Pediatric Psychodermatology: A Clinical Manual of Child and Adolescent Psychocutaneous Disorders (Health, Medicine and Human Development)

Psychodermatology is a relatively new field in evolution and thus, there is a comparative paucity of information in general. However, when it comes to children and adolescents there is a complete vacuum of information as no other book has aimed to specifically address the psychodermatological issues facing this particular population. For assessment, diagnosis, comprehensive treatment of children with psychodermatologic conditions and establishing a relationship between skin and psyche, there is a lack of clear and relevant clinical information about these complex disorders. The complexity of these disorders is related to lack of understanding in genetic, embryonic, physiologic, neuroimmunologic, neurocutaneous, stress-related neuromodulation, and psychosomatic interconnections. This book presents a clinically relevant approach to the management of psychodermatologic issues encountered in normal practice. Various classifications and major categories that are discussed include psychophysiologic disorders, psychiatric conditions with dermatologic manifestations, dermatologic disorders predisposing to psychiatric disorders, systemic diseases with psychodermatological manifestations, and special issues in management of psychocutaneous disorders in children and adolescents. * First book focusing on psychocutaneous issues in the pediatric population * Covers the dermatological and psychiatric features of each topic * Explains the diagnosis and treatment from both dermatologic and psychiatric perspective Foreword I Foreword II Preface Author index Abbreviations Part I: INTERFACE OF DERMATOLOGY AND PSYCHIATRY 1 Perspectives on management of pediatric dermatologie disorders 1.1 Introduction 1.2 Skin infections and infestations 1.2.1 Bacterial infections 1.2.2 Viral infections 1.3 HIV/AIDS 1.3.1 Non-infectious skin lesions 1.3.2 Bacterial infections in HIV 1.3.3 Viral infections in HIV 1.3.4 Fungal infections in HIV 1.3.5 Fungal infections 1.3.6 Topical antifungals 1.3.7 Infestations 1.4 Dermatitis 1.4.1 Irritant dermatitis 1.4.2 Dry-skin dermatitis 1.4.3 Seborrheic dermatitis 1.4.4 Allergic dermatitides 1.4.5 Idiopathic dermatitides 1.5 Hypersensitivity 1.5.1 Urticaria 1.5.2 Drug eruptions 1.6 Miscellaneous skin conditions 1.6.1 Acne vulgaris 1.6.2 Nevi 1.6.3 Papulosquamous disorders 1.6.4 Lichens 1.6.5 Psoriasis 1.7 Dermatologic manifestations of systematic disorders 1.7.1 Pruritus without rash 1.7.2 Inflammatory bowel disease (IBD) 1.7.3 Erythema nodosum 1.7.4 Pyoderma gangrenosum 1.7.5 Less common skin manifestations 1.7.6 Management 1.8 Collagen vascular disease 1.8.1 Lupus erythematosus (SLE) 1.8.2 Dermatomyositis 1.8.3 Juvenile idiopathic arthritis 1.8.4 Management 1.9 Endocrinologic disorders 1.9.1 Thyroid disorders 1.9.2 Diabetes mellitus 1.9.3 Adrenal disorders 1.9.4 Management 1.10 Hair and nails 1.10.1 Alopecia areata 1.10.2 Telogen effluvium 1.10.3 Androgenic alopecia 1.10.4 Trichotillomania 1.10.5 Traction alopecia 1.10.6 Hirsutism and hypertrichosis 1.10.7 Hair changes with systemic disease 1.10.8 Infection 1.10.9 Bacterial 1.10.10 Fungal 1.10.11 Onychodystrophy 1.10.12 Nail changes with systemic and nutritional disorders 2 Psychoneuroimmunology and other interactions between skin and psyche 2.1 Introduction 2.1.1 History of psychodermatology 2.1.2 Classification of psychodermatologic disorders 2.1.3 Psychological perspective of skin 2.1.4 Skin, mind, and the embryological embrace 2.2 Psychoneuroimmunology 2.2.1 Neuroendocrine response to stress 2.2.2 Immune response and central nervous system 2.2.3 Immune response and peripheral nervous system 2.2.4 Immune response and skin disease 2.2.5 Immune response and psychiatric disease 2.3 Conclusion 3 A clinician’s approach to psychocutaneous diseases in adolescents: Untying the Gordian knot 3.1 Introduction 3.1.1 History taking skills in adolescent patients 3.2 Interviewing the adolescent patient 3.2.1 Confidentiality 3.2.2 Parental confidentiality 3.2.3 Health questionnaires 3.2.4 Interview techniques 3.2.5 Active listening skills 3.3 Concepts of the physical examination 3.4 Successful management of the adolescent patient 3.4.1 Informed consent 3.4.2 Shared decision makings 3.4.3 Improving compliance 3.5 Conclusion 4 Quality of life issues in children and adolescents with dermatological conditions and their wider impact on the family and society 4.1 Introduction 4.2 Pediatric quality of life and its assessment 4.3 Skin disease and quality of life 4.3.1 Impact of skin diseases on children’s quality of life 4.3.2 Quality of life assessment in children with dermatological conditions 4.3.3 Children’s Dermatology Life Quality Index (CDLQI) 4.3.4 Infant’s Dermatitis Quality of Life Index (IDQoL) 4.3.5 Impact of skin disease on the quality of life of adolescents 4.4 Assessment of adolescents’ quality of life in dermatology 4.4.1 Teenager’s QoL questionnaire (T-QoL) 4.4.2 Skindex-Teen 4.4.3 Impact of skin disease on family quality of life: The “greater patient” concept 4.5 Assessment of family quality in dermatology 4.5.1 Family Dermatology Life Quality Index (FDLQI) 4.5.2 Dermatitis Family Impact questionnaire (DFI) 4.5.3 Parents’ Index of Quality of Life in Atopic Dermatitis (PIQoL-AD) 4.5.4 Childhood Atopic Dermatitis Impact Scale (CADIS) 4.5.5 Psoriasis Family Index (PFI) 4.6 Societal impact of childhood dermatological conditions 4.7 Conclusions Part II: PSYCHOPHYSIOLOGIC DISORDERS 5 Atopic dermatitis: a psychocutaneous review 5.1 Introduction 5.1.1 Epidemiology 5.2 Pathophysiologic factors in atopic dermatitis 5.2.1 Genetic predisposition 5.2.2 Socio-economic status 5.2.3 Family size 5.2.4 Food allergens 5.3 Psychoneuroimmunologic factors 5.3.1 Breast feeding 5.3.2 Environmental allergens 5.4 Psychophysiological aspects of atopic dermatitis 5.4.1 Impact of stress on the immunological system 5.4.2 Psychoanalytic hypothesis 5.4.3 Biopsychosocial model 5.4.4 Psychological dysregulation due to atopic dermatitis 5.5 Clinical features 5.6 Diagnosis 5.6.1 Allergy Testing 5.6.2 Differential Diagnosis 5.7 Management 5.7.1 Prevention of relapse 5.7.2 Food allergens 5.7.3 Aeroallergens 5.7.4 Optimizing the epidermal barrier (EB) 5.7.5 Hydration therapy 5.7.6 Management of pruritus 5.7.7 Topical corticosteroids 5.7.8 Topical immunomodulators 5.8 Systematic treatment of atopic dermatits 5.8.1 Antihistamines 5.8.2 Phototherapy 5.8.3 Antibiotics 5.8.4 Systemic corticosteroids 5.8.5 Immunomodulators 5.8.6 Cyclosporine 5.8.7 Azathioprine 5.8.8 Infliximab 5.8.9 Interferon-γ 5.8.10 Leukotriene inhibitors 5.9 Psychiatric comorbidities 5.9.1 Family dynamics 5.9.2 Internalizing and externalizing behaviors 5.9.3 Anxiety and depression 5.9.4 Personality traits 5.10 Management of psychiatric comorbidities 5.10.1 Multidisciplinary approach 5.10.2 Psychoeducation 5.10.3 Psychosocial assessment 5.10.4 Psychiatric symptoms review 5.10.5 Quality of life assessment 5.10.6 Psychodynamic therapy 5.10.7 Cognitive behavioral therapy 5.10.8 Behavioral modifications 5.10.9 Psychotropic medications 5.11 Conclusion 6 Psoriasis and children: A psychological approach 6.1 Introduction 6.1.1 Epidemiology 6.2 Dermatological clinical features 6.2.1 Plaque psoriasis 6.2.2 Guttate psoriasis 6.2.3 Erythrodermic psoriasis 6.2.4 Pustular psoriasis 6.2.5 Psoriatic arthritis 6.2.6 Inverse psoriasis 6.3 Psychological clinical features 6.3.1 Differential diagnosis 6.3.2 Psychotherapeutic intervention 6.3.3 Psychotherapy 6.4 Conclusions 7 The acnes: Acne vulgaris, acne rosacea, and acne excoriée 7.1 Acne Vulgaris 7.1.1 Introduction 7.1.2 Epidemiology 7.1.3 Pathogenesis 7.1.4 Classification 7.1.5 Management 7.1.6 Teratogenicity and isotretinoin 7.1.7 Depression, suicidality, and isotretinoin 7.2 Acne Rosacea 7.2.1 Pathophysiology 7.2.2 Management of acne rosacea 7.3 Acne Variants 7.4 Conclusion 8 Psychogenic purpura (Gardner-Diamond syndrome) 8.1 Introduction 8.2 History 8.3 Etiology and pathogenesis 8.4 Clinical features 8.5 Differential diagnosis 8.5.1 Disease course 8.5.2 Histopathology 8.5.3 Laboratory testings 8.5.4 Psychological disturbances 8.6 Treatment approaches and recommendations 8.7 Conclusion Part III: PSYCHIATRIC DISORDERS WITH DERMATOLOGIC MANIFESTATIONS 9 Body dysmorphic disorder in adolescents 9.1 Introduction 9.2 Definition 9.2.1 Epidemiology 9.2.2 Clinical features 9.2.3 Differential diagnosis 9.3 Management 9.3.1 Preliminary considerations 9.3.2 The clinical interview 9.3.3 Assessment 9.3.4 Patient education 9.3.5 Treatment 9.4 Other treatment techniques 9.4.1 Anxiety management training (AMT) 9.4.2 Eye movement desensitization and reprocessing (EMDR) 9.4.3 Family therapy 9.4.4 Group therapy 9.4.5 Metaphors 9.4.6 Mindfulness 9.4.7 Intervention 9.4.8 Nonpsychiatric medical treatment 9.4.9 Final management considerations 9.5 Conclusions 10 Delusional infestation in childhood, adolescence, and adulthood 10.1 Introduction 10.2 How to diagnose a delusion 10.3 Primary and secondary delusional infestation 10.4 The context of children and adolescence 10.5 Clinical pictures 10.5.1 Case one 10.5.2 Case two 10.5.3 Case Three 10.5.4 Commentary on these three cases 10.6 Delusional elaboration (“Wahnarbeit”) 10.7 Prevalence of delusional infestation 10.7.1 Treatment 10.7.2 Which antipsychotic in DI? 10.8 Antipsychotics 10.9 Conclusion 11 Dermatitis artefacta, skin picking, and other self-injurious behaviors: A psychological perspective 11.1 Introduction 11.2 Epidemiology 11.3 Etiology 11.4 Clinical features 11.4.1 Dermatitis Artefacta 11.4.2 Skin picking 11.4.3 Self-mutilation behavior 11.5 Differential diagnosis 11.6 Management 11.6.1 Pharmacological Treatment 11.6.2 Psychotherapy 11.6.3 Issues with Treatment 11.7 Conclusions 12 Trichotillomania 12.1 Introduction 12.2 Definition 12.3 Differential diagnosis 12.4 Assessment 12.5 Management 12.5.1 Psychotherapy 12.5.2 Medication 12.6 Conclusions: Future directions 13 Psychogenic pruritus with particular emphasis on children and adolescents 13.1 Introduction 13.2 Epidemiology 13.3 Clinical features 13.4 Differential diagnosis 13.5 Management 13.6 Conclusion Part IV: DERMATOLOGIC DISORDERS PREDISPOSING TO PSYCHIATRIC DISORDERS 14 Disorders of hair loss 14.1 Introduction 14.2 Causes of hair loss 14.3 Diagnostic approach to hair loss 14.3.1 History 14.3.2 Examination 14.3.3 Laboratory investigation 14.4 Tinea capitis 14.5 Telogen effluvium 14.6 Alopecia areata 14.7 Male pattern hair loss 14.8 Hair Loss due to Chemotherapy 14.9 Psychiatric aspects 14.9.1 Psychological treatment approaches 14.10 Conclusion 15 Disorders of skin pigmentation 15.1 Introduction 15.2 Disorders of hypopigmentation 15.2.1 Vitiligo 15.2.2 Albinism 15.2.3 Postinflammatory hypopigmentation 15.2.4 Pityriasis alba 15.2.5 Tinea versicolor 15.3 Disorders of hyperpigmentation 15.3.1 Postinflammatory hyperpigmentation 15.3.2 Melasma 15.3.3 Hyperpigmentation associated with medical disorders 15.3.4 Café-au-lait spots 15.3.5 Lentigines 15.4 Psychological aspects of disorders of pigmentations 15.4.1 Psychosocial management of disorders of pigmentation 15.5 Conclusion 16 Skin adnexal disorders 16.1 Hidradenitis suppurativa (HS) 16.1.1 Introduction 16.1.2 Diagnosis 16.1.3 Etiology 16.1.4 Clinical features 16.1.5 Differential Diagnosis 16.2 Hyperhidrosis 16.2.1 Definition 16.2.2 Epidemiology 16.2.3 Etiology 16.2.4 Clinical features 16.2.5 Differential diagnosis 16.2.6 Management 16.3 Anhidrotic ectodermal dysplasia 16.3.1 Definition 16.3.2 Epidemiology 16.3.3 Clinical features 16.3.4 Differential diagnosis 16.3.5 Management 16.4 Nevus sebaceous 16.4.1 Definition 16.4.2 Epidemiology 16.4.3 Clinical features 16.4.4 Differential diagnosis 16.4.5 Management 16.5 Conclusion Part V: SYSTEMATIC DISEASES WITH PSYCHODERMATOLOGIC MANIFESTATIONS 17 Neurocutaneous disorders 17.1 Introduction 17.2 Neurofibromatosis 17.2.1 Clinical features 17.2.2 Neuropsychiatric aspects of neurofibromatosis type 1 17.2.3 Management 17.2.4 NF1 summary 17.3 Tuberous Sclerosis Complex (TSC) 17.3.1 Introduction 17.3.2 Clinical features of TSC 17.3.3 Neurologic lesions 17.3.4 Psychiatric symptoms 17.3.5 Management 17.3.6 Treatment of neuropsychiatric problems 17.4 Conclusion 18 Collagen vascular disorders: Psychiatric and dermatologic manifestations 18.1 Lupus erythematosus (LE) 18.1.1 Epidemiology 18.1.2 Clinical features 18.1.3 Cutaneous manifestations 18.1.4 Neuropsychiatric systemic lupus erythematosus (NPSLE) 18.1.5 Differential diagnosis 18.1.6 Clinical diagnosis 18.1.7 Diagnostic workup 18.1.8 Management 18.1.9 Treatment of cutaneous lupus lesions 18.1.10 Treatment of NPSLE 18.2 Dermatomyositis 18.2.1 Epidemiology 18.2.2 Clinical features 18.2.3 Cutaneous manifestations 18.2.4 Psychiatric manifestations 18.2.5 Management 18.3 Rheumatoid Arthritis 18.3.1 Epidemiology 18.3.2 Etiopathogenesis 18.3.3 Clinical features 18.3.4 Cutaneous manifestations 18.3.5 Psychiatric manifestations 18.3.6 Laboratory findings 18.3.7 Management 18.3.8 Management of psychiatric issues 19 Psychocutaneous manifestations of endocrine disorders 19.1 Introduction 19.2 Diabetes Mellitus 19.2.1 Clinical features 19.2.2 Dermatological manifestations 19.2.3 Psychiatric manifestations 19.2.4 Management of psychiatric conditions 19.3 Disorders of growth hormone 19.3.1 Acromegaly 19.3.2 Dermatological manifestations 19.3.3 Psychiatric manifestations 19.3.4 Diagnostic workup 19.3.5 Clinical management 19.3.6 Management of dermatological manifestations 19.3.7 Management of psychiatric manifestations 19.4 Thyroid hormone disorders 19.4.1 Hypothyroidism 19.4.2 Hyperthyroidism 19.4.3 Clinical features of thyroid disorders 19.4.4 Dermatological manifestations of hypothyroidism 19.4.5 Dermatological manifestations of hyperthyroidism 19.4.6 Psychiatric manifestations 19.4.7 Diagnostic workup 19.4.8 Management of hypothyroidism 19.4.9 Management of hyperthyroidism 19.4.10 Management of psychiatric disorders 19.5 Adrenal gland disorders 19.5.1 Hypoadrenocorticism (adrenal insufficiency [AI] or Addison disease [AD]) 19.5.2 Hyperadrenocorticism (Cushing syndrome) 19.6 Disorders of parathyroid glands 19.6.1 Hypoparathyroidism 19.6.2 Hyperparathyroidism 19.7 Disorders of hormones of the reproductive system 19.8 Androgen disorders 19.8.1 Hypogonadism in males 19.8.2 Androgen disorders in Females 19.9 Estrogen disorders 19.9.1 Estrogen disorders in males 19.9.2 Estrogen disorders in females 19.9.3 Psychiatric manifestations of disorders of androgen and estrogens 19.10 Conclusion 20 Inborn errors of metabolism with psychiatric and dermatologic features 20.1 Introduction 20.2 Phenylketonuria [PKU] 20.2.1 Genetics and pathophysiology 20.2.2 Clinical features 20.2.3 Cutaneous manifestations 20.2.4 Psychiatric manifestations 20.2.5 Laboratory diagnosis 20.2.6 Management 20.3 Hartnup disease 20.3.1 Genetics and pathophysiology 20.3.2 Cutaneous manifestations 20.3.3 Psychiatric manifestations 20.3.4 Laboratory findings 20.3.5 Management 20.4 Homocystinuria 20.4.1 Genetics and pathophysiology 20.4.2 Clinical features 20.4.3 Cutaneous manifestations 20.4.4 Psychiatric Manifestations 20.4.5 Management 20.5 Porphyrias 20.5.1 Genetics and prevalence 20.5.2 Clinical features 20.5.3 Cutaneous manifestations 20.5.4 Psychiatric manifestations 20.5.5 Laboratory diagnosis 20.5.6 Management 20.6 Conclusion Part VI: SPECIAL ISSUES IN MANAGEMENT OF PSYCHOCUTANEOUS DISORDERS 21 Psychiatric complications of dermatological treatments 21.1 Introduction 21.2 Epidemiology 21.3 Clinical features by medication category 21.3.1 Antibacterial agents 21.3.2 Antiviral agents 21.3.3 Corticosteroids 21.3.4 Dapsone 21.3.5 Antimalarial agents 21.3.6 Retinoids 21.3.7 Interferons 21.3.8 Other agents 21.4 Differential diagnosis 21.5 Management 21.5.1 Drug-drug interactions 21.5.2 Non-pharmacologic interventions 21.6 Conclusion 22 Dermatologic manifestations of psychotropic medications 22.1 Introduction 22.1.1 Epidemiology 22.2 Diagnosis 22.3 Pathogenesis 22.4 Categories 22.5 Common adverse cutaneous reactions 22.5.1 Pruritus 22.5.2 Exanthematous eruptions 22.5.3 Urticaria and angioedema 22.5.4 Fixed drug eruptions 22.5.5 Photosensitivity 22.5.6 Pigmentation 22.5.7 Diaphoresis 22.5.8 Alopecia 22.6 Serious and life-threatening cutaneous reactions 22.6.1 Erythema multiforme 22.6.2 Stevens-Johnson Syndrome and Toxic Epidermolysis Necrolysis 22.6.3 Drug hypersensitivity syndrome 22.6.4 Vasculitis 22.6.5 Exfoliative dermatitis 22.6.6 Anaphylactoid reactions 22.7 General dermatologic conditions 22.7.1 Acneiform eruptions 22.7.2 Psoriasiform eruption 22.7.3 Seborrheic eruption 22.7.4 Lichenoid eruption 22.8 Conclusion 23 Non-pharmacological approaches to treat psychocutaneous disorders 23.1 Introduction 23.2 Non-pharmacological modalities 23.2.1 Acupuncture 23.2.2 Aromatherapy 23.2.3 Biofeedback 23.2.4 Brief dynamic psychotherapy 23.2.5 Cognitive behavioral therapy methods 23.2.6 Emotional freedom techniques (EFT) 23.2.7 Eye Movement Desensitizing and Reprocessing (EMDR) 23.2.8 Hypnosis 23.2.9 Music 23.2.10 Placebo 23.2.11 Suggestion 23.3 Conclusion 24 Psychiatric disorders frequently encountered in dermatology practices 24.1 Introduction 24.1.1 Epidemiology 24.2 Mood disorders 24.2.1 Epidemiology 24.2.2 Diagnosis of depressive disorders 24.2.3 Differential diagnosis of depressive disorders 24.2.4 Management of depressive disorders 24.3 Bipolar spectrum disorders 24.3.1 Types of bipolar disorders 24.3.2 Diagnosis of bipolar disorders 24.3.3 Differential diagnosis of bipolar disorders 24.4 Anxiety spectrum disorders 24.4.1 Obsessive compulsive disorder 24.4.2 Social anxiety disorder (SAD) 24.4.3 Eating disorders 24.5 Personality disorders (PDs) 24.5.1 Introduction 24.5.2 Clinical diagnosis 24.6 Conclusion APPENDIX 25 About the editors 26 FDA approved psychotropic medication indications for children and adolescents 27 Common psychiatric terms 28 Common dermatotologic lesions Index Plate section

Psychodermatology is a relatively new field in evolution and thus, there is a comparative paucity of information in general. However, when it comes to children and adolescents there is a complete vacuum of information as no other book has aimed to specifically address the psychodermatological issues facing this particular population. For assessment, diagnosis, comprehensive treatment of children with psychodermatologic conditions and establishing a relationship between skin and psyche, there is a lack of clear and relevant clinical information about these complex disorders. The complexity of these disorders is related to lack of understanding in genetic, embryonic, physiologic, neuroimmunologic, neurocutaneous, stress-related neuromodulation, and psychosomatic interconnections.

This book presents a clinically relevant approach to the management of psychodermatologic issues encountered in normal practice. Various classifications and major categories that are discussed include psychophysiologic disorders, psychiatric conditions with dermatologic manifestations, dermatologic disorders predisposing to psychiatric disorders, systemic diseases with psychodermatological manifestations, and special issues in management of psychocutaneous disorders in children and adolescents.

Psychodermatologic disorders comprise for up to one third of dermatologic conditions in different clinical settings. By virtue of their complex nature these disorders can be very difficult to treat and adversely impact long term outcomes. This book examines the bidirectional relationship between psychiatry and dermatology in children and adolescents. The informationarepresented in an easy to follow format to be used as a clinical reference by physicians and paramedical staff in various fields of medicine including pediatrics, primary care, internal medicine, psychiatry and dermatology. Ruqiya Shama Tareen, Donald E. Greydanus, Mohammad Jafferany, and Dilip R. Patel, Michigan State University, East Lansing, Michigan, USA;Joav Merrick, Ministry of Social Affairs and Social Services, Jerusalem, Israel Psychodermatologic disorders comprise for up to one third of dermatologic conditions in different clinical settings. By virtue of their complex nature these disorders can be very difficult to treat and adversely impact long term outcomes. This book examines the bidirectional relationship between psychiatry and dermatology in children and adolescents. The information are presented in an easy to follow format to be used as a clinical reference by physicians and paramedical staff in various fields of medicine including pediatrics, primary care, internal medicine, psychiatry and dermatology