No Difference in Psychotropic Medication Use in Cosmetic and General Dermatology Patients
July 2016 | Volume 15 | Issue 7 | Original Article | 858 | Copyright © 2016
Heather K. Hamilton MD,a Evelyn Lilly MD,a,b Kenneth A. Arndt MD,a and Jeffrey S. Dover MD FRCPCa
aSkinCare Physicians, Chestnut Hill, MA; Yale University School of Medicine, New Haven, CT
bHarvard Medical School, Boston, MA; Massachusetts General Hospital, Boston, MA
BACKGROUND: Patients presenting for appearance-related concerns are often perceived as being more difficult (ie, more needy, more difficult to satisfy) than patients presenting for medical dermatologic problems. While the reasons for this perception are many, some hypothesize that this may be related to a higher rate of anxiety, depression, or body image issues among these patients.
OBJECTIVE: To determine the prevalence of psychotropic medication use in cosmetic dermatology patients compared to the prevalence of such medication use in general dermatology patients.
METHODS & MATERIALS: The study was a retrospective chart review of female patients, 18 or older, new to a private practice. Exclusion criteria included dermatologic disorders with known psychosocial comorbidity. Psychotropic medication use was recorded.
RESULTS: The percentage of subjects in the medical group (n=156) who reported using psychotropic medications was 22.2% compared to 26.8% in the cosmetic group (n=154; P=0.09).
CONCLUSION: The prevalence of psychotropic medication use among all dermatology patients in our practice was relatively high, but there was no statistically significant difference in the rate of psychotropic medication use in cosmetic dermatology patients compared to general dermatology patients.
J Drugs Dermatol. 2016;15(7):858-861.
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Patients seen in consultation for appearance related concerns (cosmetic patients) are often perceived as being needier or more difficult to satisfy than patients seen for medical dermatologic problems. While the reasons for this perception are many, some have hypothesized that that this may be related to a higher rate of anxiety, mild depression or body image issues among this patient population. Studies of cosmetic patients in the Plastic Surgery and Ears, Nose, and Throat literature suggest a higher prevalence of mental health issues in these patients versus controls.1,2 In addition, in one study, the prevalence of body dysmorphic disorder in cosmetic dermatology patients was found to be higher (14.0%) than general dermatology (6.7%) and control patients (2.0%).3 As pharmacotherapy is the most common treatment for mental illness,4 psychotropic medication use may be a marker of mental health illness. Yet, Orringer et al found no statistically significant difference in the prevalence of psychotropic medication use between cosmetic (18%) and medical (17%) dermatology patients.5 We sought to further investigate the prevalence of psychotropic medication use in cosmetic dermatology patients and to compare it to the prevalence of such medication use in general dermatology patients from the same practice.
From February 21, 2013 to April 9, 2013, a retrospective chart review was conducted on all new female patients greater than age 18 at a single suburban comprehensive dermatology private practice. New patients included established patients who had not been seen at the practice for 3 years prior. The study received exemption from review from the New England Institutional Review Board. Demographic information (age, ethnicity, and race), reason for visit, and psychiatric history (diagnoses and medications) were self-recorded by the patient on an intake form. Psychotropic medications included antidepressants, anxiolytics, antipsychotics, mood stabilizers, and medications for Attention Deficit Hyperactivity Disorder (ADHD).
Exclusion criteria included dermatologic diagnoses previously reported to have significant psychiatric co-morbidity (eg, psoriasis, vitiligo, delusions of parasitosis, and neurotic excoriations). We also excluded patients who presented for both general dermatology and cosmetic dermatology concerns. The study ended when the number of participants calculated to provide sufficient power was reached.
All statistical evaluations were performed by Excel and SPSS version 19 (SPSS Inc., Chicago, IL). Baseline characteristics were summarized and presented as means and numbers and as percentages. Differences in baseline characteristics between the groups were assessed with a simple binomial population z-test with normal approximation or a one-tailed z-test, as appropriate. A one-sided P<0.05 was considered statistically significant.