Strong Rapport Critical in Treating Pediatric Psychodermatologic Disorders

trichotillomania girl pulling hair
trichotillomania girl pulling hair
Current data and management strategies for some of the more common skin disorders in the pediatric population are reviewed.

Although managing repetitive psychodermatologic disorders in children and adolescents is challenging, establishing a strong rapport is crucial for successful therapy, according to study findings published in Pediatric Dermatology.

Part I of this review included studies centered on body-focused repetitive disorders. Literature searches were conducted in February 2021 on PubMed and Embase. The articles were selected included information on the diagnosis, clinical presentation, or management of pediatric trichotillomania, body dysmorphic disorder, onychophagia, delusions of parasitosis, skin-picking disorder, or dermatitis artefacta.

Evidence indicates that the best first-line treatment for trichotillomania is habit reversal therapy (HRT) the investigators noted; a randomized controlled trial of youths aged 7 to 17 years indicated a higher response rate among those treated with 2 months of HRT vs without (76% vs 21%). In addition, patients and families may respond negatively to a trichotillomania diagnosis, believing that it is a skin condition rather than a psychiatric disorder. Management for skin-picking disorder may include pharmacotherapy, psychotherapy, behavior management techniques, or HRT; N-acetylcysteine demonstrated efficacy in treating skin-picking disorder in several studies. Treatment for onychophagia includes behavioral modification, identifying the factors leading to nail-biting, pharmacotherapy, and family members providing positive reinforcement of therapeutic progress.

The study researchers concluded, “Management is challenging for providers, parents, and patients; however, establishing a strong rapport is the foundation for a successful therapeutic relationship.” The researchers indicated that “while some treatments, such as psychotherapy, have demonstrated effectiveness in the pediatric population, more research is necessary.”


Mosca M, Martin K, Hadeler E, Hong J, Brownstone N, Koo J. Review of the diagnosis and management of pediatric psychodermatologic conditions: part I. Published online December 20, 2021. Pediatr Dermatol. doi:10.1111/pde.14888