| Table 3-29 Neuropsychocutaneous Disorders |
| |
Entity |
|
Clinical Findings |
|
Treatment |
| |
Delusions of parasitosis |
|
Fixed false belief of being infested with parasites;
imaginary parasites typically reported as ‘bugs’
crawling under skin (formication)
{Need to distinguish from substance-induced
formication} |
|
Treatment: antipsychotic medication
such as pimozide (side effects
include extrapyramidal side effects
and prolonged QT interval) or
risperidone |
| |
Body dysmorphic
disorder |
|
Excessive concern over perceived defect in
body image with ↑↑ time spent checking for
imperfections |
|
Spectrum ranges from obsessive to
delusional thinking
Treatment: SSRIs if OCD variant,
antipsychotics if delusional variant |
| |
Dermatitis artefacta
(Factitial dermatitis) |
|
Deliberate creation of self-inflicted cutaneous lesions;
lesion morphology variable but often with bizarre
geometric shapes with sharp margins
{Typically lesions created to sastisfy an
unconscious psychological or emotional need
(secondary gain)} |
|
Treatment: topical medication to
help with healing; ± antidepressants,
antipsychotic or antianxiety
medications |
| |
Neurotic excoriations |
|
Unconscious to uncontrollable picking
(either at pre-existing skin lesions or de novo);
excoriations with irregular borders |
|
Treatment: treat any underlying
cutaneous disease (i.e. acne),
antihistamines for pruritus (i.e.
doxepin), ± SSRIs |
| |
Gardner-Diamond
syndrome |
|
Factitial disorder; painful swollen ecchymoses at sites of trauma, often in
women with an underlying psychiatric illness |
|
Treatment: difficult |
| |
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