A review of patients managed at a combined psychodermatology clinic: a Singapore experience

<p><b>INTRODUCTION</b>Recognising and appropriately treating psychosomatic factors in dermatological conditions can have a significant positive impact on the outcomes of patients. Treatment of psychodermatological patients requires a multidisciplinary approach that involves dermatologists, psychiatrists and allied health professionals.</p><p><b>METHODS</b>This was a retrospective case series of patients seen in our psychodermatology liaison conferences from November 2009 to July 2011. We reviewed all the case notes and analysed data such as age, gender, dermatologic and psychiatric diagnoses, treatment and outcome.</p><p><b>RESULTS</b>The majority of patients in our cohort were diagnosed with either a psychophysiologic disorder or a primary psychiatric disorder. The most common diagnosis among patients with primary psychiatric disorder was delusions of parasitosis. Other common primary psychiatric disorders seen were trichotillomania and dermatitis artefacta. About a fifth of our patients had psychiatric disorders resulting from their underlying dermatological conditions. A third of our patients were lost to follow-up.</p><p><b>CONCLUSION</b>Managing patients with psychocutaneous disorders can be challenging, with many patients defaulting treatments. Psychodermatology clinics will benefit both patients and their caregivers. A collaborative approach using a consultation-liaison relationship between two medical departments in a friendly environment would result in more effective, integrated and holistic treatment strategies for such patients. Further studies should be conducted to determine how beneficial such services are to patients. With more experience, we hope to improve this service.</p>

Drug hypersensitivity syndrome with significant gastrointestinal involvement

Drug hypersensitivity syndrome (DHS) is an idiosyncratic systemic reaction to a drug. The clinical presentation of this syndrome comprises a diverse spectrum, ranging from mild to fulminating organ failure. Nonspecific gastrointestinal symptoms are common in DHS, but severe morbidities and mortalities attributed to gut disease in DHS are rarely described. We present a case of DHS with significant gastrointestinal symptoms of prolonged profuse watery diarrhoea and persistent hypokalaemia requiring judicious intravenous water and electrolyte replacement. The symptoms resolved only after the introduction of intravenous hydrocortisone. It is important to consider intravenous corticosteroids if the gastrointestinal system is involved, as accelerated gut motility and mucosal damage would affect absorption of oral medications. Supportive treatment with the monitoring of fluid and electrolytes status and judicious replacement remains fundamental in the management of DHS patients with gut involvement.