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Psychogenic skin symptoms — Clinical Guidelines

Overview

Psychogenic skin symptoms refer to dermatological manifestations without identifiable organic causes, often linked to psychological factors such as anxiety, stress, or psychiatric disorders. These symptoms can mimic various skin conditions and require a thorough psychological evaluation alongside dermatological assessment 28.

Diagnosis

Clinical Evaluation: Comprehensive history taking focusing on psychological stressors and psychiatric history 28.

Exclusion of Organic Causes: Rule out underlying dermatological conditions through physical examination and relevant tests 28.

Psychological Assessment: Utilize standardized tools for anxiety, depression, and other psychological disorders 28.

Skin Biopsy/Tests: When necessary, perform biopsies or specific dermatological tests to exclude organic pathology 28.

Management

Psychological Interventions: Cognitive-behavioral therapy (CBT) and psychodynamic therapy 28.

Medication: Anxiolytics or antidepressants if anxiety or depression is significant, e.g., SSRIs like sertraline or escitalopram 28.

Supportive Care: Education about psychogenic symptoms and reassurance 28.

Multidisciplinary Approach: Collaboration between dermatologists and mental health professionals 28.

Special Populations

Pediatrics: Anxiety and gastrointestinal symptoms often overlap, necessitating careful assessment of sleep quality as a mediator 2.

Elderly: Consider drug-induced upper gastrointestinal symptoms due to polypharmacy 18.

Comorbidities: Address concurrent psychological conditions like anxiety that may exacerbate skin symptoms 2 28.

Key Recommendations

Conduct a thorough psychological evaluation alongside dermatological assessment to diagnose psychogenic skin symptoms (Evidence: Expert opinion 28).

Exclude organic causes through appropriate dermatological tests and examinations (Evidence: Expert opinion 28).

Implement psychological therapies such as CBT for management, especially in cases with significant anxiety or depression (Evidence: Expert opinion 28).

Monitor and manage medications in elderly patients to prevent drug-induced gastrointestinal symptoms (Evidence: Moderate 18).

Consider sleep quality assessment in pediatric patients presenting with psychogenic symptoms, given its potential mediating role (Evidence: Moderate 2).

References

1 Smith AL, Sutcliffe S. Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium-Update for Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). Neurourology and urodynamics 2026. link 2 Wang W, Yao M, Li S, Lv Y, Lu Y, Fan Y et al.. The relationship between anxiety symptoms and gastrointestinal symptoms in gastroenterology outpatients aged 6 to 18 years with the mediating role of sleep quality. Scientific reports 2025. link 3 Santos LB, Mizubuti GB, da Silva LM, Silveira SQ, Nersessian RSF, Abib ACV et al.. Effect of various perioperative semaglutide interruption intervals on residual gastric content assessed by esophagogastroduodenoscopy: A retrospective single center observational study. Journal of clinical anesthesia 2024. link 4 Senderovich H, Meaney C, Vashishtha S. Cannabis-Induced Gastrointestinal Tract Symptoms in the Adult Population: A Systematic Review. Medical principles and practice : international journal of the Kuwait University, Health Science Centre 2024. link 5 Mizrahi J, Marhaba J, Buniak W, Sun E. Transition-of-care program from emergency department to gastroenterology clinics improves follow-up. The American journal of emergency medicine 2023. link 6 Schneider A, Wagenknecht A, Sydow H, Riedlinger D, Holzinger F, Figura A et al.. Primary and secondary data in emergency medicine health services research - a comparative analysis in a regional research network on multimorbid patients. BMC medical research methodology 2023. link 7 Fitzgerald CM, Fok C, Kenton K, Lukacz E, Markland AD, Meister M et al.. The RISE FOR HEALTH study: Methods for in-person musculoskeletal assessment. Neurourology and urodynamics 2023. link 8 Quattrone F, Aimo A, Castiglione V, Passino C, Bergamasco M, Barsanti S et al.. Using co-creation to develop a cardiology online open course: an effective approach for implementing digital learning. Journal of cardiovascular medicine (Hagerstown, Md.) 2022. link 9 Landaverde E, Généreux M, Maltais D, Gachon P. Respiratory and Otolaryngology Symptoms Following the 2019 Spring Floods in Quebec. International journal of environmental research and public health 2022. link 10 Richards NE, Richards RD. Alpha-Gal Allergy as a Cause of Intestinal Symptoms in a Gastroenterology Community Practice. Southern medical journal 2021. link 11 de Caprariis PJ, de Caprariis-Salerno A, Lyon C. Healthcare Professionals and In-Flight Medical Emergencies: Resources, Responsibilities, Goals, and Legalities as a Good Samaritan. Southern medical journal 2019. link 12 Hillery S. Developing a new one-stop urology diagnostics service. British journal of nursing (Mark Allen Publishing) 2018. link 13 Tan SY, Praveena SM, Abidin EZ, Cheema MS. Heavy metal quantification of classroom dust in school environment and its impacts on children health from Rawang (Malaysia). Environmental science and pollution research international 2018. link 14 Almario CV, Chey WD, Khanna D, Mosadeghi S, Ahmed S, Afghani E et al.. Impact of National Institutes of Health Gastrointestinal PROMIS Measures in Clinical Practice: Results of a Multicenter Controlled Trial. The American journal of gastroenterology 2016. link 15 Maurer AH. Gastrointestinal Motility, Part 1: Esophageal Transit and Gastric Emptying. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2015. link 16 Harewood GC, Foley G, Farnes Z. Pricing practices of gastroenterologists in New York. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2014. link 17 Madineh SM. Avicenna's Canon of Medicine and modern urology. Part IV: Normal voiding, dysuria, and oliguria. Urology journal 2009. link 18 Pilotto A, Franceschi M, Vitale D, Zaninelli A, Masotti G, Rengo F. Drug use by the elderly in general practice: effects on upper gastrointestinal symptoms. European journal of clinical pharmacology 2006. link 19 Folkestad B, Spångberg A. Validation of timed micturition--a comparison of flow rates measured at home manually and electronically. Scandinavian journal of urology and nephrology 2004. link 20 Hinchliffe A, Tonkin S, Williams C, Kirkwood L. Utilising frequency volume charts. Nursing times 2003. link 21 Bass C, Hyde G, Bond A, Sharpe M. A survey of frequent attenders at a gastroenterology clinic. Journal of psychosomatic research 2001. link00229-4) 22 Schwartz DA, Connelly NR, Theroux CA, Gibson CS, Ostrom DN, Dunn SM et al.. Gastric contents in children presenting for upper endoscopy. Anesthesia and analgesia 1998. link 23 van Mastrigt R, Eijskoot F. Analysis of voided urine volumes measured using a small electronic pocket balance. Scandinavian journal of urology and nephrology 1996. link 24 Matzkin H, Greenstein A, Prager-Geller T, Sofer M, Braf Z. Do reported micturition symptoms on the American Urological Association Questionnaire correlate with 24-hour home uroflowmetry recordings?. The Journal of urology 1996. link 25 Chancellor MB, Rivas DA. American Urological Association symptom index for women with voiding symptoms: lack of index specificity for benign prostate hyperplasia. The Journal of urology 1993. link35872-x) 26 Erkkola R, Hirvonen E, Luikku J, Lumme R, Männikkö H, Aydinlik S. Ovulation inhibitors containing cyproterone acetate or desogestrel in the treatment of hyperandrogenic symptoms. Acta obstetricia et gynecologica Scandinavica 1990. link 27 Meunier P. Study of micturition parameters in healthy young adults using a uroflowmetric method. European journal of clinical investigation 1983. link 28 Godec CJ, Cass AS. Psychosocial aspects of micturition. Urology 1981. link90257-0)

Psychogenic skin symptoms