Obsessive-compulsive disorders and dermatologic disease

OCD, TTM, pathologic skin picking, and BDD may share aspects of phenomenologic presentation, neurobiologic underpinning, or pharmacotherapeutic response. Recent epidemiologic studies have demonstrated that OCD, which was once thought a rare disorder, is in fact a relatively common psychiatric disorder [42]. Although the prevalence of many of the OCD-related disorders has not yet been established, it seems clear that many of these disorders are frequently seen by dermatologists. One reason for this frequent presentation may be that that these disorders represent grooming action repertoires that have been aberrantly triggered. Graybiel [43,44] posits that basal ganglia recodes cortically derived information into action "chunks" to facilitate storage and easy retrieval, with different striatal circuits coding for different "chunks" Disturbances in these circuits lead to emergence of unwanted behaviors, and also help explain the symptom overlap between the various disorders. These theoretical considerations also seem to have important practical applications. The notion of an OCD-related spectrum reminds physicians to enquire about important comorbid symptoms in the patient and family, avoids unnecessary procedures, and suggests particular avenues of treatment including antiobsessional medication. It is important for the dermatologist to be aware of these conditions; to look for them in patients; and once diagnosed to provide support, education, and appropriate referral.