David Castillo

Psychoneurocutaneous medicine: past, present and future

SummaryPsychoneurocutaneous medicine is an important and rapidly growing field. It is an integrative science created to address the interaction between the mind, nervous system and skin. Four major fields are involved: psychiatry, psychology, neurology and dermatology. The history of psychoneurocutaneous medicine is old and fascinating. Even though it is a young science only established in the last century, allusions to the nervous system and diseases of the skin can be traced back thousands of years in the literature. Characteristically, the last two centuries were of special importance for the development of this field in Europe, lately in America, with great effort placed on research and publications. More recently, the creation of associations, work groups and the merging of subspecialties dedicated exclusively to study the psychological impact of skin disorders in subpopulations of patients have helped to give momentum to psychoneurocutaneous medicine. Further development of this field will shed light on the appropriate diagnosis and treatment of psychodermatologic disorders, enhancing the functionality and quality of life of patients. This paper presents a summary of the most influential facts in the history of psychoneurocutaneous medicine, its present and future perspectives.

A synopsis of the history of Hansen’s disease

SummaryLeprosy is a contagious infectious disease caused by the bacillus Mycobacterium leprae. This microorganism was discovered by Dr. Gerhard Hansen, and the illness was then baptized as Hansen’s disease. For a long time, Hansen’s disease was thought to be hereditary—a curse or a punishment from God. The disease affects skin and nerves and can cause severe damage. Due to its destructive effects, leprosy has caused fear, segregation, and prejudice in all societies since Biblical times. Patients with Hansen’s disease have not been treated humanely around the world throughout the ages. This article is a summary of curious and interesting facts about the history and cultural aspects of Hansen’s disease, which has chastised humanity for centuries. These facts are about the discovery of the disease, its propagation, the evolution of treatments, and the prejudice of society towards patients.

Body dysmorphic disorder: history and curiosities

SummaryBody dysmorphic disorder is a chronic psychiatric disorder characterized by excessive preoccupation with an absent or minimal physical deformity. It causes severe distress and impairs normal functioning. In the last centuries, this disorder has been mentioned in the medical literature by important mental health practitioners by different names, such as “dysmorphophobia” or “dermatologic hypochondriasis”. However, not until the last century was it included among the obsessive–compulsive disorders, although its classification has changed over time.Patients with body dysmorphic disorder constantly seek cosmetic treatments in order to improve their physical appearance, which more often deteriorates their mental condition. The high prevalence of psychiatric disorders in cosmetic medical practice has led in this field of study to the new science “cosmetic psychodermatology”. This paper presents a summary of important facts about body dysmorphic disorder and its description throughout the history of medicine.

Non-cosmetic dermatological use of botulinum neurotoxin: FRANÇA et al.

Botulinum toxin is a neurotoxin produced by the Clostridium botulinum that has been used in cosmetic and non-cosmetic medical practices for decades. Botulinum toxin binds peripherally to the presynaptic membrane of the neuromuscular or neuroglandular junction to irreversibly inhibit the release of acetylcholine and block signal transmission. The effect in muscle is a flaccid paralysis and the blockade of exocrine gland secretion. This neurotoxin is widely used in the cosmetic practice for the correction of face and necklines, facial asymmetry, and lip rhytides. It has also been used in the management of hyperhidrosis, anal fissures, migraines headaches, bruxism, and other medical conditions. Forbat et al. provides growing evidence supporting the use of botulinum toxin in non-cosmetic dermatological disorders such as pruritic dermatosis (pompholyx, idiopathic pruritus, lichen planus), acantholytic disorders (Hailey–Hailey disease, Darier’s disease), inflammatory dermatosis (hidradenitis suppurativa, flexural psoriasis), scarring, fissures and ulceration (Anal fissures, Raynaud’s disease, and ulcers) and painful disorders such as vulvodynia and cutaneous leiomyomas (Forbat, Ali, & Al-Niaimi, 2016). Some of these effects are likely secondary to regulation of the substance P, glutamate, and mechanisms not completely yet understood. Botulinum toxin is a powerful neurotoxin with a wide range of dermatological applications expanding every year. A complete understanding of its mechanism in these disorders will expand its potential applications, and although more clinical studies are needed, the evidence of the effectiveness of Botulinum toxin in non-cosmetic dermatological disorders is growing.

Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations

Trichotillomania (hair pulling disorder) is a fairly common but underreported disorder characterized by recurrent episodes of pulling hair from different parts of the body. Currently classified in Diagnostic and Statistical Manual of Psychiatric Disorders (DSM‐5) under the heading of the “Obsessive–compulsive spectrum and related disorders.” The estimated prevalence data suggest that 0.5–2% of the general population suffers from this disorder. Stress and anxiety are directly correlated to the production of trichotillomania symptoms. The psychosocial aspects of trichotillomania are greatly underestimated, but recent literature suggests an increased interest in this neglected area. Although no FDA approved medications are available for the treatment of trichotillomania, a variety of medications including N‐acetylcysteine have shown benefit in case reports. Combined liaison clinics, with an interdisciplinary approach, are highly advisable in the treatment of these cases.

Contact dermatitis: a historical perspective

SummaryContact dermatitis is a common skin condition that can have a considerable impact on patient quality of life and function. Historically, contact dermatitis has played a significant role in the evolution of dermatology as the understanding of a relationship between environmental exposure and specific skin disease became more widely accepted. Reports about this relationship can be found throughout the history of humanity, thousands of years ago. The Egyptians were perhaps the first to document this relationship in ancient history, and documentation has also been found in several other cultures and nations such as the Chinese, Indians, Europeans, and American colonizers. The patch test emerged over a century ago and has remained a powerful tool for diagnosing and directing patients. This paper provides historical and curious facts about contact dermatitis.

Artificial Hair: By the Dawn to Automatic Biofibre® Hair Implant

Since the beginning of the twentieth century, there have been attempts at creating artificial hair to treat baldness. Major evolution took place at the end of 1970’s when, unfortunately, artificial hair treatments were applied without appropriate medical controls, resulting in sub-standard results from the use of unsuitable materials and technique. The large improper use of this technique in North America from no medical personnel and with dangerous fibres led the Food and Drug Administration (FDA) to suspend the procedure in 1983. In Europe, a new trial on artificial hair procedure started at the beginning of 1990’s. In 1995 the European Union (UE) recognised the artificial hair implant as a legitimate medical treatment and outlined the rules related to that procedure. In 1996, biocompatible fibres (Biofibre®) produced by Medicap® Italy were approved by the UE Authorities and by the Australian Therapeutic Goods Administration (TGA) as medical devices for hair implant. An effective medical protocol was developed during the following years to provide correct guidelines for appropriate treatment, and to reduce possible related complications. Automatic Biofibre® hair implant represents the last achievement in this hair restoration technique with significant advantages for the patients.

UVA‐1 in the treatment of alopecia areata

Alopecia areata (AA) is a T cell mediated autoimmune form of hair loss characterized by nonscarring destruction of hair follicles. AA affects both men and women and people of all ages. Psychological factors, family history, autoimmune and endocrine disorders, trauma among other factors have been implicated in its pathogenesis. Several therapies are available; however, none leads to long term response or cure in this relapsing disorder. Therefore, alternative therapies such as phototherapy, which has been used for the treatment of skin conditions for decades, are being evaluated for the treatment of AA. UVA-1 is the type of phototherapy with the deepest skin penetration and has been used for several skin disorders, including lichen sclerosus et atrophicus, idiopathic follicular mucinosis and necrobiosis lipoidica diabeticorum (Herz-Ruelas et al., 2017). It is known that UVA affects the immune system by inducing T and B cells, antigen presenting cells, and mast cells in the skin by different mechanisms. Herz-Ruelas et al. conducted a prospective study to evaluate the optimal dose, initial and increments, of escalating UVA-1 in AA unresponsive to first line therapy (topical, intralesional, and systemic steroids, retinoic acid, minoxidil, or cyclosporine). They included 22 patients, 9 men and 13 women. The severity and pattern of hair loss were evaluated using the severity of alopecia tool (SALT). The patients received a total of 75 sessions of UVA1 in 6 months starting with 25 sessions (3–5 times a week) at a dose of 30 J/cm. This dose was increased up to 60 J/cm if no response (hair regrowth <75%) in the first 25 sessions. If still unresponsive, 25 more sessions at 120 J/cm were given. Response to treatment was evaluated by comparing SALT score, scalp photographs, and biopsies, and total hair count at baseline and at the end of the intervention. The authors found that hair grow was greater with 60 J/cm by the end of the 75 sessions. 30 J/cm showed no effect and a few patients required 120 J/cm. Dermatopathology also showed decreased inflammation and increased total hair count by the end of the intervention. The response to treatment was maintained for a 6-month follow-up.