TRANSLATIONAL AND CLINICAL MEDICINE - Georgian Medical Journal

Background:

Psychodermatology examines the complex bidirectional relationship between the skin and the mind. This interaction becomes particularly significant in vulnerable populations such as older adults with cognitive decline and younger individuals with psychosocial or developmental vulnerabilities.

Aim:
To illustrate the heterogeneity of psychodermatological presentations across the lifespan and highlight the role of cognition, insight, and psychosocial context in clinical manifestations.

Methods:
We present a case-based analysis of three patients with distinct psychodermatological conditions: (1) delusional parasitosis associated with cognitive decline, (2) somatic preoccupation with mild neurocognitive impairment, and (3) factitious dermatitis in a young adult with intellectual disability. Clinical, neuropsychological, and contextual factors were analyzed comparatively.

Results:
Older patients demonstrated dermatological symptoms linked to cognitive impairment and altered insight, including delusional infestation and psychosomatic skin complaints. In contrast, the younger patient exhibited self-inflicted lesions consistent with factitious disorder, driven by psychosocial stress and limited coping capacity. Insight varied across cases and was closely associated with cognitive status and psychosocial environment.

Conclusions:
Psychodermatological conditions differ significantly across age groups but share a common biopsychosocial foundation. Early cognitive screening, careful psychiatric assessment, and interdisciplinary collaboration are essential for accurate diagnosis and effective management.

Fischer CE, Ismail Z, Schweizer TA. Delusions in Alzheimer’s disease: a systematic review. Int J Geriatr Psychiatry. 2012;27(2):127–138. doi:10.1002/gps.2725

Freudenmann RW, Lepping P. Delusional infestation. Clin Microbiol Rev. 2009;22(4):690–732. doi:10.1128/CMR.00018-09

Gupta MA, Gupta AK, Haberman HF. The self-inflicted dermatoses: a critical review. Gen Hosp Psychiatry. 2016;39:40–50. doi:10.1016/j.genhosppsych.2015.11.007

Jafferany M, Huynh TV, Silverman MA, Zaidi Z. Geriatric dermatoses: a clinical review. Int J Dermatol. 2012;51(5):509–522. doi:10.1111/j.1365-4632.2011.05311.x

Jafferany M, Franca K. Psychodermatology: basic concepts. Acta Derm Venereol. 2016;96(217):35–37. doi:10.2340/00015555-2378

Langan EA, Millington GWM. Psychodermatology—A special edition. Skin Health Dis. 2022;2(4):e192. doi:10.1002/ski2.192

Latheef ENA, Hafi BNA. Introduction to psychodermatology. Clin Dermatol Rev. 2023;7(4):303–309. doi:10.4103/cdr.cdr_10_22

Rodríguez Pichardo A, García Bravo B. Dermatitis artefacta: a review. Actas Dermosifiliogr. 2013;104(10):854–866. doi:10.1016/j.adengl.2012.10.024

Rossi A, Barbieri C, Troiano G. Skin health of community-living older people: a scoping review. Arch Dermatol Res. 2024;316(2):319–330. doi:10.1007/s00403-024-03059-0

Silverberg JI, Kim HJ, Byrne L. Psychiatric and psychological aspects of chronic skin diseases. Clin Dermatol. 2023;41(1):75–81. doi:10.1016/j.clindermatol.2022.09.007

Yadav S, Narang T, Kumaran MS. Psychodermatology: a comprehensive review. Indian J Dermatol Venereol Leprol. 2013;79(2):176–192. doi:10.4103/0378-6323.107646