Sir,

The psyche and the skin have been associated with each other for a long time. The aim of this study was to investigate the prevalence of skin diseases among the hospitalized patients in the psychiatric ward of a general hospital in Greece during the last five years from March 1919 till March 2024. All patients who required dermatological examination were examined by a consultant dermatologist. Males (61.11%) outnumbered females (38.88%), with male-ot-female of 1.15:1. The most common skin disease in males was interdigital dermatophytosis, seen in 11% of the patients. Disseminated folliculitis, onychomycosis, and prurigo of Hyde were each seen in 9%. Seborrheic dermatitis and nummular eczema were each seen in 7%. Acne, melanocytic nevus, molluscum pendulum, parasitosis delusion syndrome, and herpes simplex were each seen in 5%. Finally, scabies, vitiligo of the penis, dermographism, epidermoid cyst, candida folliculitis, dry skin, spider nevi, psoriasis, varicose veins, angular cheilitis, and photodermatitis induced by olanzapine were each seen in 2% (Table 1).

Table 1: Skin diseases of male and female population.

The two most common skin diseases seen in females were seborrheic dermatitis and eczema seen each in 13% of the patients, followed by onychomycosis seen in 11%. Facial lentigo and seborrheic wart were each seen in 8%. Foot callosities, psoriasis, perioral dermatitis, and warts were seen in 5%. Finally, erysipelas, pathomimes, interdigital dermatophytosis, giant angioma, insect bites, nodular prurigo of Hyde, pthiriasis of the pubic area, pthiriasis of the scalp, pruritus sine materia, and herpes simplex were each seen in 3%. All patients suffered from severe mental disorders such as schizophrenia or bipolar psychosis.

The prevalence of onychomycosis is 2.8% in the general population, and that of interdigital dermatophytosis is 2.9% in Spain; data is not available for the Greek population [1]. The prevalence of seborrheic dermatitis is 2.5% in the general population in the US.; data is not available for the Greek population [2]. The prevalence of psoriasis is 2% in the general population worldwide and that of eczema is 10.2% [3].

The prevalence of skin diseases was presented with frequencies (n) and percentages (%).

The comparison of the prevalence of skin diseases between males and females and between the psychiatric inpatients and the general population was performed using the z-test.

All tests are two-sided. Statistical significance was at p < 0,05. All analyses were performed using the statistical package SPSS, version 21.00 (IBM Corporation, Somers, NY, USA).

There was no statistical difference in the prevalence of skin disorders between men and women hospitalized in the psychiatric ward. Statistical analysis was performed to compare the prevalence of seborrheic dermatitis, interdigital dermatophytosis, onychomycosis, psoriasis, and eczema between hospitalized patients in the psychiatric ward and the general population. Due to the low prevalence of the rest of the skin disorders, no statistical analysis was performed.

The skin diseases presented with the higher prevalence were: interdigital dermatophytosis (11.4%), onychomycosis (9.1%), and prurigo of Hyde (9.1%) for males and seborrheic dermatitis (13.2%), eczema (13.2%), and onychomycosis (10.5%) for females (Table 1).

The psychiatric inpatients presented a higher statistically significant prevalence of interdigital dermatophytosis (p = 0.021), onychomycosis (p < 0.005), and seborrheic dermatitis (p < 0.005) when compared with the prevalence of those diseases in the general population (Table 2).

Table 2: Comparison of skin diseases between the males and females.

The prevalence of seborrheic dermatitis has been found in previous studies to be higher in psychiatric outpatients than in the general population, although the exact cause has not yet been elucidated. [4–5]. This was confirmed in this study on the hospitalized psychiatric patients. The prevalence of interdigital dermatophytosis and onychomycosis was higher in the hospitalized psychiatric patients when compared with the general population. This might be explained by the neglect and/or the lack of adequate personal hygiene associated with the underlying mental disorder in these patients. The prevalence of psoriasis and eczema was not higher in the hospitalized psychiatric patients when compared with those in the general population. The limitation was the small size of the sample. However, one has to bear in mind that the recruitment of patients hospitalized in a psychiatric ward suffering from skin diseases is quite difficult.

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