Psychiatric disorders and pruritus

The skin and psyche are intimately related with various skin diseases caused by or resulting in psychiatric disturbances. Pruritus is a commonly reported symptom in psychiatric patients, and likewise psychiatric co-morbidities, including anxiety and depression, are frequently seen in chronic pruritus patients. Primary psychodermatologic conditions, such as somatic symptom disorder, dermatitis artefacta, obsessive-compulsive and related disorders (excoriation disorder and prurigo nodularis), delusional infestation, and substance use disorder, can all induce significant pruritus in patients, severely affecting their quality of life. Such entities can be challenging to manage, and therefore a greater understanding of the underlying psychopathology and evaluation of associated psychosocial factors is necessary. In addition to proper skin hygiene and first-line pharmacotherapies such as selective serotonin reuptake inhibitors, noradrenergic and selective serotonin antidepressants, antiepileptics, and antipsychotics (for delusional and psychotic disorders), patients with psychopruritic disorders should be offered psychotherapy to maximize the therapeutic efficacy.