Pediatrik Dermatolojide Psikiyatrik Yaklaşım
Synopsis
Examining the psychiatric approach in pediatric dermatology, this study draws attention to the close embryological connection between the skin and the central nervous system—both originating from the ectoderm—and highlights the clinical significance of psychodermatology. Psychodermatological diseases are categorized into five main groups: primary psychiatric disorders, psychophysiological disorders, secondary psychiatric disorders, cutaneous sensory disorders, and non-psychiatric conditions utilizing psychotropic drugs. Due to physical changes and heightened body image awareness during childhood and especially adolescence, dermatological diseases are accompanied by psychiatric conditions such as depression and anxiety in 30% of cases, potentially leading to embarrassment, social isolation, and stigmatization. While atopic dermatitis and verrucae are most common in children, acne vulgaris predominates during adolescence. A holistic treatment approach requires thorough evaluation, reassuringly preparing and referring the patient to child psychiatry, and implementing appropriate therapies. Alongside non-pharmacological interventions such as cognitive behavioral therapy, relaxation exercises, biofeedback, and hypnosis, pharmacological treatments including SSRIs, tricyclic antidepressants, or anxiolytics should be administered within a strong physician-patient therapeutic relationship. Furthermore, considering potential psychiatric side effects of dermatological medications like isotretinoin and glucocorticoids, as well as the heightened suicide risk associated with acne, close collaboration and multidisciplinary follow-up between dermatologists and child and adolescent psychiatrists are essential.
References
Mercan S, Altunay İ.K. Psikiyatri ve Dermatolojinin Ortak Çalışma Alanı: Psikodermatoloji. Türk Psikiyatri Dergisi 2006; 17(2).
Lyell A. Dermatitis artefacta and another self-inflicted dermatoses. Scotland J of Medicine 1972, 17:187-196.
Koo JYM. Psychodermatology: Current Concepts. Kalamazoo, Mich: The Upjohn Company, 1989, 1-14.
Nanda A, Al-Hasawi F, Alsaleh QA. A prospective survey of pediatric dermatology clinic patients in Kuwait: An analysis of 10.000 cases. Pediatr Dermatol 1999;16:6-11.
Tamer E, Ilhan MN, Polat M.et al. Prevalence of skin diseases among pediatric patients in Turkey. J Dermatol 2008;35:413-8.
Tekin NS, Sezer T, Altınyazar HC. ve ark. Zonguldak bölgesinde çocukluk çağında görülen deri hastalıklarının prevalansı: Beş yıllık retrospektif analiz. T Klin J Dermatol 2007;17:92-8.
Uğur,G, (1996).Üniversite öğrencilerinde atılganlık ve beden algısı ilişkisi.Yüksek Lisans Tezi, Sağlık Bilimleri Enstitüsü İzmir.
Halvorsen JA, Stern RS, Dalgard F, et al. Suicidal ideation, mental health problems and social impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol. 2011; 131: 363–370.
Cotterill JA: Dermatologic nondisease. Dermatol Clin.1996. 14 (3):439-445.
Ana Paula Dornelles da Silva Manzoni, Rita Langie Pereira,Roberta Zaffari Townsend, et al. Assessment of the quality of life of pediatric patients with the major chronic childhood skin diseases. An. Bras. Dermatol. vol.87 no.3 Rio de Janeiro May/June 2012.
Wolberg LR. The technique of Psychotherapy (4th ed). New York. Grune & Stratton Inc. 1988 ̈103–30.
Gupta MA, Gupta AK. Psychodermatology: An update. J Am Acad Dermatol 1996; 34: 1030-46.
Gupta MA, Gupta AK. The use of antidepressant drugs in dermatology. J Eur Acad Dermtol Venereol. 2001;15:512-518.
Savin JA, Cotterill JA. Psychocutaneous disorders. In: Champion RH; Burton JL, Elbling FJ, eds. Textbook of dermatology, Vol 4, 5th ed. Oxford: Blackwell Scientific Publ 1992; 2479-96.
Lamberg L. Acne drug depression warnings highlight need for expert care. JAMA 1998; 279:1057.
