A surge in psychocutaneous diseases during COVID‐19: experience at an academic medical center – Hrin – – International Journal of Dermatology

Dear editor,

Psychocutaneous disorders (PDs) are primary psychiatric disorders with secondary cutaneous manifestations that are not well understood.1 Psychopathologies such as depression, anxiety and stress are believed to be associated with Parkinson’s disease severity and have been observed to increase during COVID-19.2 While the pandemic has disrupted daily life and triggered a rise in stress-related conditions such as telogen effluvium, its impact on Parkinson’s disease has not been extensively evaluated.3 In this study, we evaluated the incidence of PD observed at our facility before and during COVID-19. We also examined psychiatric comorbidities, demographics, and parameters related to PD diagnosis and treatment (eg, biopsy rates, pharmacologic interventions, treatment outcomes, referral to mental health specialists).

Following Institutional Review Board approval, a retrospective review of patients aged 5 years and older from Wake Forest Baptist Health’s outpatient dermatology clinic evaluated between December 1, 2019 and May 31, 2020 with the following diagnoses was conducted : Delusions of parasitosis, dermatitis artefacta (factual dermatitis), formication, Morgellon’s disease and trichotillomania. Patients were divided into pre-COVID-19 (December 1, 2019-February 29, 2020) and during COVID-19 (March 1, 2020-May 31, 2020) groups for analysis. Fisher’s exact tests were used to test for significance. Statistical analyzes were performed with R (version 4.0.3). Charts were created with Tableau.

Twenty-six patients, predominantly white (85%) females (85%), mean age 54 ± 19 years, were evaluated at Wake Forest Baptist Health’s Dermatology Outpatient Clinic between December 1, 2019 and May 31, 2020 for the following psychocutaneous conditions examines diseases: delusional parasitosis, dermatitis artefacta (factual dermatitis), pins and needles, Morgellon’s disease and trichotillomania (Table 1). An increased proportion of PD cases were observed during COVID-19 compared to immediately before COVID-19 (0.20% vs. 0.07%; P=0.017). Thirteen patients presented in May 2020 (0.43% of all May cases), an increase of >500% over the previous 5 month average (0.08%) (Fig. 1). Although no statistically significant differences were found between groups for a single disorder, more patients were prescribed gabapentin (10 vs. 1; P=0.036) and had fewer biopsies performed (6 vs. 2; P=0.008) compared to before COVID-19. Gabapentin has been prescribed to treat eczema (5), trichotillomania (2), pins and needles (2), and itching associated with intrinsic atopic dermatitis (1) during COVID-19. Only a slightly larger number of non-white patients were studied during COVID-19 than before (4 vs. 0; P=0.263). However, Black/Hispanic populations have been disproportionately affected by the pandemic, and several factors play a role in obtaining an in-person dermatological exam, such as: B. Access barriers to health care.4 Larger studies are needed to further elucidate the extent of potential racial differences. Although stimulant use (33% pre-COVID-19, 24% during COVID-19) and pre-existing psychiatric comorbidity (44% pre-COVID-19, 59% during COVID-19) were not observed in overwhelmingly large proportions in our study, They have been reported to be associated with PD.5 The majority of our patients were female (100% before COVID-19, 76% during COVID-19), consistent with previous PD studies.5

Table 1.
An increase in psychocutaneous disorders, gabapentin prescriptions, and a decrease in the number of biopsies performed during COVID-19

	Pre-COVID (December 1, 2019 – February 29, 2020)	During COVID (March 1, 2020 – May 31, 2020)	P value
incident
PD cases	9	17
total patients	12,130	8,655
PD incidence	0.07%	0.20%	0.017
Age, years (mean ± SD)	59±20	52±19
sex
Feminine	9	13
Male	0	4
race
black	0	3
White	9	13
Other	0	1
Pre-existing psychiatric illnessa
depression	3	6
fear	1	5
panic disorder	0	2
insomnia	2	4
Post-traumatic stress disorder	0	1
Attention Deficit Hyperactivity Disorder	1	1
Attention Deficit Disorder	0	1
none	5	7
Medications for psychiatric disorders prior to the onset of Parkinson’s disease
SSRIs	7	8th
SNRIs	1	2
Atypical antidepressant	3	2
Tricyclic antidepressant	1	1
stimulants	3	4
PD treatment
trifluoperazine	4	8th
gabapentin	1	10	0.036
management parameters
Improvement reported by patients	4	11
biopsy	6	2	0.008
Psychiatric Referral	0	1

• COVID, coronavirus; PD, psychocutaneous disease (parasitic delusions, actual dermatitis, Morgellon’s disease, trichotillomania); SD, standard deviation; SRI, selective serotonin reuptake inhibitor.

Increase in psychocutaneous diseases during COVID-19

Our results are limited by a small sample size. However, we believe the disproportionate increase in PD cases in May 2020 is sufficiently meaningful to provide insight into how COVID-19 and its multidimensional disruptions have impacted PD. It appears that the mental health wave of the pandemic may have accelerated the development and worsening of PD. Larger studies with more diverse patient populations are needed.

knowledge

Audited and approved by Wake Forest University Health Sciences IRB00073183.

source https://www.bisayanews.com/2022/01/29/a-surge-in-psychocutaneous-diseases-during-covid%e2%80%9019-experience-at-an-academic-medical-center-hrin-international-journal-of-dermatology/