Digital Strategies for Patients With Chronic Dermatosis With Pruritus / Skin Picking Disorder
Condition: Skin-Picking; Acne; Dermatosis
MeSH terms: Pruritus; Skin Diseases
Study type: Interventional

Summary: 
      Almost 35% of patients treated to dermatosis have some psychiatric disorder. The aim of this
      study is to evaluate the prevalence and severity of skin picking disorder and other
      dermatosis, and also test the efficacy of an online-delivered cognitive-behavioral therapy to
      improve skin picking disorder severity.
    

Detailed description: 
      The interface between dermatology and psychiatry represents a major challenge for the
      management of chronic itchy pathologies. Dermatology requires adherence to chronic treatments
      that must be incorporated as changes in habit. In addition, patients with chronic pruritic
      dermatoses often develop a scratching habit that often leads to the development of
      dermatillomania, requiring psychiatric intervention. In general, among the patients who seek
      the dermatologist, 33% complain of psychiatric symptoms. On the other hand, patients with
      psychiatric conditions have a higher prevalence of dermatoses when compared to the healthy
      population, with anxiety, depression and psychosis being situations that can induce or worsen
      dermatological conditions. Despite the important interface between dermatology and
      psychiatry, there is still a gap in the literature about the best way to diagnose and treat
      these patients affected by psychodermatosis, and also a lack of professionals' knowledge
      about this theme. One study addressed the quality of the treatments currently offered for
      skin picking, also known as dermatillomania, finding that only 53% of patients report having
      received the correct diagnosis of their pathology, and after the treatment offered, 54.7% of
      individuals reported that their clinical condition was unchanged or worse, and only 11% of
      patients reported feeling better with the treatment performed. When asked about the training
      of professionals, 85% of patients reported that the professional did not seem to have
      knowledge about his clinical condition.

      The current world moment, in the face of the Covid-19 pandemic, keeps these patients away
      from possible interventions that could bring relief to the situation, either for fear of
      contamination, difficulties in displacement or even a temporary reduction in vacancies for
      care. The great and just effort of the Health Systems to face the pandemic can, on the other
      hand, impact the offer of assistance to chronic dermatological diseases. Around the world,
      telemedicine and other distance health care protocols have been used in an attempt to assist
      patients. But not all carriers of these chronic diseases are part of health systems. It is
      also known that during the COVID pandemic19, dermatoses frequently associated with
      dermatillomania are still the most common causes of consultations with dermatologists, such
      as acne and eczema. Changes in routine, especially food and physical activity, but also in
      certain habits, such as frequent hand hygiene and the use of astringent substances, such as
      alcohol gel, worsen or trigger inflammatory conditions. Still, the frequent use of masks
      induces the appearance of pruritus, which can increase the severity of already existing
      dermatoses and, also, lead to the misuse of props.

      Thus, the investigators propose the development of an electronic website with educational
      strategies and self-applicable tools for cognitive behavioral therapy to patients with
      dermatoses who have pruritus or symptoms on the skin with the potential to develop or even
      with the diagnosis of skin picking. The website proposed here aims to help patients with
      chronic dermatoses seeking both the prevention and treatment of possible complications. This
      set of Internet pages aims to provide educational material, strategies to increase adherence
      to treatment and interventions with cognitive-behavioral therapy techniques, facilitating
      patients' autonomy in caring for their skin disorders, especially in times as troubled as the
      current one.
    

Intervention name(s): internet-based cognitive-behavioral therapy; Quality of life improving intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Composed of 4 modules: the first module will address psychoeducation on dermatillomania, self-monitoring of symptoms and habit reversal techniques; the second module works with anxiety coping techniques (diaphragmatic breathing and muscle relaxation); module 3 addresses cognitive correction techniques, such as stopping thinking, analyzing evidence, reassigning severity and responsibilities; the last module reviews the techniques learned and addresses techniques for preventing symptom relapse. The modules will be applied by the patient in an online format, each module lasts an average of 30 minutes. The platform will send notice by email through automation tools, SMS or message by application to patients to remind them to complete 1 module per week.; consisting of videos with guidance on quality of life, with a total of 4 videos of 2 minutes, each being made available in 1 week, consisting of: guidance on sleep hygiene; guidance on healthy eating; guidelines on the practice of physical activity and guidelines on the excessive use of social networks.
Other intervention name(s): Active intervention group; Active control group
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: skin picking; cognitive-behavioral therapy; internet-based therapy; psychodermatosis; acne