Integrative clinic at Henry Ford Health System.
J Am Acad Dermatol
Introduction: The association between psychiatric and dermatologic illnesses has been well characterized in the present literature with estimates of up to 40% of dermatology patients having comorbid psychiatric conditions. Most dermatologists, however, lack specific training to adequately identify and appropriately manage this unique comorbidity and associated clinical presentation. An integrated psychodermatology clinic where trainees are able to evaluate patients with these comorbid conditions under adequate supervision may assist with addressing this gap in training while offering appropriate and much needed services to patients who suffer from this often debilitating comorbidity. Our aim is to present the results from a psychodermatology clinic started at a health system in Detroit, Michigan.
Methods: At the Henry Ford Health System, a half-day psychodermatology clinic was offered to patients at one of our urban dermatology clinic sites. A retrospective chart review was performed of patients that were referred to this clinic from April 2016 to July 2017. Patients were referred to the clinic after presenting to a general dermatology clinic with a significant psychiatric symptom related to their skin condition or if they carried a psychiatric diagnosis resulting in cutaneous manifestations. New patients were scheduled for one-hour appointments with return patients typically scheduled for thirty-minute appointments resulting in two to three patients scheduled per clinic. Clinics were staffed by trainees and attendings from dermatology and psychiatry. Collaborative management plans were discussed and presented to patients at the end of each visit.
Results: In the 16 months analyzed, 70 patients were referred ranging from 11 to 86 years of age, of which 73% were female and 27% were male. The top three most commonly referred diagnoses were delusions of parasitosis, neurotic excoriations, and isotretinoin initiation in a patient with a history of a psychiatric disorder.
Conclusion: Psychodermatology is a unique area of dermatologic practice, one in which many dermatologists do not have expertise, and most don’t feel comfortable practicing. An integrated psychodermatology clinic may offer an opportunity to provide care for these patients. This approach also offers an opportunity to train residents in caring for these comorbid disorders while learning the pearls of a collaborative care model.