North Texas Research Forum 2025
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Division
North Texas
Hospital
Medical City Fort Worth
Specialty
Dermatology
Document Type
Poster
Publication Date
2025
Keywords
atopic dermatitis, itching, psychodermatology, stress
Disciplines
Dermatology | Medicine and Health Sciences | Psychiatry and Psychology | Skin and Connective Tissue Diseases
Abstract
Introduction: Psychodermatology is an interdisciplinary branch of psychosomatic medicine that addresses interactions between the psyche and skin. Stress is often a key exacerbating factor and highlights the bidirectional relationship between psychological factors and skin disorders. Atopic dermatitis (AD) is a chronic skin condition affecting pediatric and adult populations with an estimated global prevalence of approximately 2.6%, or approximately 204 million people. AD classically presents with a red, scaly, pruritic rash. Here, we present a case of biopsy-proven AD induced by stress-associated behaviors related to patient-identified obsessive-compulsive habits. Case Presentation: A 61-year-old female presented for persistent itching and white discoloration in the interdigital spaces of her feet. She had seen multiple clinicians without improvement and failed oral and topical antifungal trials. Dermatologic history was significant for chronic AD on bilateral elbows and knees and managed with clobetasol 0.05% ointment. Self-reported allergies included over thirteen foods and medications. On physical exam, there were white scaly plaques between the interdigital spaces of the right and left feet. Clinical examination suggested tinea pedis. Histopathology demonstrated epidermal hyperplasia with mild spongiosis, hyperkeratosis, and focal parakeratosis. Periodic acid-Schiff stain was negative for hyphae. This was consistent with AD and secondary lichen simplex chronicus. After obtaining biopsy results, further questioning revealed the patient developed an abscess between her buttocks 8-years ago requiring drainage and hospitalization for methicillin-resistant staphylococcus aureus. She feared developing another infection and followed a strict hygiene regimen that involved bathing 2-hours twice per day. Bathing habits involved close skin inspection while scrubbing with soap. The patient disclosed she was self-diagnosed with obsessive-compulsive disorder and stated her children agreed her behavior was extreme. Recommended behavior modification therapy included decreasing scrubbing and replacing rubbing behaviors with a new habit of applying petroleum jelly. Hydrocortisone 2.5% cream was prescribed. On 6-week follow-up, the patient reported improved pruritus but continued bathing 4-hours daily. Learning Points: Our case demonstrates an atypical presentation of AD complicated by psychiatric factors perpetuating dermatologic symptoms. In this case, skin biopsy provided a clue to diagnosis. Patient workup should include a thorough assessment of medical and social history, psychological state, and inquiry into living habitus and/or environment. While this patient’s presenting symptoms slowly improved, her disease process stems from underlying stress-associated behaviors. An interdisciplinary care team may be optimal for long-term management of psychocutaneous disorders with the goal of halting perpetuation of the disease cycle.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Lim, Henry; Choe, Jamie Y.; Hall, Marshall; Felicitas, Arianne; Scheufele, Christian; Furth, Garrett; Carletti, Michael; and Weis, Stephen, "A Case of Biopsy-Proven Atopic Dermatitis Perpetuated by Psychosomatic Factors" (2025). North Texas Research Forum 2025. 28.
https://scholarlycommons.hcahealthcare.com/northtexas2025/28
Included in
Dermatology Commons, Psychiatry and Psychology Commons, Skin and Connective Tissue Diseases Commons