Collaborative Psychiatric-Dermatologic Care Improves Outcomes for Complex Patients

Psychiatric and dermatologic care intersect across pharmacology, immunomodulation, and behavioral treatment, according to James Bourgeois, OD, MD, and Xiaofeng Yan, MD, continuing their discussion of the psychiatry-dermatology interface. Advances in psychopharmacology and neuromodulation technologies, including transcranial magnetic stimulation, were increasingly applied to patients initially identified in a dermatologic context who also had substantial comorbid psychiatric illness, according to Bourgeois, who emphasized that both conditions needed to be treated in parallel with active communication between specialties.

A major area of interest was the psychiatric implications of immunomodulating therapies, such as corticosteroids and other agents used for dermatologic and rheumatologic disease, which carried psychiatric side effects requiring simultaneous management alongside the underlying illness. "Someone on a large dose of corticosteroids for some other illness, including a dermatologic illness, may develop psychosis from the steroids themselves, not the illness," Bourgeois said.¹

Physician self-care was also emphasized as foundational to patient care, with Bourgeois noting that clinicians needed to model the same health-promoting behaviors—appropriate diet, physical activity, and work-life balance—that they encouraged in patients. Yan agreed, adding that lifestyle factors, including diet and exercise, mattered alongside psychiatric and dermatologic treatment. Grounding techniques and relaxation training were described as useful tools for patients experiencing anxiety, with referral to therapists specializing in anxiety and cognitive behavioral therapy recommended when appropriate.

Behavioral interventions, rather than medications, represented the primary treatment for pain and sleep problems, according to Bourgeois. "It's largely the consensus now that one of the main clinical interventions for pain, clinical interventions for sleep problems, are not medications but are psychotherapy," Bourgeois said.² He added that medication should supplement, not substitute for, behavioral improvement. Yan noted that coping skills learned through therapy provided durable, lifelong benefit when incorporated into patients' daily routines, addressing common patient reluctance toward indefinite medication use.

Both speakers described the psychiatry-dermatology interface as historically underappreciated and often perceived as difficult to manage, but expressed optimism about collaborative, triangulated care models in which clinicians communicate directly—an approach Bourgeois noted extends well beyond dermatologic illness. Yan reiterated that skin disease does not occur in isolation from mental health and social stress, and that early, collaborative, multidisciplinary treatment was needed to improve patients' overall well-being.

Dr Yan is an attending psychiatrist at NorCal Neurostimulation and a volunteer assistant professor in the departments of dermatology and psychiatry at UC Davis.

Dr Bourgeois is vice chair of Hospital Psychiatry Services and a professor at UC Davis Health in Sacramento, California.

References

1. Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006;81(10):1361-1367.

2. Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-133.