Resident's Forum
RF - Updated Overview and Approaches to the Management of the Main Psychodermatological Disorders
FR - Actualización en el tratamiento de los principales trastornos psicodermatológicos
O. Alwattar-Ceballos
, L. Martínez-Montalvo, F. Moro-Bolado
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Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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"apellidos" => "Botella-Estrada" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731023004908?idApp=UINPBA000044" "url" => "/00017310/unassign/S0001731023004908/v1_202307180913/en/main.assets" ] "asociados" => array:1 [ 0 => array:17 [ "pii" => "S0001731024004848" "issn" => "00017310" "doi" => "10.1016/j.ad.2023.07.032" "estado" => "S200" "fechaPublicacion" => "2024-07-12" "aid" => "3981" "copyright" => "AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Foro de Residentes</span>" "titulo" => "FR - Actualización en el tratamiento de los principales trastornos psicodermatológicos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "RF - Updated Overview and Approaches to the Management of the Main Psychodermatological Disorders" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O. Alwattar-Ceballos, L. Martínez-Montalvo, F. Moro-Bolado" "autores" => array:3 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "Alwattar-Ceballos" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Martínez-Montalvo" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Moro-Bolado" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024004848?idApp=UINPBA000044" "url" => "/00017310/unassign/S0001731024004848/v1_202407120430/es/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident's Forum</span>" "titulo" => " RF - Updated Overview and Approaches to the Management of the Main Psychodermatological Disorders" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "O. Alwattar-Ceballos, L. Martínez-Montalvo, F. Moro-Bolado" "autores" => array:3 [ 0 => array:4 [ "nombre" => "O." "apellidos" => "Alwattar-Ceballos" "email" => array:1 [ 0 => "oalwattar@sescam.jccm.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Martínez-Montalvo" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Moro-Bolado" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR - Actualización en el tratamiento de los principales trastornos psicodermatológicos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The skin is the largest and most visible organ of the body, so its condition can affect our mental health and vice versa.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> It is common to see patients in consultations who suffer from primary psychiatric disorders that lead them to self-inflict cutaneous signs and symptoms.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently, an article was published to help dermatologists in the psychopharmacological management of 5 common psychiatric disorders ofte found in dermatology.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> This review includes a list of commonly used psychotropic drugs and details their prescription, dosage, and side effects to initiate early treatment in these patients who often lack awareness of their illness and may refuse a referral to a psychiatrist.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The disorders covered are delusional parasitosis (DP), body dysmorphic disorder (BDD), trichotillomania (TTM), onychophagia, and excoriation disorder (ED). The Diagnostic and Statistical Manual of Mental Disorders (DSM5) categorizes DP as a psychotic disorder, while the others are categorized as obsessive-compulsive disorders, with TTM, onychophagia, and ED being subcategorized as body-focused repetitive behaviors (BFRBs).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Of note that all these disorders benefit from combined treatment, consisting of pharmacological therapy and psychotherapy (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), with varying techniques depending on the illness.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">For DP, also known as Ekbom's disease, the recommended pharmacological treatment of choice is risperidone, at a dose of 0.5 milligrams (mg) per day. If the patient tolerates the dose, it can be up titrated every 2 weeks to 0.25-0.5<span class="elsevierStyleHsp" style=""></span>mg until control is achieved or even up to a maximum of 3<span class="elsevierStyleHsp" style=""></span>mg daily. Although pimozide is more familiar in dermatology,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> this drug is considered a third-line option, after aripiprazole.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The first-line drugs for BDD are selective serotonin reuptake inhibitors (SSRIs), particularly escitalopram and sertraline due to their safety and efficacy profile. If the patient remains unresponsive, it should be replaced for clomipramine. More complex cases may require the addition of antipsychotics.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Pharmacological management in BFRBs is similar. First-line therapy includes the use of N-acetylcysteine (NAC). This drug is safe for both adults and pediatric patients and is free of the side effects associated with SSRIs and antipsychotics. In ED, treatment typically starts with a SSRI, leaving NAC as a second-line therapy. More options include clomipramine and olanzapine.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally, dermatologists should become familiar with the regular use of, at least, 1 SSRI and 1 antipsychotic, as these are widely used to treat the most frequent psychodermatological disorders.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Adequate knowledge and understanding of these drugs can facilitate the dermatologist's work and enable a multidisciplinary approach to treating these patients, allowing for the early initiation of pharmacological treatment and continuing management in collaboration with psychiatry.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "xpalclavsec1878969" "titulo" => "Palabras clave" ] 1 => array:2 [ "identificador" => "xpalclavsec1878968" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1878968" "palabras" => array:4 [ 0 => "Psychopharmacology" 1 => "Mental disorders" 2 => "Antipsychotic agents" 3 => "Dermatology" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">DP: delusional parasitosis; NAC: N-acetylcysteine; BDD: body dysmorphic disorder; ED: excoriation disorder; TTM: trichotillomania.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BDD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Onychotillomania \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ED \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TTM \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risperidone 1-3 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Escitalopram 10-20 mg/day, or sertraline 100-200 mg/day<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAC 1200-2400 mg/day in 2 takes<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Escitalopram 10-20 mg/day, or sertraline 100-200 mg/day<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Escitalopram 10-20 mg/day, or sertraline 100-200 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Psychotherapy</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Second-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aripiprazole 2-10 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clomipramine 150-250 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clomipramine 150-250 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAC 1200-2400 mg/day in 2 takes<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAC 1200-2400 mg/day in 2 takes<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Third-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pimozide 1-3 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buspirone (15-30 mg/12h); venlafaxine (150-225 mg/day); bupropion (150-300 mg/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Venlafaxine 150-225 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clomipramine 150-250 mg/day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fourth-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Olanzapine 5-10 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Add antipsychotic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Olanzapine 5-10 mg/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3660795.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These patients may require doses of escitalopram up to 50<span class="elsevierStyleHsp" style=""></span>mg/day or sertraline up to 300<span class="elsevierStyleHsp" style=""></span>mg/day.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Start with 600<span class="elsevierStyleHsp" style=""></span>mg/day. If well-tolerated, up titrate to 600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h. For adults, doses can be up titrated to 1200<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h. May cause oral ulcers.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pharmacological management of the main psychiatric disorders with cutaneous involvement.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychopathological symptoms in dermatology: A basic approach toward psychocutaneous disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.M. Rahman" 1 => "A. Abduelmula" 2 => "M. Jafferany" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.16344" "Revista" => array:5 [ "tituloSerie" => "Int J Dermatology." "fecha" => "2023" "volumen" => "62" "paginaInicial" => "346" "paginaFinal" => "356" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychopharmacology in dermatology: Treatment of primary psychiatric conditions in dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Torales" 1 => "O. Melgarejo" 2 => "I. González" 3 => "O. García" 4 => "I. Barrios" 5 => "M. Jafferany" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/dth.13557" "Revista" => array:5 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2020" "volumen" => "33" "paginaInicial" => "e13557" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32396243" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychopharmacology in dermatology: Five common disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.L. Ha" 1 => "M. Magid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clindermatol.2023.03.010" "Revista" => array:4 [ "tituloSerie" => "Clin Dermatol" "fecha" => "2023" "paginaInicial" => "112" "paginaFinal" => "120" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recent developments in psychodermatology and psychopharmacology for delusional patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.D. Brownstone" 1 => "J. Koo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12788/cutis.0144" "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "2021" "volumen" => "107" "paginaInicial" => "5" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33651860" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/unassign/S0001731024007129/v1_202409200439/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/00017310/unassign/S0001731024007129/v1_202409200439/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024007129?idApp=UINPBA000044" ]
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