[Psychotropics in dermatology].

In dermatology, psychotropics are sometimes useful. But it is not still popular in clinical dermatology. It is recommended to use them for the patients who have psychosomatic aspect, anxiety and depression due to skin disease. Psychotropics are also useful to alleviate the sensation of itch. Trichotillomania and excess scratch are treated with antidepressants, anticonvulsants or antipsychotics. Cutaneous dysesthesia and delusional parasitosis are treated with antipsychotics. In prescribing benzodiazepines and hypnotics, we have to check abuse and dependency. Decrease of dosage should be made gradually. Antidepressants, anticonvulsants (except barbiturates) and antipsychotics have no dependency. They are much easily used than benzodiazepines. Drowsy and thirsty are main side effects that antihistamines also have. It should be noticed to use both simultaneously.

Development and validation of the psychosomatic scale for atopic dermatitis in adults.

Psychosocial factors play an important role in the course of adult atopic dermatitis (AD). Nevertheless, AD patients are rarely treated for their psychosomatic concerns. The purpose of the present study was to develop and validate a brief self-rating scale for adult AD in order to aid dermatologists in evaluating psychosocial factors during the course of AD. A preliminary scale assessing stress-induced exacerbation, the secondary psychosocial burden, and attitude toward treatment was developed and administered to 187 AD patients (82 male, 105 female, aged 28.4 +/- 7.8, 13-61). Severity of skin lesions and improvement with standard dermatological treatment were assessed by both the dermatologist and the participant. Measures of anxiety and depression were also determined. In addition, psychosomatic evaluations were made according to the Psychosomatic Diagnostic Criteria for AD. Factor analysis resulted in the development of a 12-item scale (The Psychosomatic Scale for Atopic Dermatitis; PSS-AD) consisting of three factors: (i) exacerbation triggered by stress; (ii) disturbances due to AD; and (iii) ineffective control. Internal consistency indicated by Cronbach's alpha coefficient was 0.86 for the entire measure, 0.82 for (i), 0.81 for (ii), and 0.77 for (iii), verifying the acceptable reliability of PSS-AD. Patients with psychosomatic problems had higher PSS-AD scores than those without. PSS-AD scores were positively associated with the severity of the skin lesions, anxiety and depression. The scores were negatively associated with improvement during dermatological treatments. In conclusion, PSS-AD is a simple and reliable measure of the psychosomatic pathology of adult AD patients. It may be useful in dermatological practice for screening patients who would benefit from psychological or psychiatric interventions.

Malignant pilomatricoma.

A 47-year-old woman presented with a nodular lesion in the left retroauricular area. The lesion was enucleated and a diagnosis of malignant pilomatricoma was made. This was treated by wide excision and no residual tumour was found. The patient remained disease-free at the 18 months follow-up.