Introduction

The psychiatric comorbidity in dermatological disorders is often one of the most important indices of the overall disability associated with the dermatological condition (Panconesi, 1984; Gupta & Gupta, 1996; Woodruff et al., 1997; Picardi et al., 2000; Gupta & Gupta, 2003; Picardi et al., 2004; Sampogna et al., 2004). It is well established that significant psychiatric and psychosocial comorbidity is present in at least 30% of dermatological patients, and untreated comorbid psychiatric disorders may adversely affect the response of the dermatological disorder to standard dermatological therapies (Picardi et al., 2003). Psychiatric pathology is important in both (i) the cutaneous associations of primary psychiatric disorders such as delusional states and some of the self-inflicted dermatoses such as dermatitis artefacta, and (ii) a wide range of primary dermatological disorders that have psychiatric comorbidity. Any dermatological disorder that is cosmetically disfiguring can be associated with significant psychiatric morbidity. Stress-related neuroimmunomodulation may affect the course of viral infections such as warts, and possibly the course of certain malignancies such as melanoma. There is a group of disorders such as psoriasis, atopic dermatitis, chronic idiopathic urticaria, alopecia areata and acne that have a stronger psychiatric and psychosocial component as they are often exacerbated by psychosocial stress and are frequently comorbid with major psychiatric syndromes such as depressive illness.