Skin disorders in chronic psychiatric illness

• Published in: Journal of the European Academy of Dermatology and Venereology Vol. 24; no. 10; pp. 1151 - 1156
• Main Authors: Mookhoek, EJ, Van De Kerkhof, PCM, Hovens, JEJM, Brouwers, JRBJ, Loonen, AJM
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-10-2010
• Subjects: Adult; Benign; Comorbidity; Dermatitis - epidemiology; dermatology; diabetes mellitus; Female; Hospitals, Psychiatric; Humans; Inpatients; Male; mental disorders; Mental Disorders - epidemiology; Middle Aged; Netherlands; Prevalence; Psoriasis - epidemiology; skin diseases; Skin Diseases - epidemiology; Skin Diseases, Infectious - epidemiology; Netherlands
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.2010.03609.x

Background  Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce.
Objective  To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients.
Methods  Ninety‐one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin.
Results  Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40–49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38–39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67–24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34–10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation.
Conclusions  Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.