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Managing Dermatologic Delusional Disorders: A US Psychodermatology Perspective for Clinicians.

Andrea Leung1, John Koo2

  • 1Department of Dermatology, University of California, San Francisco, 2340 Sutter St N414, San Francisco, CA, 94115, USA. andrealeung.sf@gmail.com.

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|June 16, 2026
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Summary
This summary is machine-generated.

Managing dermatologic delusional disorders (DI) involves antipsychotic medications like pimozide and risperidone. Effective treatment requires clinician empathy and strategic engagement, overcoming patient denial of psychiatric links.

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Area of Science:

  • Psychiatry
  • Dermatology
  • Psychopharmacology

Background:

  • Dermatologic delusional disorders (DI) involve delusions of infestation, previously considered untreatable.
  • Antipsychotic medications, particularly pimozide and risperidone, have shown efficacy in treating DI.
  • Patient denial of psychiatric involvement complicates management.

Purpose of the Study:

  • To provide a psychodermatology perspective on managing dermatologic delusional disorders.
  • To synthesize clinical experience and available evidence for practical management strategies.
  • To highlight engagement, pharmacotherapy, safety, and research priorities.

Main Methods:

  • Synthesis of single-center clinical experience from a US clinic.
  • Review of existing evidence on managing dermatologic delusional disorders.
  • Focus on pragmatic engagement and pharmacotherapy principles.

Main Results:

  • Antipsychotic medications are effective for DI, despite initial skepticism.
  • Diplomacy, empathy, and strategic engagement are crucial for patient management.
  • Limited high-quality comparative data necessitates experience-based recommendations.

Conclusions:

  • Successful management of DI requires a combination of pharmacotherapy and skillful patient interaction.
  • Addressing patient denial and building rapport are essential for effective treatment.
  • Further research is needed to establish evidence-based guidelines.