Psychosocial impact of dermatology diseases

Working in dermatology, one quickly learns that applying a simple medical model approach of diagnosis and treatment is neither suitable nor sufficient. In some patients the dermatological disease makes the patient suffer so much that psychological support is clearly needed and for others their skin condition does not respond to appropriate treatment so the patient requires ongoing support for their condition. Furthermore, some patients have primary psychiatric disorders - such as delusional parasitosis (DP) - but do not want or will not consult psychiatrists (Lyell 1983). These patients thus need psychologically adapted care in dermatology. During my training in Dermatology, I have developed a special interest in studying the impact on quality of life of chronic dermatoses like atopic eczema and psoriasis. So, this thesis focuses on the effects of atopic dermatitis on quality of life and on patients‘ knowledge, expectations and fears about their skin conditions. I also have included DP, a psychiatric illness that has significant morbidity but which presents to dermatologists and poses unique difficulties, Finally as part of evaluating how we should respond to the psychological challenges seen in our patients, I studied the use of an assessment and counselling service provided by a clinical psychologist in the dermatological outpatient setting.