Psychocutaneous Diseases in Children: A Clinical Dermatological Approach

In the clinical practice, we can observe a greater prevalence of psychiatric disorders among dermatologic diseases and vice versa. Self-inflicted cutaneous disorders (SICD) with “pathological” clinical manifestations are classified in the Statistical Manual of Mental Disorders (DSM-5) and by the European Society for Dermatology and Psychiatry and Diagnostic. We discuss SICD focusing on children and including: factitious disorder imposed on self or another, excoriation disorders, trichotillomania, body-focused repetitive behavior disorder. Skin damage may be self-induced in delusional parasitosis by scratching and pricking to eliminate imagined parasites. In addition, the following psychiatric disorders with dermatological manifestations involve pediatric age and are debated in order to define skin signs to achieve the diagnosis: body dysmorphic disorder or dysmorphophobia, eating disorders, olfactory reference syndrome. Diagnosis and management of psychiatric conditions with cutaneous manifestations may be challenging due to stigma or shame perceived by patients, poor educational opportunities for dermatologists, limited literature data on pediatric age, refusal of medical or psychiatric help by patients or their parents.