Stimulant use, psychiatric disorders common in those with psychocutaneous disease
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Medications and psychiatric history should be reviewed for patients who present with psychocutaneous disease due to an association with stimulant use and psychiatric comorbidities, according to a study.
“Dermatologists often encounter patients with psychocutaneous disease, a collection of dermatological disorders that are not only extremely diverse in presentation but also remarkably poorly understood,” Patricia M. Richey, MD, of the department of dermatology at University of Iowa Hospitals and Clinics, and colleagues wrote. “Many cases have been attributed to stimulant medications, but this relationship has never been fully elucidated in the existing literature, most of which focuses on clinical presentations and treatment rather than etiology and prevalence.”
The retrospective cohort study included 317 patients diagnosed with pseudoparasitic dysesthesias, delusions of parasitosis, acne excoriée, neurotic excoriations, dermatitis artefacta, factitial dermatitis and skin-picking disorder at one clinic location.
Demographic data as well as history of illicit substance use and psychiatric diagnoses were gathered.
A psychiatric diagnosis was present is 85.2% of the study group, the most common being depression (48.1%), anxiety (34.2%) and ADHD (24.9%).
Stimulant use was recorded in 60.2% of patients, which included both illicit and prescription use. Prescription stimulants were used in 53.3% of the group. More than one stimulant was being used in 63 patients (19.9%), with amphetamine-dextroamphetamine (53 patients), venlafaxine (58 patients) and bupropion (44 patients) being the most common.
Limitations of the study included its dependence on patient reporting or toxicology reports for stimulant use history and its retrospective nature.
“Most patients with psychocutaneous disease display high rates of stimulant use and psychiatric comorbidity,” the authors wrote. “Dermatologic evaluation of these patients should include a review of current medications and psychiatric history and, if applicable, consideration of a non-stimulant alternative should be addressed with the patient’s psychiatrist or primary care physician.”