Abstract
An assessment of suicidal behaviors in the dermatology patient may be necessary in
several situations: (1) in the presence of psychiatric comorbidity (major depressive
disorder, body dysmorphic disorder, substance use disorder, posttraumatic stress disorder),
encountered in up to 30% of dermatology patients; (2) when dermatologic symptoms (“dysmorphophobia,”
dermatitis artefacta) represent psychiatric pathologic conditions; (3) when psychosocial
stressors (bereavement, interpersonal violence) increase the risk of suicidal behavior
and exacerbate stress-reactive dermatoses (psoriasis, acne); (4) in the presence of
high disease burden (chronicity, increased disease severity); (5) in instances of
significant pruritus or chronic sleep disruption; (6) in the presence of facial lesions
or facial scarring; (7) when social exclusion or feelings of alienation arise secondary
to the skin disorder; (8) with use of medications (retinoids, biologics) for which
suicidal behavior has been implicated as a possible side effect; and (9) when treating
psychiatric patients experiencing a serious reaction to psychotropic medications (eg,
Stevens-Johnson syndrome and anticonvulsants). Suicide risk must be assessed within
a demographic context because suicide rates rise rapidly in adolescents and young
adults, among whom the prevalence of skin disorders associated with suicidal behaviors
(acne, psoriasis, atopic dermatitis) is also high, and suicide rates are increasing
among white men, who tend to be overrepresented in dermatology clinical trials.
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