Classification of psychodermatological disorders: Proposal of a new international classification

Abstract

Currently, psychodermatological disorders are classified under different criteria exhibiting several limitations, and no single universal classification system exists. Herein, we discuss previous suggested classifications in psychodermatology, highlighting their limitations, and we propose a new classification system, without redundant information and with accurate terminology, incorporating the relevance of the terms “disorder,” “disease,” and “illness” in psychodermatology. In this new classification, the following three groups are then suggested: “primary psychodermatological disease,” to include primary dermatoses, where psychological stress, a psychological mechanism, and/or psychopathology are some of the main elements that are recognized in the etiopathogenesis (which may induce and/or worsen a primary dermatosis); “primary psychodermatological illness,” to include skin symptoms, with or without secondary self-induced skin lesions (such as excoriations), without a primary dermatosis, and where psychopathology, psychological characteristics, and/or a neuropathic mechanism, where stress plays a relevant role, are key features responsible for the skin symptoms and the secondary skin lesions; and “secondary psychodermatological disorder,” to include medications prescribed in dermatology with psychiatric consequences and medications prescribed in psychiatry with dermatologic consequences. Our goal with this system is to broaden the recognition of psychodermatology and improve patient management, with practical and scientific relevance for dermatologists, psychiatrists, and psychologists working in psychodermatology, but also for general practitioners, physicians from other medical and surgical specialties as well as specialists in esthetic dermatology, who frequently encounter patients with psychodermatological disorders.