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Summary: Background: Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective, interventions. BDD symptoms are more prevalent in patients with dermatological conditions than in the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. Objectives: To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. Methods: This observational, cross‐sectional, comparative multicentre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological outpatients at 22 clinics in 17 European countries, and 2808 healthy skin controls (66% female). BDD symptoms were assessed by the Dysmorphic Concern Questionnaire. Sociodemographic data and information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD‐10 by a dermatologist. The study was registered with number DRKS00012745. Results: The average participation rate of invited dermatological patients was 82.4% across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than 11‐fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared with healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than sixfold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatization. Conclusions: Clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management. What is already known about this topic?Body dysmorphic disorder (BDD) is a common psychiatric disorder with a prevalence of about 2% in the general population.Skin diseases pose a high psychological burden on patients. People with these problems often experience increased self‐consciousness, skin‐related shame and stigmatization.Single‐centre studies including small samples of patients with skin conditions showed that these patients show symptoms of a similar nature to BDD more often than the general population. What does this study add?In this large multicentre study, BDD symptoms were fivefold more prevalent in dermatological patients than in healthy skin controls, and were related to young age, female sex, psychological stress and stigmatization experience.Certain patient groups (e.g. hyperhidrosis) had a greater than 11‐fold increased chance of BDD symptoms compared with controls.Doctors should consider appearance‐related concern and BDD more often and refer patients when needed to an appropriate service for assessment and treatment. Body dysmorphic disorder (BDD) is a psychiatric condition affecting about 2.5 % of the general population. Patients with this condition are preoccupied with negative thoughts about their own appearance which highly impair their daily functioning. Skin diseases can pose a high psychological burden on patients partly due to visible skin lesions. BDD has been shown to affect dermatological patients quite often, but there are no large studies that include both patients with different dermatological conditions and healthy skin controls. This study included 8295 participants: 5487 patients with different skin diseases (56% female) recruited among dermatological out‐patients at 22 clinics in 17 European countries and 2808 people with healthy skin (66% female). Symptoms of BDD were measured using a self‐report questionnaire. In addition, each patient was given a dermatological diagnosis by a dermatologist. It was shown that BDD symptoms were five times more prevalent in patients with dermatological conditions than in people with healthy skin (10.5% vs. 2.1%). Certain dermatological patients (e.g. with excessive sweating, circular hairloss and white spot disease) had a more than eleven‐fold increased chance of BDD symptoms compared to people with healthy skin. It was also shown that BDD symptoms more often occurred in younger and in female persons, and those experiencing higher psychological stress and feeling stigmatized. As BDD symptoms are so common in dermatological patients, general practitioners and dermatologists should consider both BDD and appearance related distress and refer patients when identified to an appropriate service for further assessment and management. Linked Comment: P. Magin and K. Fisher. Br J Dermatol 2022; 187:5. Plain language summary available online [ABSTRACT FROM AUTHOR]

The link between acne and psychiatric morbidities has been demonstrated in many studies; however, large scale studies aiming to reveal the psychosocial impact of acne are rare. The aim of this study was to assess the psychological burden of adult acne patients. This analysis was based on a multicenter study including 213 acne patients and 213 controls from 13 European countries. The Hospital Anxiety and Depression Scale (HADS), Dermatology Life Quality Index, and EuroQol 5 dimensions 3 levels scores of the patients with acne were analyzed. Patients with acne (n = 213) had higher HADS scores for anxiety (mean ± standard deviation 6.70 ± 3.84) and depression (3.91 ± 3.43) than the controls (p < 0.001 for both). For patients with acne, 40.6% reported that they were very concerned about their skin disease, 12.3% had suicidal ideation, and, among those, 10 (4%) patients implied that acne was the cause of their suicidal thoughts. After adjusting for other variables, patients who had suicidal ideation (p = 0.007, and adjusted odds ratio 3.32 [95% confidence interval (CI): 1.39-7.93]) and stressful life events (p < 0.001, and adjusted OR 5.85 [95% CI: 2.65-12.86]) had a greater chance of fulfilling the HADS criteria for anxiety. This study highlights the need for a psychotherapeutic approach in order to recognize the concerns of acne patients and optimize their treatment. [ABSTRACT FROM AUTHOR]

Skin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%). The largest reduction in HRQoL attributable to therapy, as a percentage of total DLQI, adjusted for confounders, was seen in blistering conditions (10.7%), allergic/ drug reactions (10.2%), psoriasis (9.9%), vasculitis/ immunological ulcers (8.8%), atopic dermatitis (8.7%), and venous leg ulcers (8.5%). In skin cancer, although it had less impact on HRQoL, the reduction due to therapy was 6.8%. Treatment for skin disease contributes considerably to reducing HRQoL: the burden of dermatological treatment should be considered when planning therapy and designing new dermatological therapies. [ABSTRACT FROM AUTHOR]

There are limited data on the differences in the impact of psoriasis between various countries with respect to quality of life (QoL). The aim of this study was to explore the psychosocial health of patients with psoriasis in different European countries. A total of 682 patients were recruited in 13 European countries. All patients completed a questionnaire regarding sociodemographic information, negative life events, suicidal ideation and satisfaction with their dermatologist. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS), and QoL with the Dermatology Life Quality Index (DLQI) and EuroQoL (EQ-5D). The lowest anxiety and depression scoring was noted in patients from Denmark, the lowest level of impairment in QoL in subjects from Spain, and the highest level of impairment in QoL in patients from Italy. The most relevant parameters influencing patients' well-being were severity of pruritus and satisfaction with their dermatologist. The level of anxiety and depression symptoms correlated significantly with suicidal ideation. [ABSTRACT FROM AUTHOR]

Introduction Patients and methods Results Conclusion Hidradenitis suppurativa (HS) can severely affect the quality of life (QoL) and is linked to psychological distress, including anxiety, depression, and reduced self‐esteem. Stigmatization due to physical appearance may significantly contribute to the psychological burden and impact on QoL for HS patients. This study investigates the association between stigmatization, depression, anxiety, and health‐ and disease‐related variables among HS patients in Europe.This observational cross‐sectional multicenter study was conducted across 22 dermatological outpatient clinics in 17 European countries. Data collected included sociodemographic variables, general health variables, disease‐related variables, perceived stigmatization (PSQ), and mental health (PHQ‐2, GAD‐2).Of the 5487 dermatological patients, 142 (2.6%) were diagnosed with HS, and data from 135 patients (70.1% women, mean age 38.2 years) who completed the PSQ questionnaire were analyzed. Scores on the stigmatization measure indicated that significant stigmatization levels were present in the sample. Linear regression models revealed a significant relationship between stigmatization and both the duration of HS and the presence of itch. Similar findings were noted for the PSQ “confused/staring behavior” scale with depression. The PSQ “absence of friendly behavior” scale was inversely associated with general health status, whereas the “hostile behavior” scale was positively linked to depression.HS patients experience significant stigmatization linked to disease duration, itch, and depression. Comprehensive management, including screening for psychosocial co‐morbidity, is essential, as is providing access to psychological interventions that support patients to both manage internal distress and the potential reactions of others. [ABSTRACT FROM AUTHOR]

Clinical epidemiological knowledge concerning psychodermatology patients is scarce. The objective of this study was to assess morbidity in a new psychodermatology service. Information was gathered from patient records at the psychodermatology unit in Skåne University Hospital, Malmö, Sweden, from 1 February 2017 to 31 January 2018. All patients were screened with the Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI) at baseline and after 12 months. Additional information was collated from the patient records. A total of 50 patients were treated during the 12 months, 86% were women, mean age 44 years (standard deviation (SD) 16 years). Itch was present in 72% of patients. Forty-two percent of patients were diagnosed with mood disorders, 30% with personality disorders, and 16% with delusional disorders. At baseline 40% of patients had a DLQI score >11, clinical depression was present in 14%, and clinical anxiety in 28%. These data emphasize the need for access to a multidisciplinary unit for dermatology patients.

Pain and discomfort are important symptoms in dermatology. The aim of this cross-sectional, multicentre study was to describe the prevalence of pain/discomfort and its associations in patients with several dermatological conditions across 13 European countries. The outcome was the prevalence of pain/discomfort according to a question of the EQ-5D questionnaire. Data collected from November 2011 to February 2013 were complete for 3,509 consecutive outpatients. Moderate or extreme pain/discomfort was reported by 55.5% of patients and 31.5% of controls with no skin conditions. The highest proportions were reported by patients with hidradenitis suppurativa (92.9%), leg ulcer (81.4%), prurigo (80%) and lichen planus (75.6%). Pain/discomfort was associated with older age, low educational level, clinical severity, flare on scalp or hands, itch, depression, anxiety, low quality of life, and thoughts of suicide. It is important to enquire specifically about pain/discomfort during clinical consultations and to address it when planning a patient's care.

The burden of atopic dermatitis (AD) was assessed. A population-based, cross-sectional questionnaire study was performed among 34,313 Swedish adults in 2017. The prevalence of AD was 14%. Adults with mild AD had an increased relative risk ratio (RRR) of severe depression (aRRR 1.78, 95% confidence interval (95% CI) 1.50-2.12) and anxiety (aRRR 1.97, 95% CI 1.69-2.30), which was higher for severe AD (aRRR 6.22 95% CI 4.60- 8.42, aRRR 5.62 95% CI 4.10-7.71, respectively). Persons with severe AD were less likely to have a university degree (aRRR 0.55, 95% CI 0.34-0.90) and more likely to have a lower annual income (238,000-324,000 SEK: aRRR 0.51, 95% CI 0.39-0.77; 325,000 SEK or more 0.36; 0.25-0.58) compared with individuals without AD. These results suggest that AD implies an increased prevalence of comorbid mental conditions and an adverse impact on academic achievement and work. These adverse associations increase substantially for patients with severe AD and comorbid asthma.

Pruritus is a frequent symptom in medicine. Population-based studies show that every 5th person in the general population has suffered from chronic pruritus at least once in the lifetime with a 12-month incidence of 7%. In patient populations its frequency is much higher depending on the underlying cause, ranging from around 25% in haemodialysis patients to 100% in skin diseases such as urticaria and atopic dermatitis (AD). Pruritus may be the result of a dermatological or non-dermatological disease. Especially in non-diseased skin it may be caused by systemic, neurological or psychiatric diseases, as well as being a side effect of medications. In a number of cases chronic pruritus may be of multifactorial origin. Pruritus needs a precise diagnostic work-up. Management of chronic pruritus comprises treatment of the underlying disease and topical treatment modalities, including symptomatic antipruritic treatment, ultraviolet phototherapy and systemic treatment. Treating chronic pruritus needs to be targeted, multimodal and performed in a step-wise procedure requiring an interdisciplinary approach. We present the updated and consensus based (S2k) European guideline on chronic pruritus by a team of European pruritus experts from different disciplines. This version is an updated version of the guideline that was published in 2012 and updated in 2014 (www.euroderm.org).

Itch is an unpleasant symptom, affecting many dermatological patients. Studies investigating the occurrence and intensity of itch in dermatological patients often focus on a single skin disease and omit a control group with healthy skin. The aim of this multi-centre study was to assess the occurrence, chronicity and intensity (visual analogue scale 0-10) of itch in patients with different skin diseases and healthy-skin controls. Out of 3,530 dermatological patients, 54.3% reported itch (mean ± standard deviation itch intensity 5.5 ± 2.5), while out of 1,094 healthy-skin controls 8% had itch (3.6 ± 2.3). Chronic itch was reported by 36.9% of the patients and 4.7% of the healthy-skin controls. Itch was most frequent (occurrence rates higher than 80%) in patients with unclassified pruritus, prurigo and related conditions, atopic dermatitis and hand eczema. However, many patients with psychodermatological conditions and naevi also reported itch (occurrence rates higher than 19%).

There are limited data on the differences in the impact of psoriasis between various countries with respect to quality of life (QoL). The aim of this study was to explore the psychosocial health of patients with psoriasis in different European countries. A total of 682 patients were recruited in 13 European countries. All patients completed a questionnaire regarding socio-demographic information, negative life events, suicidal ideation and satisfaction with their dermatologist. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS), and QoL with the Dermatology Life Quality Index (DLQI) and EuroQoL (EQ-5D). The lowest anxiety and depression scoring was noted in patients from Denmark, the lowest level of impairment in QoL in subjects from Spain, and the highest level of impairment in QoL in patients from Italy. The most relevant parameters influencing patients' well-being were severity of pruritus and satisfaction with their dermatologist. The level of anxiety and depression symptoms correlated significantly with suicidal ideation.