions influenced by the skin and mind in older adults (individuals aged ≥65 years). As the population ages, recognition of these disorders has become increasingly important. This clinical review summarizes the clinical presentation and therapeutic interventions of the most common psychocutaneous conditions in older adults, including delusional infestation, lichen simplex chronicus, prurigo nodularis, psychogenic pruritus, and skin-picking disorder. Treatment options include first- and second-generation antipsychotics, antiepileptics, antidepressants, topical antipruritic agents (eg, capsaicin), topical glucocorticoids, antihistamines, and immunosuppressants such as methotrexate, N-acetylcysteine, and biologics. However, management in older adults requires special consideration, as these therapies may be associated with side effects that could be potentially more worrisome in older patients, such as the anticholinergic effects associated with antipsychotics or increased sedation and fall risk from antihistamines. These risks are compounded by the high burden of comorbid medical conditions and polypharmacy in older adults, highlighting the need for careful dosing, close monitoring, and interdisciplinary collaboration. Effective management requires addressing both the acute dermatologic symptoms and the underlying psychiatric component. Larger, geriatric-specific studies are necessary to better inform management of these patients.

Cutaneous sensory syndromes (CSS) comprise a heterogeneous group of disorders characterized by symptoms of itch, burning, pain or other dysaesthesias on normal or minimally altered skin. They share convergent biology that includes aberrant small-fibre input, spinal and supraspinal sensitization and neuroimmune crosstalk that perpetuates the itch-scratch cycle. This narrative review synthesizes current concepts and practical management across seven types of CSS encountered in adult practice: scalp dysaesthesia, vulvodynia, scrotodynia, brachioradial pruritus, notalgia paraesthetica, burning mouth syndrome and psychogenic itch. We first outline a clinically focused pathophysiology from peripheral pruriceptors through dorsal horn circuits to cortical networks and descending control, and we integrate the brain-skin axis and autonomic influences. We then present a pragmatic evaluation framework that emphasizes targeted history, symptom mapping, red flags, a minimal laboratory panel, selective imaging or biopsy, and patch testing when product exposure suggests contact allergy. Management is organized around education and trigger modification, topical neuromodulators for focal disease, class-level systemic neuromodulators when symptoms are frequent or widespread and psychodermatology integration that addresses attention, mood, sleep and behavioural loops. Disorder-specific sections highlight distinctive clinical cues and low-risk first steps, with adjuncts for patients with refractory cases. This narrative review provides a concise, mechanism-informed roadmap to improve diagnosis, counselling and outcomes in patients with CSS.

BACKGROUND:Vitiligo is an autoimmune condition marked by depigmentation of the skin and is frequently associated with psychosocial distress. Although often dismissed as cosmetic, vitiligo carries a substantial burden influenced by cultural beliefs, stigma, and access to medical education. AIMS:This review aims to examine the literature on cross-cultural beliefs, stigmatization, psychological comorbidities, and quality of life (QoL) outcomes in individuals with vitiligo. METHODS:A comprehensive search of PubMed, Embase, and PsycINFO was conducted to identify peer-reviewed studies discussing cultural beliefs, stigma, psychological burden, or QoL in individuals with vitiligo. Inclusion criteria encompassed original studies in English assessing relevant psychosocial or cultural domains. RESULTS:Twenty-three studies met inclusion criteria. Cultural attributions of vitiligo varied widely, with some populations linking the disease to contagion, divine punishment, or supernatural causes. These beliefs were more prevalent in regions with lower health literacy and limited access to dermatologic care. Stigmatization-manifesting as social exclusion, employment and marital discrimination, and internalized shame-was consistently reported across settings, though more severe in female patients and individuals with darker skin phototypes in certain regions. QoL impairment was greater in African, Middle Eastern, and South Asian populations compared to Western cohorts. Coping strategies included concealment, spiritual reliance, and use of complementary and alternative medicine (CAM). CONCLUSION:Vitiligo imposes a global psychosocial burden that is amplified by cultural misconceptions and stigma. Culturally tailored, multidisciplinary interventions-including education, psychological support, and community-based stigma reduction-are crucial to improving outcomes. Future research should focus on high-stigma, underrepresented populations to inform equitable care.

ABSTRACT Psychodermatology examines the bidirectional relationship between mental health and skin disease, offering an integrated approach to understanding the psychosocial impacts of dermatologic conditions. Intricate interactions between physiological stressors, immune system responses and hormonal signals are central to this relationship. For women, hormonal transitions throughout the lifespan play a critical role in modulating both skin pathophysiology and mental health. In this narrative review, we discuss how hormonal milestones, such as menstruation and pregnancy, contribute to cutaneous manifestations. We examine these fluctuations through the lens of the brain–skin axis and the Neuro‐Immuno‐Cutaneous‐Endocrine (NICE) network, which incorporates hormonal, immune and neural signals within the skin. Additionally, we draw attention to common psychiatric comorbidities that present alongside skin disorders, including depression, anxiety and body dysmorphia. By focusing on these challenges, we hope to highlight the unique psychosocial burdens faced by women with visible skin conditions and advocate for integrative treatment approaches. Ultimately, this review underscores the need for gender‐specific care that addresses the full spectrum of women's psychodermatologic health.

Factitious skin disorders remain under-recognized in dermatology, which leads to repeated procedures, ineffective treatments and patient distress. We developed the Factitious Skin Disorder Inventory (FSDI), which is a brief, patient-administered screening tool that quantifies behavioural patterns, psychosocial impact and psychological distress to support early recognition and targeted intervention. The FSDI offers a practical, structured framework for clinical assessment and generates standardized data to guide future research and evidence-based management of this complex, under-recognized condition.

Introduction: Diffuse lichen planopilaris (DLPP) is a rare inflammatory scalp disorder that leads to progressive scarring alopecia, affecting patients' physical and psychological well-being. Objective: To assess quality of life (QoL) in Moroccan patients with DLPP and identify factors influencing their well-being. Materials and Methods: A cross-sectional study included 87 patients with DLPP at Cheikh Khalifa and Mohammed VI International University Hospitals in Casablanca, Morocco. The Dermatology Life Quality Index (DLQI) was used to assess the impact of DLPP on daily activities, emotional health, and social interactions. Results: The majority of patients were females (75.86%). Hair loss occurred in 90% of cases, with changes in hair quality (85.06%), pruritus (85.06%), and trichodynia (43.7%). Diffuse scales were visible in 87.36% of cases, with erythema present in 55.17%. Localized patches and early frontal fibrosing alopecia coexisted with DLPP in 6.9% and 65.52% of patients, respectively; 40.2% of patients had a DLQI >10, which indicates serious QoL impairment. The ‘symptoms’ domain was most affected, particularly among individuals with trichodynia (P=0.038) and changes in hair quality (P=0.009). Conclusion: DLPP markedly reduced QoL, especially in symptomatic forms. Trichodynia and decreased hair quality significantly impacted daily functioning and leisure activities. Early diagnosis and management are crucial to preserve hair potential and protect mental health.

Background:Psoriasis is a long-lasting inflammatory condition of the skin associated with various comorbidities, including depression and suicidal ideation. Management strategies for psoriasis include symptom alleviation, quality-of-life enhancement, and prevention of disease progression. Psoriasis treatments include topical therapies, phototherapy, oral systemic medications, and biologics. Objectives:In this review, we evaluate the impact of psoriasis treatments on depression and suicidal ideation in affected patients. Methods:We systematically searched multiple databases, including PubMed, Scopus, and Web of Science, until September 30, 2024, to identify relevant articles. Studies that examined the effects of psoriasis therapies on depression and suicidal thoughts were included. Data on treatment modalities, psychological health outcomes, and psoriasis severity was obtained. Quality evaluation instruments, such as JBI, consolidated standards of reporting trials (CONSORTs), Center for Evidence-Based Management (CEMBa), and appraisal tool for cross-sectional studies (AXIS), were used to appraise study quality. Results:Ten studies met inclusion criteria, predominantly focusing on biologic therapies. Biologics like guselkumab, brodalumab, and bimekizumab have shown notable reductions in depression symptoms, probably through the alleviation of psoriasis severity and the enhancement of quality-of-life. Suicidal ideation occurred in some cases, especially with brodalumab; however, a definitive causal relationship was not established. Conclusions:Treatments for psoriasis, especially biologics, have shown some advantages in reducing depression symptoms as well as relieving skin symptoms. However, cautious monitoring is required due to the possible hazards of suicidal thoughts with certain therapeutic options such as biologics. Addressing the complex issues of psoriasis requires comprehensive therapy that includes dermatologists and mental health specialists.

Background: Psychodermatology is an interdisciplinary field that bridges psychiatry and dermatology, addressing the psychosocial and psychiatric aspects of skin diseases. Managing such cases presents a challenge for both dermatologists and psychiatrists as patients often resist psychiatric consultations, complicating diagnosis and treatment. Aim: This study aimed to assess the level of knowledge and awareness of psychodermatology among dermatologists in Ibero-Latin America, explore their experiences with psychodermatological conditions, and identify the educational needs and challenges in this interdisciplinary field. Materials and Methods: An observational, descriptive, cross-sectional study was conducted through an online survey from December 2023 to March 2024. The survey was distributed through messaging apps and emails and targeted a sample of dermatologists from Ibero-Latin America to explore their experience, training, and perceived challenges in psychodermatology. The participants were selected through non-probabilistic sampling from the staffing records of the Ibero-Latin American College of Dermatology. Results: Of 301 dermatologists, the vast majority (99%) reported a good level of knowledge in the field of psychodermatology; however, only 36.5% had substantial clinical experience with these conditions. Approximately 70.1% did not prescribe psychotropic medications, reflecting hesitancy or lack of confidence in managing the psychiatric issues of dermatological conditions. The study also highlighted a strong preference (86.7%) for a multidisciplinary approach for managing psychodermatological disorders. Significant perceived challenges included limited access to professional training and patients’ reluctance to accept psychological contributions to their dermatological conditions. Conclusion: The level of knowledge in psychodermatology is widespread among Ibero-Latin American dermatologists, even though a significant gap in practical experience and confidence in integrating psychological management into their dermatological practice was found. These findings emphasize the need for enhanced professional training programs and an interdisciplinary approach to effectively address psychodermatological conditions.