Psychodermatologic Disorders Strongly Linked to Neuropsychiatric Comorbidities

Patients with primary psychodermatologic disorders (PPDs) and psychophysiological dermatologic conditions have a high burden of neuropsychiatric comorbidities with distinct and shared clinical profiles, according to study results published in the Journal of Cutaneous Medicine and Surgery.

Researchers conducted a nested case-control study using data from the All of Us Research Program, which included electronic health records and self-reported survey information. Patients aged 18 to 90 years with diagnosed PPDs and psychophysiological disorders were matched with control patients in a 1:4 ratio based on age, sex, and race/ethnicity. Neuropsychiatric comorbidities — including mood, anxiety, sleep, personality, neurodevelopmental, neurological, and substance use disorders — were identified using ICD-10 and Systematized Nomenclature of Medicine codes.

The PPD cohort included patients with skin picking disorder (n=482), dermatitis artefacta (n=299), trichotillomania (n=113), body dysmorphic disorder (n=70), and delusions of parasitosis (n≤20), with point prevalences ranging from 0.01% or less to 0.17%. The psychophysiological disorder group included patients with atopic dermatitis (n=16,419), acne vulgaris (n=14,603), psoriasis (n=7472), hidradenitis suppurativa (n=1652), and vulvodynia (n=389). The point prevalence among those with psychophysiological disorders ranged from 0.14% to 5.72%. Most patients in both cohorts were women and White, with patients with PPD showing notable socioeconomic disparities compared with control patients (P <.001).

Psychiatric comorbidities were highly prevalent in all PPD subgroups. Trichotillomania had strong associations with obsessive-compulsive disorder (OCD; adjusted odds ratio [aOR], 55.96), depressive disorders (aOR, 13.94), and personality disorders (aOR, 13.56). Similarly, skin picking disorder was strongly linked with OCD (aOR, 25.09), depressive disorders (aOR, 6.30), and personality disorders (aOR, 8.67). Body dysmorphic disorder showed a particularly strong association with eating disorders (aOR, 33.97) and OCD (aOR, 48.32).

In patients with psychophysiological conditions, more moderate associations were noted. Atopic dermatitis was strongly associated with somatoform disorders (aOR, 3.62), trauma- and stressor-related disorders (aOR, 2.88), and personality disorders (aOR, 2.85). Sleep-wake disorders (aOR, 3.95), personality disorders (aOR, 3.91), and depressive disorders (aOR, 3.13) had the strongest association with hidradenitis suppurativa. Sleep-wake disorders (aOR, 3.95), depressive disorders (aOR, 2.24), and trauma- and stressor-related disorders (aOR, 2.11) were most strongly associated with psoriasis. In patients with acne the strongest associations were observed with sleep-wake disorders (aOR, 3.95), whereas the highest relative risk in those with vulvodynia was with somatoform disorders (aOR, 6.13).

Study limitations include potential misclassification bias, modest sample sizes for specific PPDs, and the inability to establish causality or directionality of associations.

The researchers concluded, “Our findings reaffirm the substantial burden of neuropsychiatric comorbidities associated with PPDs as well as several psychophysiological disorders.” They added, “Prospective, longitudinal studies are warranted to elucidate the temporal relationships and shared neurobiological mechanisms underpinning these comorbidities.”

This article originally appeared on Dermatology Advisor