Introduction to “Conclusions”

Psychiatric disorders are common in dermatology patients. Recent research on psychodermatological disorders has provided a deeper understanding of their pathogenetic mechanisms, in which stress can be an important trigger. Mood and anxiety symptoms, psychosis, and suicidality are often associated with skin conditions, as well as they can precipitate various skin disorders. Current findings in primary and secondary psychiatric disorders suggest that inflammation and immunopathological mechanisms play a critical role in skin disorders. It is well known that the pathogenetic mechanism of depression involves the dysregulation of monoamines. Because depression is often associated with dermatological conditions and in its severe form with suicidality, we suggest that consideration be given to the role of the inflammatory pathway in suicide. Furthermore, because lower levels of estrogen in women have been associated with higher level of depression and suicide, we propose to investigate the role of estrogen in the inflammatory pathway. The very fact that in alopecia areata, topical prostaglandins have been used successfully, suggests that lipid dysregulation in the arachidonic acid pathway may be involved in the alopecia areata pathogenesis. Regarding psoriasis and its association with suicide and various medical comorbidities, we suggest that the inflammatory mechanism they share may shed a different light on the understanding of suicide. Multiple cytokines such as TNFa, IL6, IL12,17, and 23 have been investigated in various models in the pathogenesis of both psoriasis and depression and suicidal ideation. Future research should focus on the potential role of these ILs as potential biomarkers for the early diagnosis of suicidality. While we do not fully understand the relationship between immune mechanisms and monoamines, more comparative research is needed. Despite a major gap in our knowledge about suicide and how to quantify it biologically, further work is necessary to clarify its biological underpinnings and take appropriate steps to minimize it. In doing so, we keep in mind that early intervention is paramount for patients’ safety. We strongly feel that these studies can exert a strong influence on both the fields of dermatology and psychiatry.