Dermatological non-disease: a common and potentially fatal disturbance of cutaneous body image

A group of patients presenting with dermatological complaints but with no significant objective dermatological pathology on examination are described. Twenty-eight patients, twelve male and sixteen female, age range 16--76 years, mean 46 years, were seen. Symptomatology was confined to three main body areas: the face--eight patients; scalp--nine patients; perineum--eight patients. The complaints related to the face were burning, intense itching and hirsutes. Scalp symptoms included excessive hair loss and intense irritation. Genital symptoms included itching, excessive redness, burning and discomfort, which in three instances prevented the patient sitting. A disturbed body image (dysmorphophobia) was common and the most frequent psychological illness present was depression. Two patients were demented and in two a diagnosis of schizophrenia was made. One patient committed suicide and two patients attempted suicide. Female patients presenting with facial symptoms have a more ominous prognosis, both with regard to the risk of suicide and the development of psychosis. It is important that dermatologists recognize this common group of patients with dermatological non-disease. Those patients who are anxiously preoccupied with their skin may be managed by superficial psychotherapy and antidepressants. Those patients who are truly deluded should be referred to a psychiatrist.