# From Itch to Access: Psychodermatological Care Challenges and the Promise of Telehealth

## TL;DR

This study shows that patients with chronic skin diseases in German-speaking regions face limited access to psychodermatological care and highlights telehealth as a promising solution.

## Contribution

The study identifies telemedicine as a potential solution to improve access to psychodermatological care for patients with chronic inflammatory skin diseases.

## Key findings

- Patients with chronic inflammatory skin diseases often feel underserved by dermatological care alone and report significant psychological distress.
- Telemedicine consultations revealed high distress levels and a preference for online or hybrid treatment options among participants.
- Psychological factors were identified as major contributors to pruritus, suggesting the need for integrated dermatological and psychological care.

## Abstract

Background/Objectives: Pruritus is a prominent symptom of chronic inflammatory skin diseases and significantly affects quality of life. Psychological stress can exacerbate pruritus and worsen skin conditions, yet psychological aspects are often insufficiently addressed in clinical routine. While psychodermatological treatments are becoming more available in German-speaking countries, they are mostly confined to specialized clinics, limiting access for many patients. This study aims to explore the unmet needs of patients with chronic inflammatory skin diseases in German-speaking regions and assess the potential role of telemedicine in bridging existing psychodermatological care gaps. Methods: Patients with chronic inflammatory skin diseases were invited via the Network of People with Autoimmune Diseases to participate in free video consultations with a licensed psychotherapist. Quantitative data on disease, pruritus, and distress were analyzed alongside qualitative feedback from consultations and surveys. Results: Of 174 individuals who received the newsletter, 124 opened it, and 16 engaged with the scheduling link. Over one month, five patients (mean age 40.4 years, all female) participated in psychodermatological video consultations. All had chronic inflammatory skin diseases and were under dermatological care but felt insufficiently treated by dermatological approaches alone. Barriers to multimodal care included lack of awareness, distance to specialized clinics, and long waiting times. Three participants reported pruritus with an average intensity of 75/100 on a Visual Analog Scale (VAS). Psychological factors were identified as significant contributors to pruritus by all participants. Post-consultation, 4/5 of participants completed a survey, reporting high levels of distress (average 74/100 VAS) and favoring online or hybrid treatment options. Conclusions: Dermatological treatment alone often fails to address psychological aspects in patients with chronic inflammatory skin diseases. These findings emphasize the need for integrated dermatological and psychological treatment, with telemedicine offering a valuable avenue to improve access and foster interdisciplinary collaboration.