ABSTRACT
Psychiatric and psychosocial factors are reported to play a role in at least 30% of dermatological disorders (1-6). Among the wide range of psychopathological states encountered in dermatology, depressive disease is one of the most frequently encountered psychiatric syndromes. It is important to recognize and effectively treat depressive disease that is comorbid with dermatological disorders, as depression among dermatological patients has been associated with suicidal ideation and cases of completed suicide. Furthermore, coexisting depression may prolong the morbidity associated with a dermatological disorder, e.g., in some pruritic dermatoses. Depressive disease is encountered in both the major groups of psychodermatological disorders: 1) the cutaneous associations of psychiatric disorders such as neurotic excoriations, some cases of delusions of parasitosis where delusional depression may be present, and markedly
excessive concerns about cutaneous body image that are not consistent with objective clinical dermatological evaluation, and 2) the large group of dermatological disorders such as psoriasis, atopic dermatitis, chronic idiopathic urticaria, alopecia areata and acne that are both exacerbated by psychosocial stress and comorbid with a wide range of psychiatric disorders including major depressive disorder. The impact of the skin disorder on the quality of life of the patient, which results mainly from the social stigma associated with having a cosmetically disfiguring disease, can result in significant psychological morbidity including major depressive disorder. It is important to recognize, however, that depression among dermatological patients is generally a multifactorial problem, and in certain disorders like acne, the degree of depression is not always directly correlated with the clinical severity of the dermatological disorder.
