Skin is recognized as the boundary between an individual and society. Skin is also known to impact social and psychiatric conditions. The social aspect of skin characteristics has been gaining attention especially when it comes to hair-pulling or skin-picking disorders. These disorders, which target skin, hair or nails, have been investigated and described in the revised version of DSM-5 as “body-focused repetitive behaviors”(BFRB).
Most patients with BFRB have psychiatric problems. However, most will visit a dermatologist, and not a psychiatrist, although the psychiatric symptoms and recurrent BFRBs are difficult to manage for dermatologists who do not typically have psychiatric knowledge. The untreated psychiatric symptoms, including targeting of the skin, will eventually result in skin damage such as lesions, infection, and scars.
DSM-5-revised describes a new categorization of obsessive-compulsive and related disorders (OCRDs). Hair-pulling disorder known as trichotillomania is now categorized as an OCRD, whereas it was previously recognized as an impulse-control disorder under DSM-IV. Additionally, excoriation (skin-picking) disorder and body-focused repetitive behavior disorder, recognized as a new unit in diagnosis, have also been categorized as OCRDs. These revisions in diagnostic criteria reflect significance of the close relationships between BFRB and OCRDs, as well as the importance of psychosomatic dermatology and psychodermatology, which examine the clinical relationships between dermatology and psychiatry.
This study reviews literature that is relevant to hair-pulling and skin-picking disorders, as well as scratching behavior, especially that which occurs in patients with atopic dermatitis (AD). The paper also investigates the clinical characteristics and treatment of a patient with hair-pulling disorder and AD treated in a child psychiatry clinic, demonstrating the benefits of placing greater focus on psychodermatology, and the importance of collaboration between child psychiatrists and dermatologists.
"},{"@language":"ja","@value":"皮膚は個人と社会との境界であり，皮膚と精神の状態は相互に影響することが知られる。DSM-5改訂では，抜毛や皮膚むしり・爪噛み行動など身体を対象とする反復行動を総称する“Body-focused repetitive behaviors （BFRB）”（身体集中反復行動）との用語が記載された。皮膚症状を伴うBFRBの多くは精神医学的問題を有するものの，精神科を受診する例は少ない上，精神症状の治療は容易ではない。精神症状と反復行動の持続から，創部の感染や瘢痕を生じる例もあり，皮膚科では治療的対応が問題とされてきた。
DSM-5改訂ではBFRBにおける強迫性が重視され，DSM-IVでは衝動制御障害に分類されていた抜毛症（hair-pulling disorder, trichotillomania）が「強迫症および関連症群（obsessive-compulsive and related disorders: 以下OCRDs）」へ再分類された。また，新たに病名として採用された皮膚むしり症（skin-picking disorder, excoriation disorder）と身体集中反復行動症（body-focused repetitive behavior disorder）もOCRDsに分類された。BFRBをOCRDsに含めた今回の改編は，皮膚科と精神科の臨床的接点を検討する精神皮膚科学（psychosomatic dermatology, psychodermatology）の重要性を示す。
本稿ではBFRBの観点から，抜毛症，皮膚むしり症，皮膚の掻破行動とアトピー性皮膚炎の関連について検討した。また，抜毛とアトピー性皮膚炎を有する自験例の精神医学的特徴を検討し，児童精神科での治療，皮膚科との連携について考察した。
"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410282763134349952","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000403978111"}],"foaf:name":[{"@language":"en","@value":"SAKAI Reiko"},{"@language":"ja","@value":"境 玲子"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Habilitation and Consultation Center for Childhood and Adolescence"},{"@language":"ja","@value":"小児療育相談センター"},{"@language":"ja","@value":"横浜市立大学医学部・皮膚科学"},{"@language":"en","@value":"Department of Dermatology, Yokohama City University School of Medicine"},{"@language":"ja","@value":"三木メンタルクリニック"},{"@language":"en","@value":"Miki Mental Clinic"}]},{"@id":"https://cir.nii.ac.jp/crid/1410282763134349953","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000403978112"}],"foaf:name":[{"@language":"en","@value":"IIDA Miki"},{"@language":"ja","@value":"飯田 美紀"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Habilitation and Consultation Center for Childhood and Adolescence"},{"@language":"ja","@value":"小児療育相談センター"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"02890968"},{"@type":"EISSN","@value":"24241652"},{"@type":"NDL_BIB_ID","@value":"000000039041"},{"@type":"ISSN","@value":"02890968"},{"@type":"LISSN","@value":"02890968"},{"@type":"NCID","@value":"AN00217101"}],"prism:publicationName":[{"@language":"ja","@value":"児童青年精神医学とその近接領域"},{"@language":"en","@value":"Japanese Journal of Child and Adolescent Psychiatry"},{"@language":"ja","@value":"児精医誌"},{"@language":"en","@value":"Jpn J Child Adolesc Psychiatr"}],"dc:publisher":[{"@language":"en","@value":"Japanese Society for Child and Adolescent Psychiatry"},{"@language":"ja","@value":"一般社団法人 日本児童青年精神医学会"}],"prism:publicationDate":"2016-04-01","prism:volume":"57","prism:number":"2","prism:startingPage":"298","prism:endingPage":"309"},"url":[{"@id":"http://id.ndl.go.jp/bib/027463448"},{"@id":"https://ndlsearch.ndl.go.jp/books/R000000004-I027463448"},{"@id":"https://search.jamas.or.jp/link/ui/2016340058"}],"availableAt":"2016-04-01","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=atopic%20dermatitis","dc:title":"atopic dermatitis"},{"@id":"https://cir.nii.ac.jp/all?q=body-focused%20repetitive%20behaviors","dc:title":"body-focused repetitive behaviors"},{"@id":"https://cir.nii.ac.jp/all?q=hair-pulling%20disorder","dc:title":"hair-pulling disorder"},{"@id":"https://cir.nii.ac.jp/all?q=psychodermatology","dc:title":"psychodermatology"},{"@id":"https://cir.nii.ac.jp/all?q=scratching%20behavior","dc:title":"scratching behavior"},{"@id":"https://cir.nii.ac.jp/all?q=skin-picking%20disorder","dc:title":"skin-picking disorder"},{"@id":"https://cir.nii.ac.jp/all?q=atopic%20dermatitis","dc:title":"atopic dermatitis"},{"@id":"https://cir.nii.ac.jp/all?q=body-focused%20repetitive%20behaviors","dc:title":"body-focused repetitive behaviors"},{"@id":"https://cir.nii.ac.jp/all?q=hair-pulling%20disorder","dc:title":"hair-pulling disorder"},{"@id":"https://cir.nii.ac.jp/all?q=psychodermatology","dc:title":"psychodermatology"},{"@id":"https://cir.nii.ac.jp/all?q=scratching%20behavior","dc:title":"scratching behavior"},{"@id":"https://cir.nii.ac.jp/all?q=skin-picking%20disorder","dc:title":"skin-picking disorder"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2007372176"},{"@type":"NDL_SEARCH","@value":"oai:ndlsearch.ndl.go.jp:R000000004-I027463448"},{"@type":"CIA","@value":"130007691878"}]}