Holistic Treatment Approach in Management of Skin Diseases: How often do we incorporate Psychological aspect of Skin diseases?

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Skin diseases are one of the commonest causes for Out Patient Department (OPD) visits all around the world. In large instances, skin diseases tend to be chronic and affect one’s psyche. Furthermore , neuroimmuno cutaneous axis is involved etiologically in causation and perpetuation of these skin disease, which can have consequent effect on therapeutic outcome.Management of skin diseases should involve multidisciplinary specialists and proper co-ordination with the Psychiatrist. Treatment should include assessment of underlying psychological comorbidity such as depression, anxiety, habit disorders, Obsessive Compulsive Disorders (OCD) and family dysfunction. Also, psychosocial counselling and educational training program should be incorporated to address the psycho dermatological aspect. Use of CBT, Habit reversal therapy and psychotherapy form an integral part of therapeutic regime. Psycho-pharmacotherapy with Selective Serotonin Reuptake Inhibitors (SSRI) like fluoxetine, dapoxetine and sertraline form important part of treatment in those with underlying anxiety and depression.Pregabalin, gabapentin and antipsychotics like olanzapine and quetiapine can be used based on underlying psychiatric condition. These treatment in combination with the skin disease per se, help prevent forthcoming psychiatric complications associated with these chronic illnesses.