Psychodermatology in Switzerland – the launch of a national working group
The field of psychodermatology is gaining global attraction with recent advances, including a novel classification system and several European task forces. Despite this progress, Switzerland has lagged behind—until now. A new Swiss Psychodermatology Group (SPDG) was formed under the patronage of the SGDV to bridge the gap between dermatology and mental health, aiming to enhance patient care, education, and research. This initiative marks a significant step in advancing clinical and scientific expertise and professional networking across the country and beyond.
Recent advances in psychodermatology – novel international classification and European initiatives
The field of psychodermatology has gained significant attention in recent years both in the clinical setting and in scientific research. Psychodermatology represents and explores the complex interplay between mental health and skin conditions, acknowledging that mental disorders, such as anxiety and depression, or distressing psychological factors, can significantly impact dermatological conditions and vice versa. This nuanced understanding enables a more sophisticated approach to treating skin-related diseases. Despite ongoing efforts to promote this field, there remains a lack of a universal nomenclature for psychodermatological disorders between professions. In particular, the recently updated DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revised) [1], and the ICD-11 (International Classification of Diseases, 11th Edition) [2] use different classifications and terminologies of psychodermatological disorders, thereby complicating clinical and scientific communication.
To address this classification issue, the Psychodermatology Task Force of the European Academy of Dermatology and Venereology (EADV) recently proposed a novel international classification of psychodermatological disorders [3]. This classification suggests two main clusters of disorders: (a) Primary skin disorders linked with mental health and (b) primary mental health disorders affecting the skin. Each cluster further distinguishes between disorders associated with visible and non-visible skin lesions (see figure). While acknowledging that not all disorders neatly fit into one category and some overlap exists, the proposed classification provides a valuable and comprehensive framework for healthcare providers working with patients suffering from psychodermatological disorders.
Collaborations among experts in psychodermatology, such as the EADV task force, are essential for improving clinical treatments and advancing scientific research. To meet this need, national multidisciplinary clinical services, special interest groups and working groups, dedicated to psychodermatology have been established in several European countries, including Germany, Austria, the UK, and France [4]. However, Switzerland still lacked specific and coordinated initiatives in psychodermatology.
Initiative to establish a Swiss working group in psychodermatology
To address the lack of a nationally organized structure of psychodermatological care in Switzerland, a pioneering meeting of health care professionals took place in Zurich in March of 2024 under the patronage of the Swiss Society of Dermatology and Venereology (SGDV). This meeting was initiated and organized by the authors MZ and JR, who are both affiliated with the Centre of Psychosomatics at the Sanatorium Kilchberg in Zurich. During this meeting, there was unanimous agreement on the need to establish a national working group dedicated to psychodermatology. To represent the interests and expertise of both professions, dermatology and mental health, a dual chairmanship was decided upon, consisting of two dermatologists (Chairman: SB, Vice-Chairman: OD) and two mental health specialists (Chairwoman MZ, Vice-Chairwoman: JR). The SGDV thereafter endorsed the formation of this national working group, called the Swiss Psychodermatology Group (SPDG).
At this first meeting, participants were surveyed with a self-developed questionnaire addressing their professional expertise and expectations regarding this new working group. Furthermore, the authors reached out to known professionals in dermatology and mental health who had expressed interest in participating in such an initiative but were unable to attend the first meeting in Zurich. Out of 37 professionals contacted, we received feedback from 21 (mean age 43+11.37 years, 57.1% males), resulting in a response rate of 56.8%. Among the respondents, 66.7% were dermatologists, 14.3% psychiatrists/psychosomaticians, 14.2% psychologists, and one was a medical student. While 66.7% worked in hospitals (hospital type: A: 78.6%, B: 14.3%, C: 7.1%), 28.5% worked in private practice; 50.0% of the respondents reported working with a psychodermatological focus «daily» or «often».
Where to go from here – future perspectives for psychodermatology in Switzerland
The establishment of the SPDG as a new psychodermatology working group in Switzerland marks a significant first step in raising national awareness for this field and fostering cooperation and expertise among professionals. Feedback of the consulted professionals revealed various expectations for the future role of such a group (see table):
(1) The foremost amongst these expectations was the desire for enhanced networking and collaboration opportunities in managing complex psychodermatological disorders. Most dermatologists in outpatient settings lack straightforward access to mental health specialists trained in psychodermatology and vice versa.
The SPDG could address this unmet need for swift professional exchange on diagnoses and treatment options by providing a platform for mailing lists and offering a forum for sharing news and recent developments in the field. Moreover, regular group meetings might provide the opportunity to exchange experiences and recommendations on treatment approaches.
(2)The respondents’ second most important expectation concerning the SPDG was the advancement of education in psychodermatology for healthcare professionals. Currently, the topic of psychodermatology is only marginally covered, if mentioned at all, in medical, psychology, and psychotherapy curricula in Switzerland, underscoring the critical need to educate young professionals in this field. National symposia and workshops at prominent national conferences, such as the annual congress of the SGDV and the Swiss Society for Psychiatry and Psychotherapy (SGPP) offer ideal venues to educate clinicians and gain members for the new working group. While Switzerland is yet to establish national training programs, comprehensive international initiatives already provide valuable training opportunities. For example, the European Society for Dermatology and Psychiatry (ESDaP) offers a post-graduate education program (modules 1-4) to obtain the Psychodermatology Diploma. This program equips healthcare professionals with the knowledge and skills to diagnose, treat, and manage psychodermatological disorders effectively. Through interdisciplinary training, it fosters a deep understanding of how psychological factors influence dermatological conditions and vice versa.
(3) The education of future psychodermatologists and the national dissemination of knowledge by the SPDG will significantly improve patient care. Regular online boards to discuss complex cases will further improve treatment outcomes by fostering knowledge exchange and providing opportunity for second opinion assessments. In addition, the SPDG could give treatment recommendations and propose standardized screening procedures for the clinical practice.
(4) To contribute to basic and applied scientific research, the SPDG also aims to secure funding for initiatives like establishing a national psychodermatology register and to collaborate on national and international research projects.
(5) Lastly, raising awareness about psychodermatology across Switzerland among healthcare professionals as well as the general public requires engaging diverse media platforms, including web-based information channels including social media, print media, television and radio.
Conclusion
An interdisciplinary network of dedicated dermatologists, psychiatrists, psychosomaticians, and psychologists has formed the SPDG, a new psychodermatology working group, thereby addressing a long-overdue need in Switzerland. This group aims to advance clinical and scientific expertise, as well as to facilitate networking and the exchange of knowledge about psychodermatology, both nationally and internationally.
Authors
Dr. phil. Eva Loos1,2, Dr. med. Marie Christine Zipser3, Dipl. med. Oliver Das4, Dr. med. Chrysovalandis Schwale2, Prof. Dr. med. Rainer Schaefert2, Julia Rümmelein, M.Sc.5, Dr. med. Siegfried Borelli6, PD Dr. med. Simon Mueller1
1 Department of Dermatology, University Hospital Basel, Switzerland
2 Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
3 Sanatorium Kilchberg AG, Centre of Psychosomatics, Zürich, Switzerland
5 Medbase Zürich-Oerlikon, Switzerland
5 Clienia Schlössli AG Private Hospital for Psychiatry and Psychotherapy, Oetwil am See, Switzerland
6 Triemli City Hospital, Zürich, Switzerland
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. American Psychiatric Association; 2022.
World Health Organization. International statistical classification of diseases and related health problems. 11th ed. World HealthOrganization; 2019.
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Misery, L., Schut, C., Balieva, F., Bobko, S., Reich, A., Sampogna, F., ... & Bewley, A. (2023). White paper on psychodermatology in Europe: A position paper from the EADV Psychodermatology Task Force and the European Society for Dermatology and Psychiatry (ESDaP). Journal of the European Academy of Dermatology and Venereology, 37(12), 2419-2427. https://doi.org/10.1111/jdv.19427