Diagnostic and Therapeutic Pitfalls of Psychodermatoses: A Case Report


  • Atinuke Soyinka Ajani Nigerian Association of Dermatology


Background: Psychological distress as a common corollary of skin diseases is well established in the
medical literature. What is less commonly discussed are dermatoses that are primarily psychiatric and the
challenges of diagnosing and treating such conditions in dermatology practice. Because patients with
primary psychiatric disorders often present first to the dermatologist with dermatoses that may mimic purely
dermatologic disorders, it is expedient that dermatologists are conversant with the psychopathological
component of skin diseases. This will help avert needless investigations, misdirected treatments, and
unsatisfactory therapeutic outcomes.
We present two patients with previously undiagnosed psychiatric disorders referred to the dermatology clinic
with a long history of hospital hopping, countless laboratory investigations, and repeated unsuccessful
treatments for onchodermatitis and scabies. Both patients were diagnosed with underlying primary
psychiatric illness but declined referral for psychiatric consultations. Desired clinical response was achieved
following appropriate psychotherapeutic interventions.
This case report underscores the diagnostic and therapeutic challenges of psychodermatoses. A
consideration for underlying psychiatric morbidity should be given in dermatology patients presenting with
poor clinical response to standard therapy for apparently “uncomplicated” dermatologic conditions.
Keywords: Psychodermatoses, Psychological distress, Psychiatric disorders, Psychotherapy,
Diagnostic and therapeutic pitfalls.