[Psycho-cutaneous disorders in practice. Self-inflicted skin diseases of psychological origin]

Patients with self-inflicted cutaneous lesions often consult practitioners or dermatologists rather than psychiatrists. The factitious skin lesions are pleomorphic, and may range from wounds, abrasions, blisters or burns, to relatively harmless patient-dependent aggravation of known dermatological diseases. The underlying psychopathology is highly divergent, ranging from socially induced stress behaviour to serious psychiatric disease with a high incidence of suicide. The basic psychological mechanisms of these diseases are poorly understood, and psychocutaneous disorders are difficult to treat effectively. The main challenge is to establish a trustful doctor-patient relationship, in which a joint therapeutic strategy can be established. The author describes six different psychocutaneous disorders in two selected cases, showing both the distinctions between the joint disorders and their common features. The need for constructive collaboration between practitioner or dermatologist and psychiatrist is emphasized.