Only 25.5% of Hungarian Dermatologists Report Comfortability in Treating Psychodermatological Patients

Compulsive skin picking. Image Credit: © DermNet

Only a quarter of dermatologists in Hungary (25.5%) report feeling comfortable with treating patients with psychodermatological conditions, according to a study published in Skin Health and Disease.¹

This not only encompasses patients with conditions such as parasitosis and trichotillomania, but also includes patients with anxiety secondary to skin disease, depression, body dysmorphic disorder, and common skin conditions that may overlap with psychological comorbidities (psoriasis, alopecia, and atopic dermatitis, among others).

Furthermore, less than half of respondents reported understanding psychodermatology as a link between mental health and dermatological conditions. More than 3 out of 4 dermatologists were unable to name a psychodermatology resource for patients and their families, and slightly over half (58.8%) demonstrated definitive interest in receiving psychodermatology training.

Background and Methods

Previous research has underscored the significant impact of skin disorders on patients' emotional well-being and quality of life, with a substantial portion of dermatological patients experiencing psychological or psychiatric issues. Conditions such as alopecia and vitiligo have well-documented links to hindered well-being, mental health, and quality of life.²

Despite this, many cases go underdiagnosed or undertreated due to inadequate psychodermatology services, insufficient training among dermatologists, and patient reluctance to seek psychiatric care, according to a study from the International Journal of Dermatology.³

While several studies have explored psychodermatological awareness among dermatologists in varying countries, such as the US, Canada, Great Britain, and India, none to date have examined the patterns among clinicians in Hungary.

From October 2020 to June 2021, researchers surveyed 100 dermatologists, including residents, practicing in Hungary through an online Google Form. The questionnaire used in the study was adapted from a validated version used in various international studies, originally developed and validated for dermatologists in the US.

The survey consisted of 2 blocks of questions, gathering demographic data such as age, gender, qualifications, and practice details. The second block contained 11 questions focused on psychodermatology, including open-ended prompts asking dermatologists to define psychodermatology and identify useful sources of information on the topic for patients and their families. Additional multiple-choice questions assessed comfort in treating patients with psychological components, frequency of encountering such cases, referral practices to psychiatrists or psychologists, training received in psychodermatology, and interest in further educational activities to enhance skills in this area.

Findings

The study involved 100 participants, yielding a response rate of 51%. Results indicated that nearly half of the respondents (49%) understood psychodermatology as the bidirectional interaction between mental and dermatological conditions, while 39% viewed it as either the influence of mental status on dermatological conditions or vice versa, but not both.

These results suggest a widespread awareness among participants regarding psychodermatology's significance in the pathogenesis and treatment of dermatological diseases, according to researchers, with only 12% demonstrating inadequate understanding or no response.

Regarding psychodermatology in practice, 88.2% of respondents had reported experience with psychodermatological issues, with 43.1% reporting moderate to frequent encounters. However, comfort levels in treating such patients varied, with only 25.5% feeling comfortable, while 33.3% expressed discomfort. Female dermatologists reported lower comfort levels compared to their male counterparts.

Common dermatological disorders with a psychological component included psoriasis, atopic dermatitis, acne, vitiligo, alopecia areata, and hyperhidrosis. Referral to psychologists or psychiatrists was infrequent, with 76% of respondents referring patients only once a year or less often, primarily for conditions such as atopic dermatitis, anxiety, parasitosis, and depression.

Interest in further training on psychodermatology was high, with only 3.9% showing no interest. However, only 58.8% showed a "definite" interest in attending training. Topics of interest included anxiety secondary to skin disease (70.6%), atopic dermatitis (62.7%), depression (60.8%), psoriasis (54.9%), and acne (54.9%), reflecting a desire among participants to enhance their knowledge and skills in managing psychological aspects of dermatological conditions.

Conclusions

Potential limitations of the study include its limited sample size, potential non-respondent bias, and the possible presence of information bias.

"The results of our study showed that Hungarian dermatologists have a high awareness of the term "psychodermatology" in comparison to many other countries (USA, Turkey and the Balkans), but many of them had never participated in continuing medical education and/or formal training on psychodermatology," according to study authors Cápec et al.

Addressing the disparity in psychodermatology requires a multifaceted approach involving education, collaboration, and continued professional development, they wrote. Moving forward, authors recommended incorporating psychodermatology courses into the training curricula for dermatology and psychiatry residents.

In addition, they recommended regular continuing medical education events and establishing liaison clinics to facilitate collaboration between psychiatry and dermatology. This, they noted, will promote a holistic, multidisciplinary approach, ultimately leading to better patient outcomes for patients with psychodermatological disorders and chronic skin conditions with psychological comorbidities.

References

1. Cápec G, Jafferany M, Cápec S, Hoffmann S, Sárdy M. Psychodermatology in Hungary: Awareness and practice patterns of dermatologists. Skin Health Disease. Published online July 2, 2024. https://doi.org/10.1002/ski2.419
2. Lavda A, Webb T, Thompson A. A meta-analysis of the effectiveness of psychological interventions for adults with skin conditions. Br J Dermatol. 2012; 167(5): 970–979. https://doi.org/10.1111/j.1365-2133.2012.11183.x
3. Jafferany M, Stoep A, Dumitrescu A, Hornung R. The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol. 2010; 49(7): 784–789. https://doi.org/10.1111/j.1365-4632.2009.04372.x