PracticeUpdate: Dermatology & Rheumatology

AAD 2016 13

Forty-five percent of patients with dermatological disease suffer from psychiatric comorbidity A total of 44.7% of patients with

L inda García-Hidalgo, MD, of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, explained that few methodologically reliable studies have been performed on the prevalence of psychiatric disorders in dermatological consultation, but the reported prevalence is approximately 30%. Since many adults with dermatological diagnoses may present with chronic diseases that impact the development of psychopathology, it is important to estimate the magnitude of the problem. Such estimation will help promote a multidisciplinary intervention for patients suffering from both dermatological and psychiatric illness.

4 to 114 patients attending the outpatient dermatology clinic. Measured variables were demographics (sex, age, marital status, education, and occupation); psychiatric diagnosis; dermatological diagnosis; and comorbidities. Of the 114 patients, 37 (32.5%) were men and 77 (67.5%) were women. Men and women were of similar age (men, median of 40 years; women, median of 43 years). Forty- eight percent of both men and women were married. Seventy-three percent of men had attained a high educational level, versus 68% of women. A total of 44.7% of patients did present psychiatric illness and 55.3% did not. Among the main psychiatric illnesses were major depressive disorder 23.7%; generalised anxiety disorder 15.8%; alcohol dependence 14.9%; alcohol abuse 7%; and specific phobia 5.3%. A total of 54.4% suffered from psychodermatologic disorders. Of these, 21.9% suffered psychophysiologic disorders, 8.8% suffered psychiatric disorders with dermatologic symptoms, 54.4% suffered from dermatologic disorders with psychiatric symptoms; and 14.9% suffered from miscellaneous psychodermatologic disorders. Dr García-Hidalgo concluded that the prevalence of psychiatric illnesses in a dermatological patient population was shown to be significantly higher than the general Mexican population. The prevalence was significantly higher in women than men. hopes to develop a model for predicting the likelihood of cellulitis versus pseudocellulitis to help guide clinical management, then to conduct a prospective study to validate the predictive model in emergency department and inpatient settings. He said, “Results of the study gave us insight into the problem, and a starting point. Now that we’ve identified the problem, we can proceed to address the issue. Ultimately, if validated in a prospective study, a model could be incorporated into national guidelines or electronic health records.” He added, “The overriding goal is to help our emergency department, family medicine, and internal medicine colleagues, who see these patients early in the clinical course.”

a dermatological diagnosis were found to suffer from a comorbid psychiatric illness in a descriptive, transverse, observational, single-centre study.

Timely identification of patients with psychiatric comorbidity and skin disease can help lead to better long-term treatment, avoid frequent relapses by promoting proper adherence to treatment, and improve the overall prognosis of patients with these disorders. Dr García-Hidalgo and colleagues set out to identify the most common psychiatric disorders in patients with skin disease in their outpatient clinic. Over a 5-month period in 2014, liaison psychiatrists administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders

All of the 48 pseudocellulitis patients who did not require antibiotics were given at least one intravenous antibiotic while an inpatient. Twenty six (54.2%) were given an intravenous or oral antibiotic on discharge. Average days of antibiotic prescription at discharge were 9.4 ± 5.0 days (median 10 days). Over 60% of pseudocellulitis patients turned out to have had vascular causes, such as venous stasis, heart failure, or peripheral vascular disease. The team calculated that the estimated cost of hospitalisation for misdiagnosed lower ex- tremity cellulitis is US$345 million annually. Dr Raff concluded that pseudocellulitis is not only costly but results in unnecessary antibiotic administration in all cases. He

turned out not to have it. So I questioned whether this was a larger problem that need- ed to be addressed in a systematic manner.” Of 259 patients included in the analysis, 180 (69.5%) were discharged with a diagnosis of cellulites, while 79 (30.5%) were found to have pseudocellulitis. Among patients with pseudocellulitis, the primary reason for ad- mission was cellulites in 52 (65.8%). Of the 52 pseudocellulitis patients whose primary indication for admission was cel- lulites, antibiotics were unnecessary in 48 (92.3%) and admission was unnecessary in 44 (84.6%). Determination of proper man- agement was by consensus between study dermatologists. Average hospital stay for unnecessary admission was 4.3 ± 3.7 days.

DECEMBER 2016