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The number of elderly patients with chronic pruritus has been gradually increasing in aging countries. Bullous pemphigoid, a common autoimmune blister disease in the elderly, is always heralded by pruritic eczematous dermatitis and is often associated with neurodegenerative diseases. We hypothesized that chronic eczematous dermatitis in patients with neurodegenerative diseases may be an early marker of bullous pemphigoid. By conducting retrospective chart review, we found neurodegenerative diseases are more prevalent in elderly patients with chronic eczematous dermatitis. The mean time delay between the diagnosis of neurodegenerative diseases and onset of skin lesions is 4.17years. In all 6 patients who received skin biopsy, eosinophils in the upper dermis or at the dermo-epidermal junction were obvious, which are remnant of the pathological finding of bullous pemphigoid. Together with the well-known association between bullous pemphigoid and neurodegenerative diseases, the results suggested that unlocalized eczematous dermatitis in the elderly may be an early manifestation of bullous pemphigoid. Inter-discipline communication among neurology, dermatology and geriatrics/gerontology is required to tailor specific managements for elderly patients with pruritus and neurodegenerative diseases.

Psoriasis is associated with certain psychiatric disorders such as anxiety and depression. Although a growing body of literature has indicated high prevalence of anxiety in patients with psoriasis, it is unclear if the incidence of anxiety is correlated with severity of psoriasis. In this article, we hypothesize that anxiety is not correlated with severity of psoriasis, and therefore the issue of anxiety should not be neglected in patients with mild psoriasis. To testify this hypothesis, we performed a pilot study to investigate the correlation between anxiety questionnaires and severity of psoriasis. Thirty-two patients with psoriasis were recruited. The patients were further classified into mild or moderate to severe psoriasis according to their body surface area or Psoriasis Area Severity Index (PASI). Zung's self-rating anxiety scale (SAS) and SF-36 were adopted to evaluate anxiety and quality of life, respectively. Spearman's rank correlation coefficients were calculated between SAS and each scale of SF-36 among these 32 patients. SAS is negatively correlated with role limitation due to emotional problems, vitality, emotional well-being of SF-36. Although SAS is not significantly different between mild and moderate to severe psoriasis, the detected levels of anxiety were higher than normative standards. Physicians should not neglect potential anxiety in patients who have mild psoriasis. Inter-discipline collaboration between psychiatry and dermatology is required to provide comprehensive patient care.