Review Article
Dermatology
DOI: 10.1159/000508868
A Review of Skin Disease in
Schizophrenia
Meghan L. McPhie a Alanna C. Bridgman a Mark G. Kirchhof b
a School
of Medicine, Queen’s University, Kingston, ON, Canada; b Division of Dermatology,
Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
Keywords
Dermatologic disease · Skin disease · Schizophrenia
Abstract
Background: Schizophrenia is a debilitating neuropsychiat-
ric condition that affects 0.5% of the North American popula-
tion. Skin disease in schizophrenia has not been well de-
scribed. Identifying skin diseases that are commonly comor-
bid with schizophrenia may help clinicians address the
burden of skin disease in patients with schizophrenia. Sum-
mary: We conducted a nonsystematic review of the litera-
ture to identify skin diseases that may be associated with
schizophrenia. We searched MEDLINE, EMBASE, and PsycIN-
FO for articles published in English from December 2000
through April 2020 using the key words “skin disease” or
“dermatological” or “dermatology” and “schizophrenia.”
Based on our results, we further refined the search terms to
include more specific skin diseases. Schizophrenia appears
to be associated with a number of skin diseases, including
inflammatory dermatoses, autoimmune diseases, and cer-
tain genodermatoses. Limitations include being a nonsys-
tematic review and the relative paucity of more rigorous clin-
ical research using longitudinal study designs.
© 2020 S. Karger AG, Basel
karger@karger.com © 2020 S. Karger AG, Basel
www.karger.com/drm
Received: March 30, 2020
Accepted: May 22, 2020
Published online: August 6, 2020
Introduction
Schizophrenia is a debilitating neuropsychiatric dis-
ease characterized by hallucinations, delusions, and nega-
tive symptoms such as flat affect and anhedonia, with a
global point prevalence of 0.28% [1]. The diathesis-stress
model suggests that schizophrenia may develop due to
stress exposure on top of a pre-existing vulnerability [2].
Stress increases the risk of psychotic episodes in patients
with schizophrenia [3] and also increases the risk for sys-
temic disease [4]. Many patients with schizophrenia have
at least one chronic medical comorbidity such as meta-
bolic syndrome, diabetes, and cardiovascular disease [5–
7], as well as increased premature mortality relative to the
general population [8, 9].
Skin diseases are the 4th leading cause of disability
worldwide [10] and are associated with poor quality of life
and decreased psychosocial functioning [11, 12] to a sim-
ilar extent as other chronic medical conditions such as
cancer and heart disease [13]. As the relationship between
skin disease and schizophrenia may be under-reported
and under-recognized in the clinical setting, the goal of
this review is to discuss various noninfectious skin dis-
eases that are often seen in schizophrenia to help inform
healthcare practitioners about these important comor-
bidities in their patient population.
Mark G. Kirchhof
Division of Dermatology, Department of Medicine
University of Ottawa, 737 Parkdale Ave., 4th Floor
Ottawa, ON K1Y 1J8 (Canada)
mkirchho @ uottawa.ca
 Methods
We conducted a review of the literature aimed at identifying
published results examining the association between schizophre-
nia and various noninfectious skin diseases. We searched EM-
BASE, MEDLINE, and PsycINFO up until April 12, 2020, using
the following search terms in various combinations: “schizophre-
nia,” “dermatology,” “dermatological,” and “skin disease.” Based
on our results, we further refined the search criteria to include
specific skin diseases to ensure no relevant articles were missed.
The search was limited to human subjects, English language, and
articles published between December 2000 and April 2020. Arti-
cles were selected for review if they assessed the relationship be-
tween schizophrenia and skin disease.
Results
A concise summary of all included studies (including
statistics and confidence intervals when available) can be
found in Table 1.
Psoriasis
Psoriasis is a chronic, immune-mediated, inflamma-
tory skin condition affecting nearly 1% of adults in the
USA [14]. Psoriasis ranges in severity from limited red,
scaly plaques to involvement of almost the entire body
surface.
Psoriasis is one of the most well-recognized and re-
ported inflammatory skin diseases in schizophrenia with
a possible genetic correlation [15–17]. Several large stud-
ies have reported an increased risk of psoriasis in patients
with schizophrenia compared to those without [18–21]
and an increased risk of schizophrenia in patients with
psoriasis compared to the general population [22] and
compared to patients with nonatopic eczema [23]. One
recent meta-analysis and systematic review found an in-
creased risk of developing psoriasis in patients with
schizophrenia compared to age-matched controls [24],
and another found an average prevalence rate of 3.3% for
paranoid schizophrenia in patients with psoriasis; this
number increases to 35% when including other forms of
unspecified psychosis [25]. Cross-sectional studies have
also found increased prevalence ratios [26] and rates [27]
of schizophrenia in patients with psoriasis compared to
controls, though one case-control study of 3,147 patients
with psoriasis compared to controls found a similar prev-
alence of schizophrenia in both groups [28].
Eaton et al. [29] studied 3.57 million births in Den-
mark to assess whether autoimmune diseases are ante-
cedent risk factors for bipolar disorder, schizophrenia,
and nonaffective psychosis. Their data show statistically
2 Dermatology
DOI: 10.1159/000508868
significant positive associations for a familial relationship
between schizophrenia and psoriasis, hypothesized by the
authors to be due to increased medical attention. The au-
thors found that the adjusted relative risk of developing
schizophrenia was 2.0 when diagnoses were made con-
currently, and 1.4 when diagnoses were delayed at least 5
years apart [29]. A 2019 retrospective cohort study failed
to show a relationship between schizophrenia and psoria-
sis but did show a general pattern of more mental health
comorbidities in patients with psoriasis compared to
those without [30]. Finally, there is some weak evidence
suggesting that psychotic and psoriatic symptoms in pa-
tients with both conditions may be temporally correlated,
and that antipsychotic medication may control both types
of symptoms [31].
Atopic Dermatitis
Atopic dermatitis is a chronic, inflammatory skin dis-
ease affecting 5–7% of the US population [32, 33], char-
acterized by pruritic, ill-defined erythematous patches on
the face and body.
Several studies show a positive relationship between
schizophrenia and the presence of atopic dermatitis [23,
34–37], with a possible association between atopic der-
matitis in children and the risk of having a psychotic ex-
perience by the age of 13 years [38]. In the USA, schizo-
phrenia as the primary reason for admission to hospital
was more likely in adult patients with atopic dermatitis
compared to those without [36]. Similarly, Weber et al.
[39] examined the discharge records of over 5 million
people across hospitals in the USA between 1979 and
2003; discharge records with schizophrenia as the prima-
ry diagnosis were more likely to include contact dermati-
tis and other eczema compared to controls. There is also
some evidence that patients with severe atopic dermatitis
may have an even higher prevalence of schizophrenia
compared to controls (patients with nonatopic eczema,
urticaria, and psoriasis) [23], and that patients with
schizophrenia may have a higher prevalence of eczema
[40].
However, there have been several published studies
that have failed to find a robust relationship between
atopic dermatitis and schizophrenia. One recent study
found that hospital contact with any atopic disorder in-
creased the relative risk of schizophrenia, though the in-
creased risk was mainly driven by asthma and was not
significant when evaluating individuals with atopic der-
matitis but no asthma. A similar population-based study
using hospitalized cohorts also failed to show a relation-
ship between atopic dermatitis and schizophrenia [41].
McPhie/Bridgman/Kirchhof
Table 1. Summary of included studies

Author, year Country Study design Patients Key findings1

Psoriasis
Eaton et al. Denmark Case-control 7,704 patients with schizophrenia Adjusted IR of psoriasis in schizophrenia patients: 1.6 (0.4–6.8)
[15], 2006 and their parents; Adjusted IRR of psoriasis in parents of schizophrenia patients: 2.0
matched controls and their parents (1.2–3.2)
Benros et al. Denmark Cohort 39,364 schizophrenia cases and Adjusted IRR of psoriasis in schizophrenia patients: 2.13 (1.84–
[18], 2014 first-degree relatives 2.45) and
within first 5 years of schizophrenia onset: 3.04 (2.48–3.67)
Adjusted IRR of psoriasis ≥5 years after schizophrenia onset: 1.59
(1.29–1.95)
Adjusted IRR of psoriasis if family history of schizophrenia: 0.99
(0.88–1.11)
Yu et al. [19], Taiwan Cohort 4,980 patients with schizophrenia; IRR and adjusted HR of psoriasis in schizophrenia patients: 2.45
2017 19,920 controls (1.93–3.11), 2.35 (1.81–2.98), respectively
Males: 2.36 (1.70–3.29), 2.16 (1.53–3.05), respectively
Females: 2.55 (1.80–3.61), 2.53 (1.81–2.98), respectively
Chen et al. [20], Taiwan Case-control 10,811 schizophrenia inpatients; Adjusted OR of psoriasis in schizophrenia patients: 1.48 (1.07–
2012 108,110 controls 2.04)
Males: 1.60 (1.08–2.36)
Females: 1.26 (0.70–2.26)
Benros et al. Denmark Cohort 339,076 patients with schizophrenia Adjusted IRR of schizophrenia in psoriasis patients based on
[21], 2011 spectrum disorders history of:
No severe infection: 1.37 (1.01–1.80)
Severe infection: 2.77 (2.07–3.63)
Leisner et al. Denmark Cohort 13,675 patients with psoriasis; Incidence of schizophrenia in psoriasis patients per 1,000 person-
[22], 2019 matched general population cohort years:
0.16 (0.10–0.24)
Adjusted HR of schizophrenia in psoriasis patients: 1.64 (1.01–
2.65)
Males: 1.55 (0.81–2.96)
Females: 1.76 (0.85–3.62)
Ahn et al. [23], Korea Cross- 42,641 atopic dermatitis patients; Adjusted OR of schizophrenia in psoriasis patients compared to
2019 sectional 139,486 with nonatopic dermatitis individuals with nonatopic eczema: 1.35 (0.96–1.89)
(nonatopic eczema, urticaria,
psoriasis)
Ungprasert et – Systematic 6 studies with ~ 6.1 million Pooled RR of psoriasis in schizophrenia patients: 1.83 (1.36–2.47)
al. [24], 2018 review and participants
meta-analysis
Ferreira et al. – Systematic 34 studies with >21,000 patients Prevalence of paranoid schizophrenia in psoriasis patients: 3.3%;
[25], 2017 review with the prevalence ranged from 2.3–35% when considering other forms
psoriasis of unspecified psychosis
Tu et al. [26], Taiwan Cross- 10,796 psoriasis patients; Prevalence ratio of schizophrenia among psoriasis patients: 1.77
2017 sectional 767,327 controls (1.48–2.12)
Males: 1.59 (1.24–2.04)
Females: 1.99 (1.54–2.58)
Raikhy et al. India Cross- 1,000 dermatology outpatients Prevalence of schizophrenia in patients with psoriasis was 5.62%
[27], 2017 sectional
Schmitt and Germany Case-control 3,147 psoriasis patients; There was no difference found in the prevalence of schizophrenia
Ford [28], 2010 3,147 matched controls between cases (1.3%) and controls (1.4%), p = 0.0740
Eaton et al. Denmark Cohort 20,317 schizophrenia cases; Adjusted RR of schizophrenia in patients with a family history of
[29], 2010 39,076 nonaffective psychosis cases psoriasis:
1.2 (CI not provided)
Adjusted RR of schizophrenia and psoriasis when diagnoses were
made:
Concurrently: 2.0 (CI not provided)
≥5 years apart: 1.4 (CI not provided)

Schizophrenia and Skin Disease Dermatology 3

DOI: 10.1159/000508868
Table 1 (continued)

Author, year Country Study design Patients Key findings1

Parisi et al. [30], UK Cohort 56,961 patients with psoriasis; Prevalence ratio of schizophrenia among psoriasis patients: 0.94
2019 876,919 controls (0.86–1.03)
Miyaoka et al. Case report 3 cases Co-occurrence of psoriasis and schizophrenia in 3 individuals
[31], 2000
Atopic dermatitis (AD)
Ahn et al. [23], Korea Cross- 42,641 patients with AD; Adjusted OR of schizophrenia in psoriasis patients compared to
2019 sectional 139,486 with nonatopic dermatitis individuals with nonatopic eczema: 1.02 (0.82–1.26)
(nonatopic eczema, urticaria, Adjusted OR of schizophrenia in AD patients compared to non-
psoriasis) atopic
dermatitis group:
Overall: 1.08 (0.88–1.31)
Severe: 3.26 (2.40–4.43)
Schmitt et al. Germany Case-control 3,769 patients with AD; Adjusted OR of schizophrenic disorders in AD: 2.12 (1.22–3.71)
[34], 2009 3,769 controls
Wu et al. [35], Taiwan Cross- 377 patients with schizophrenia 46.9% of patients with schizophrenia had some form of dermatitis
2014 sectional spectrum disorders
Hsu et al. [36], USA Cass-control 835 patients with AD; Adjusted OR of hospitalization for schizophrenia among adults
2019 2,434,703 controls with AD:
1.76 (1.45–2.14)
Larsen et al. Norway Cross- 41 patients with a psychotic Correlation between eczema and psychotic disorders: r = –0.116, p
[37], 2018 sectional disorder; = 0.037
157 patients with an affective Frequency of eczema was 17.1 and 6.3% among those with
disorder psychotic and
affective disorders, respectively
Khandaker et UK Cohort 6,784 patients with AD compared to Adjusted OR for psychotic experiences at age 13 in children with
al. [38], 2014 controls AD:
1.33 (1.04–1.69)
Weber et al. USA Cross- 16,279 schizophrenia cases; Proportional morbidity ratio of dermatitis (contact and other
[39], 2009 sectional 1,936,876 with other primary eczema) in
diagnoses patients with schizophrenia: 2.9 (2.5–3.5)
George et al. India Cross- 210 psychiatric patients with skin Prevalence of eczema was 20.4% among patients with
[40], 2018 sectional disease schizophrenia
Chen et al. [41], Taiwan Cohort 44,187 schizophrenia patients; Adjusted OR of AD in schizophrenia patients: 0.92 (0.84–1.02)
2009 132,561 controls
Hidradenitis suppurativa (HS)
Patel et al. [44], USA Cross- 87,053,155 hospitalizations; Adjusted OR of schizophrenia in HS patients: 1.14 (1.26–2.59),
2018 sectional 24,666 admissions for HS compared with alopecia areata: 0.72 (0.47–1.11)
Adjusted OR of primary admission for schizophrenia among HS
patients:
1.03 (0.85–1.25), compared with alopecia areata: 2.19 (1.12–4.21)
Huilaja et al. Finland Case-control 4,381 HS patients; 39,554 psoriasis Schizophrenia/schizotypal disorder was more frequent in the HS
[45], 2018 patients; 43,248 with melanocytic group
nevi compared with the psoriasis group: 2.4 vs. 1.5%, OR 1.57 (1.24–
1.98)
Tzur Bitan et al. Israel Cohort 4,191 HS patients; Adjusted OR of schizophrenia in HS patients: 1.44 (1.10–2.07)
[46], 2020 20,941 controls
Shavit et al. Israel Cross- 3,207 HS patients; OR of schizophrenia among HS patients: 1.3 (0.9–1.9)
[48], 2015 sectional 6,412 controls
Acne vulgaris
Wu et al. [35], Taiwan Cross- 377 patients with schizophrenia Acne vulgaris was observed in 4.5% of patients with schizophrenia
2014 sectional spectrum disorders

4 Dermatology McPhie/Bridgman/Kirchhof
DOI: 10.1159/000508868
Table 1 (continued)

Author, year Country Study design Patients Key findings1

Singam et al. USA Case-control 7,766 hospitalizations with a Adjusted OR of primary admission for schizophrenia in acne
[51], 2019 diagnosis patients: 8.40 (7.65–9.23)
of acne; 1,175 with rosacea; controls
Raikhy et al. India Cross- 1,000 dermatology outpatients Prevalence of schizophrenia in patients with acne: 3.09%
[27], 2017 sectional
George et al. India Cross- 210 psychiatric patients with skin Prevalence of acne was 5.6% in patients with schizophrenia
[40], 2018 sectional disease
Rosacea
Wu et al. [35], Taiwan Cross- 377 patients with schizophrenia Rosacea was observed in 1.5% of patients with schizophrenia
2014 sectional spectrum disorders
Singam et al. USA Case-control 7,766 hospitalizations with a Adjusted OR of primary admission for schizophrenia in rosacea
[51], 2019 diagnosis patients:
of acne; 1.35 (1.14–1.61)
1,175 with rosacea; controls
Spoendlin et al. UK Case-control 53,927 rosacea patients; Adjusted OR of rosacea in schizophrenia patients: 0.71 (0.60–0.91)
[52], 2013 matched controls
Bullous pemphigoid (BP)2
Försti et al. Finland Cohort 4,524 BP patients; Adjusted OR of BP in schizophrenia patients: 2.65 (1.95–3.51)
[55], 2016 66,138 patients with basocellular Adjusted HR of schizophrenia in BP patients: 1.36 (0.55–3.37)
carcinoma
Chen et al. [56], Taiwan Case-control 3,485 BP patients; Adjusted OR of schizophrenia in BP patients: 2.56 (1.52–4.30)
2011 17,425 matched controls Males: 1.06 (0.40–2.79)
Females: 4.40 (2.28–8.49)
Eaton et al. Denmark Case-control 7,704 schizophrenia patients and Adjusted IR of pemphigoid in schizophrenia patients: 1.9 (0.3–
[15], 2006 their parents; 14.7)
matched controls and their parents Adjusted IRR of pemphigoid in parents of schizophrenia patients:
2.3 (0.8–8.2)
Eaton et al. Denmark Cohort 20,317 schizophrenia cases; Adjusted RR of schizophrenia in individuals with a family history
[29], 2010 39,076 nonaffective psychosis cases of
pemphigoid: 1.7 (CI not provided)
Benros et al. Denmark Cohort 39,364 schizophrenia cases and Adjusted IRR of pemphigoid according to family history of
[18], 2014 first-degree relatives schizophrenia:
1.41 (0.50–3.10)
Ren et al. [57], USA Case-control 72,108,077 hospital discharges Adjusted OR of schizophrenia in BP patients: 0.22 (0.07–0.74)
2017 (13,342
with a BP diagnosis); controls
Sim et al. [58], Singapore Case-control 105 BP cases; OR of schizophrenia in BP patients: 4.47 (0.37–51.24)
2017 315 controls
Pemphigus
Kridin et al. Israel Case-control 1,985 pemphigus patients; Prevalence of schizophrenia higher in pemphigus group (2.0 vs.
[59], 2019 9,874 matched controls 1.3%, p = 0.019)
OR of schizophrenia in pemphigus patients: 1.54 (1.07–2.21)
Benros et al. Denmark Cohort 39,364 schizophrenia cases and Adjusted IRR of pemphigus according to family history of
[18], 2014 first-degree relatives schizophrenia:
1.60 (0.68–3.17)
Eaton et al. Denmark Cohort 20,317 schizophrenia cases; Adjusted RR of schizophrenia among individuals with a family
[29], 2010 39,076 nonaffective psychosis cases history of pemphigus: 2.2 (CI not provided)
Alopecia areata (AA)
Singam et al. USA Case-control 87,053,155 hospitalizations; Adjusted OR of schizophrenia in AA patients: 2.06 (1.36–3.14)
[61], 2019 5,605 admissions for AA; Adjusted OR of primary hospitalization for schizophrenia in AA
controls patients:
2.43 (1.33–4.44)

Schizophrenia and Skin Disease Dermatology 5

DOI: 10.1159/000508868
Table 1 (continued)

Author, year Country Study design Patients Key findings1

Eaton et al. Denmark Case-control 7,704 schizophrenia patients and Adjusted IR of AA in schizophrenia patients: 2.5 (1.1–5.8)
[15], 2006 their parents; Adjusted IRR of AA in parents of schizophrenia patients: 1.4 (0.6–
matched controls and their parents 3.0)
Chu et al. [62], Taiwan Case-control 5,177 AA patients; 20,468 matched Prevalence of schizophrenia lower in patients with AA (0.7 vs.
2012 controls 1.1%, p < 0.01)
Adjusted OR of schizophrenia in AA patients: 0.54 (0.37–0.78)
Chen et al. [20], Taiwan Cohort 10,811 schizophrenia inpatients; Adjusted OR of AA in schizophrenia patients: 0.72 (0.29–1.83)
2012 108,110 controls Males: 0.65 (0.15–2.82)
Females: 0.78 (0.24–2.57)
Kim et al. [63], Korea Cohort 7,706 AA patients; Adjusted OR of schizophrenia, schizotypal, and delusional
2020 30,824 matched controls disorders among
AA patients: 0.75 (0.29–1.94)
Benros et al. Denmark Cohort 39,364 schizophrenia cases and Adjusted IRR of AA in schizophrenia patients: 1.05 (0.50–1.90)
[18], 2014 first-degree relatives Adjusted IRR of AA ≥ 5 years after schizophrenia onset: 0.99
(0.35–2.13)
Adjusted IRR of AA according to family history of schizophrenia:
1.08 (0.77–1.46)
Eaton et al. Denmark Cohort 20,317 schizophrenia cases; Adjusted RR of schizophrenia among individuals with a family
[29], 2010 39,076 nonaffective psychosis cases history of AA: 1.6 (CI not provided)
Systemic lupus erythematosus (SLE)
Tiosano et al. Israel Case-control 5,018 SLE patients; Adjusted OR of schizophrenia in SLE patients: 1.33 (1.00–1.74)
[65], 2017 25,090 matched controls Prevalence of schizophrenia increased in SLE patients (1.38 vs.
0.83%, p < 0.001)
Wang et al. Taiwan Cohort 64,817 patients with autoimmune Adjusted HR of schizophrenia in patients with SLE: 3.73 (2.07–
[66], 2018 disease; 64,817 matched controls 6.72)
Benros et al. Denmark Cohort 339,076 patients with schizophrenia Adjusted IRR of schizophrenia in SLE patients based on history of:
[21], 2011 spectrum disorders No severe infection: 1.84 (0.92–3.23)
Severe infection: 2.11 (1.06–3.70)
Mack et al. [67], Case report 1 case Relapsing remitting schizophrenia and comorbid SLE
2017
Funauchi et al. Case report 1 case SLE developed after a 14-year history of schizophrenia
[68], 2002
Cremaschi et al. Sweden Case-control 5,278 schizophrenia patients; Adjusted OR of SLE in controls vs. schizophrenia patients: 1.7
[69], 2017 3,798 bipolar patients; (1.2–2.5)
6,485 controls Adjusted OR of SLE in schizophrenia patients vs. bipolar patients:
3.5 (1.6–7.4)
Chen et al. [20], Taiwan Cohort 10,811 schizophrenia inpatients; Adjusted OR of SLE in schizophrenia patients: 1.22 (0.66–2.27)
2012 108,110 controls Males: 2.78 (0.76–10.12)
Females: 1.02 (0.50–2.07)
Benros et al. Denmark Cohort 39,364 schizophrenia cases and Adjusted IRR of SLE in schizophrenia patients: 1.57 (0.96–2.39)
[18], 2014 first-degree relatives Adjusted IRR of SLE within the first 5 years of schizophrenia onset:
1.41 (0.61–2.74)
Adjusted IRR of SLE ≥5 years after schizophrenia onset: 1.67
(0.89–2.28)
Adjusted IRR of SLE according to family history of schizophrenia:
1.47 (1.13–1.88)
Eaton et al. Denmark Cohort 20,317 schizophrenia cases; Adjusted RR of schizophrenia according to family history of SLE:
[29], 2010 39,076 nonaffective psychosis cases 1.0 (CI not provided)
Eaton et al. Denmark Case-control 7,704 schizophrenia patients and Adjusted IRR of SLE in parents of schizophrenia patients: 1.1 (0.5–
[15], 2006 their parents; 2.5)
matched controls and their parents

6 Dermatology McPhie/Bridgman/Kirchhof
DOI: 10.1159/000508868
Table 1 (continued)

Author, year Country Study design Patients Key findings1

Vitiligo
Patel et al. [71], USA Case-control 11,573 hospitalizations for vitiligo Adjusted OR of hospitalizations for schizophrenia and other
2019 compared to controls psychotic disorders in vitiligo patients: 1.36 (1.15–1.61)
Raikhy et al. India Cross- 1,000 dermatology outpatients Prevalence of schizophrenia in patients with vitiligo was 3.77%
[27], 2017 sectional
George et al. India Cross- 210 psychiatric patients with skin Prevalence of pigmentary disorders was 16.7% in patients with
[40], 2018 sectional disease schizophrenia
Benros et al. Denmark Cohort 39,364 schizophrenia cases and Adjusted IRR of vitiligo according to family history of
[18], 2014 first-degree relatives schizophrenia:
1.29 (0.91–1.78)
Dermatomyositis
Wang et al. Taiwan Cohort 64,817 patients with autoimmune Adjusted HR of schizophrenia in dermatomyositis patients: 5.85
[66], 2018 disease; (1.32–25.94)
64,817 matched controls
Chen et al. [20], Taiwan Cohort 10,811 schizophrenia inpatients; Adjusted OR of dermatomyositis in schizophrenia patients: 2.55
2012 108,110 controls (0.88–7.39)
Males: 5.11 (1.25–20.93)
Females: 0.93 (0.11–7.62)
Eaton et al. Denmark Case-control 7,704 schizophrenia patients and Adjusted IRR of dermatomyositis in parents of schizophrenia
[15], 2006 their parents; patients:
matched controls and their parents 3.1 (1.4–6.3)
Scleroderma
Benros et al. Denmark Cohort 39,364 schizophrenia cases and Adjusted IRR of scleroderma according to family history of
[18], 2014 first-degree relatives schizophrenia:
1.10 (0.69–1.66)
Eaton et al. Denmark Cohort 20,317 schizophrenia cases; Adjusted RR of schizophrenia according to family history of
[29], 2010 39,076 nonaffective psychosis cases scleroderma:
0.6 (CI not provided)
Shibley et al. Case report 1 case Patient with paranoid schizophrenia and comorbid scleroderma
[78], 2008
Urticaria
Ahn et al. [23], Korea Cross- 42,641 patients with atopic OR of schizophrenia in individuals with urticaria compared to
2019 sectional dermatitis; 139,486 with nonatopic individuals with nonatopic eczema: 0.83 (0.69–1.00)
dermatitis
(nonatopic eczema, urticaria,
psoriasis)
Raikhy et al. India Cross- 1,000 dermatology outpatients Prevalence of schizophrenia in patients with urticaria was 2.56%
[27], 2017 sectional
George et al. India Cross- 210 psychiatric patients with skin Prevalence of pruritic disorders was 3.7% among patients with
[40], 2018 sectional disease schizophrenia
Darier disease
Cederlöf et al. Sweden Cohort 770 patients with Darier disease; RR of schizophrenia in patients with Darier disease vs. controls:
[74], 2015 3,228 first-degree relatives; 2.3 (1.1–5.2)
100 unaffected controls RR of schizophrenia in relatives of Darier disease patients vs.
controls:
0.8 (0.4–1.8)
Dodiuk-Gad et Israel Cross- Cohort of 32 families: 28% of patients with Darier disease had a definite psychiatric
al. [76], 2016 sectional 74 individuals with Darier disease; diagnosis, most of them mood disorders and 1 patient with a
13 unaffected family members diagnosis of psychotic disorder
Gordon-Smith UK Cross- 309 patients with Darier disease Combined data: likely gene disruptive mutations higher in Darier
et al. [77], 2018 sectional disease cases with bipolar disorder, schizophrenia, or affective
psychosis compared to those without a reported history: 68 vs.
40.5%, p < = 0.011, OR 3.15 (1.25–7.91)

Schizophrenia and Skin Disease Dermatology 7

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Table 1 (continued)

Author, year Country Study design Patients Key findings1

Tang et al. [75], Case report 2 cases Association between schizophrenia and Darier disease
2010
Other
Wu et al. [79], Taiwan Cross- 26 patients (21 familial and 5 2 unrelated familial cases with chronic schizophrenia (both had
2010 sectional sporadic non-sense mutation (R783X), but another case with the same
cases) – Hailey-Hailey disease mutation did not have an underlying mental health disorder
Malik et al. Case report 1 case – X-linked ichthyosis X-linked ichthyosis with comorbid psychosis (early-onset
[80], 2017 schizophrenia)
Mahiques et al. Case report 1 case – dyskeratosis Schizophrenia diagnosed as a teen and comorbid dyskeratosis
[81], 2006
Raznahan et al. UK Case series 60 patients with tuberous sclerosis 40.0% of patients with tuberous sclerosis had a history of mental
[82], 2006 illness, but only 1.7% of the sample had a diagnosis of
schizophrenia
AlZamil et al. Case report 1 case – tuberous sclerosis Comorbid schizophrenia and tuberous sclerosis
[83], 2018
Kam et al. [84], Case report 1 case – Peutz-Jeghers syndrome Comorbid Peutz-Jeghers syndrome and schizophrenia, potential
2006 role of
chromosome 19P13

The studies are organized by type of skin disease. Some studies examined multiple skin diseases and are therefore listed more than once. Numbers in
boldface denote significance. RR, relative risk; IRR, incidence relative ratio; IR, incidence rate; OR, odds ratio; HR, hazard ratio; NOS, not otherwise speci-
fied; CI, confidence interval; AD, atopic dermatitis; HS, hidradenitis suppurativa; BP, bullous pemphigoid; AA, alopecia areata; SLE, systemic lupus erythe-
matosus. 1 95% CI presented in parentheses within the table. 2 Includes both bullous pemphigoid and pemphigoid.

However, both of the abovementioned studies are limited
by the fact that atopic dermatitis is not life threatening
and rarely entails hospital contact; therefore, patients
who have atopic dermatitis preceding schizophrenia or
comorbid with schizophrenia may be under-represented
in these studies.
Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) affects up to 4% of the
global population [42]. HS is a chronic, inflammatory
skin condition characterized by painful nodules, abscess-
es, and sinus tracts which primarily affect the intertrigi-
nous areas [43].
In general, mental health disorders appear to be more
common among inpatients with HS compared to inpa-
tients without [44, 45]. A cross-sectional analysis of the
National Inpatient Sample in the USA from 2002 to 2012
showed that HS was associated with schizophrenia in ad-
dition to other mental health issues [44], and a retrospec-
tive cohort study published in 2020 reported a 10-fold
increase in the prevalence of schizophrenia in patients
with HS compared to controls [46]. A large nationwide
retrospective study using the Finnish Care Register for
Health Care [45] also found that HS was significantly as-
sociated with schizophrenia with a prevalence of 2.4%
compared to 1.5% in psoriasis and 0.7% in the control
population. This study is strengthened by its large sample
of dermatologist-diagnosed HS patients and reliability of
the Finnish hospital register data [47]. However, in a
cross-sectional study of 3,207 patients diagnosed with
HS, the association between HS and schizophrenia was
trending to significance; HS was more strongly associated
with depression and anxiety [48]. The prevalence of
schizophrenia in this HS sample was 1.5%; due to the low
prevalence of schizophrenia in the general population, it
is possible that this sample was not powerful enough to
detect any meaningful associations between these 2 dis-
eases.
Acne Vulgaris and Rosacea
Acne vulgaris and rosacea are 2 very common inflam-
matory skin diseases of the pilosebaceous unit, with a
general population prevalence of 4.3% [49] and 5.46%
[50], respectively. In a large cohort study using the 2002–
2012 US National Inpatient Sample, primary admission
to hospital for schizophrenia was associated with acne
vulgaris and to a lesser extent with rosacea [51]. A cross-
sectional study of 1,000 patients in an outpatient Derma-

8 Dermatology McPhie/Bridgman/Kirchhof
DOI: 10.1159/000508868
tology clinic found that the prevalence of schizophrenia
in patients with acne was 3% [27] – 10-fold higher than
the global prevalence of schizophrenia.
Spoendlin et al. [52] found a substantially decreased
risk of rosacea in patients with schizophrenia and did not
find that rosacea was associated with other psychiatric
disorders such as depression and anxiety. In keeping with
these findings, a study of 337 patients with schizophrenia
had a lower prevalence of rosacea at 1.5% compared to the
general population [35]. However, this study found that
the use of atypical antipsychotics may in itself be associ-
ated with pilosebaceous disorders such as acne vulgaris
and rosacea.
Bullous Pemphigoid and Pemphigus
Bullous pemphigoid and pemphigus are 2 uncommon
autoimmune blistering skin conditions, affecting approx-
imately 0.012% [53] and 0.005% [54] of the US popula-
tion, respectively.
To date, a limited number of studies have examined the
association between bullous pemphigoid and comorbid
psychiatric conditions. Försti et al. [55] conducted a robust
nationwide retrospective study utilizing the Finnish Care
Register for Health Care and examined 4,524 patients with
bullous pemphigoid compared with 66,138 patients with
basocellular carcinoma. Among psychiatric diseases, the
corresponding risk of developing bullous pemphigoid was
strongest for individuals with schizophrenia. A large na-
tionwide case-control study using an Asian population
also found a similar elevation of risk for bullous pemphi-
goid among patients with schizophrenia [56].
Conversely, several studies utilizing data from a large
Danish cohort have failed to show a strong association
between the 2 conditions [15, 18, 29]. More specifically, a
family history of pemphigoid was not significantly associ-
ated with schizophrenia [29], and this was also true of the
reverse association studied by Benros et al. [18]. It is im-
portant to note that these studies looked at pemphigoid,
and not bullous pemphigoid specifically.
In a 2016 investigation using the US Nationwide Inpa-
tient Sample database, Ren et al. [57] found that hospital-
ization for bullous pemphigoid was associated with an
increased risk of psychosis and a decreased risk of schizo-
phrenia. The authors hypothesize that the increased prev-
alence of psychosis may be related to corticosteroid use in
this population of patients. Finally, a small retrospective
case-control study using 105 patients with bullous pem-
phigoid and 315 matched controls also failed to find a
significant difference in the prevalence of schizophrenia
between the 2 groups [58].
Schizophrenia and Skin Disease
Only a small number of studies have examined pem-
phigus specifically. One study using the Clalit Health Ser-
vices database found a significant association between
schizophrenia and pemphigus, with a higher prevalence
of schizophrenia in pemphigus patients compared to
controls (2.0 vs. 1.3%) [59]. Further, in a large cohort
study of the Danish population, Eaton et al. [29] found a
positive association for a familial relationship between
pemphigus and the broader category of nonaffective psy-
chosis, but not for schizophrenia specifically. A similar
study failed to find an increased risk of pemphigus among
individuals with a family history of schizophrenia (the
reverse temporality) [18].
Alopecia Areata
Alopecia areata is an autoimmune condition affecting
2.11% of the population [60] that typically manifests as
smooth, circular, well-demarcated areas of hair loss,
which can also progress to total scalp or body hair loss.
In a recent cross-sectional study using a US national
database of hospitalizations, patients with alopecia areata
were found to have higher rates of schizophrenia com-
pared to controls [61]. An earlier study using a Danish
cohort found a higher lifetime prevalence of alopecia
areata among schizophrenic patients [15]. Interestingly,
results from a Taiwanese nationwide study observed a
lower risk of schizophrenia in patients with alopecia area-
ta compared to controls [62].
In contrast to these results, a number of studies have
failed to observe a significant relationship between alope-
cia areata and schizophrenia. Two large studies utilizing
Danish and Taiwanese cohort data found no association
between schizophrenia and alopecia areata [18, 20, 29].
Moreover, in a recent retrospective cohort study by Kim
et al. [63], the risk for developing a psychiatric disorder
was significantly higher for the alopecia areata group than
the control group, though there was no increased risk for
schizophrenia specifically. In Denmark, researchers stud-
ied 39,364 schizophrenic patients and observed no elevat-
ed risk of schizophrenia among individuals with alopecia
areata with a family history of schizophrenia [29]. Simi-
larly, another study considered the reverse temporal fa-
milial association and also found no significant relation-
ship [18].
Systemic Lupus Erythematosus
Systemic Lupus erythematosus (SLE) is an autoim-
mune connective tissue disease that prominently affects
the skin, affecting approximately 0.03% of the US popula-
tion [64].
Dermatology 9
DOI: 10.1159/000508868
 A recent population-based study of 5,018 patients with
SLE and matched controls found a positive association
between SLE and schizophrenia [65]. Similarly, Wang et
al. [66] conducted a prospective population-based
matched cohort study to examine the risk for developing
schizophrenia among 64,817 patients with autoimmune
diseases. Their data show an increased risk for subsequent
schizophrenia in SLE patients. In a nationwide prospec-
tive cohort study, any history of hospitalization for an
infection was found to increase the risk of schizophrenia
among individuals with SLE. There are 2 case reports [67,
68] that provide further evidence, albeit weak, for an as-
sociation between schizophrenia and subsequent comor-
bid SLE.
Conversely, in a large Swedish population-based case-
control study, the control population had higher rates of
self-reported SLE relative to patients with schizophrenia
(1.4 vs. 0.8%) [69]. Findings from 2 large, nationwide
studies using Taiwanese and Danish data similarly failed
to show an association between schizophrenia and SLE
[18, 20]; however, one of the studies did find evidence for
an increased risk of SLE among individuals with a family
history of schizophrenia [18]. Eaton et al. [29] examined
the reverse temporal relationship; however, they also
failed to find a significant relationship between family
history of SLE and increased risk for schizophrenia. In an
earlier study by Eaton et al. [15], rates of SLE were not
elevated among parents of schizophrenic patients.
Vitiligo
Vitiligo is generally considered to be an autoimmune
disorder affecting approximately 0.2% of the population
[70] and is characterized by the development of white
macules and patches on the skin due to the loss or de-
struction of epidermal melanocytes.
So far, only a handful of studies have analyzed the as-
sociation between vitiligo and schizophrenia. Of the lim-
ited data to date, a cross-sectional analysis of the Nation-
al Inpatient Sample in the USA showed that vitiligo was
significantly associated with hospitalization for schizo-
phrenia [71]. In another cross-sectional study of 402 pa-
tients from a dermatology department in Jaipur, 3.77% of
patients with vitiligo were observed to have comorbid
schizophrenia [27]. Similarly, in a recent hospital-based
study, 16% of psychiatric patients with schizophrenia
were found to have a comorbid pigmentary disorder [40].
However, another study observed that a family history of
schizophrenia does not appear to be associated with vit-
iligo [18].
10 Dermatology
DOI: 10.1159/000508868
Darier Disease
Darier disease is rare autosomal dominant disorder that
typically emerges in the second decade of life and is char-
acterized by hyperkeratotic crusted papules in the sebor-
rheic areas, palmoplantar pits, and nail dystrophy [72, 73].
A robust matched cohort study using a sample of Swed-
ish national registers compared a sample of 770 individuals
with Darier disease to a sample of matched individuals
from the general population. Individuals with Darier dis-
ease were found to be at 2.3 times higher risk of being di-
agnosed with schizophrenia compared with matched con-
trols; however, relatives had no excess risk of schizophre-
nia [74]. There is also some weak, anecdotal evidence from
a case report suggesting a possible association between
Darier disease and schizophrenia [75].
Recently, some studies have found support for the the-
ory that mutations in the ATP2A2 gene, which causes
Darier disease, also confer susceptibility to psychiatric ill-
ness in individuals with Darier disease [76, 77]. This sug-
gests that neuropsychiatric symptoms in Darier disease
may not merely be a psychological consequence of having
a skin disease [77].
Other
Dermatomyositis and scleroderma are 2 autoimmune
diseases with cutaneous manifestations; however, data on
their association with schizophrenia is currently quite
limited [15, 18, 20, 29, 66, 78]. There is some evidence for
an increased risk of schizophrenia in dermatomyositis
patients [66], with some studies showing an increased
risk for males [20] or among parents of schizophrenic pa-
tients [15]. On the other hand, cohort data on the familial
association between scleroderma and schizophrenia has
been nonsignificant [18, 29]. Studies are also mixed re-
garding the relationship between schizophrenia and urti-
caria [23, 27, 40]. Evidence for the co-occurrence of
schizophrenia and other genodermatoses, such as Hailey-
Hailey disease [79], ichthyosis [80], dyskeratosis [81], tu-
berous sclerosis [82, 83], and Peutz-Jeghers syndrome
[84], is lacking and primarily limited to anecdotal reports.
Discussion
This review found support for an association between
schizophrenia and a variety of skin diseases. The associa-
tion with schizophrenia was strongest for inflammatory
dermatoses such as psoriasis, HS, and atopic dermatitis.
However, this finding was not consistent across all skin
diseases; weaker associations or contradictory results were
McPhie/Bridgman/Kirchhof
found for acne, rosacea, bullous pemphigoid, pemphigus,
alopecia areata, vitiligo, and Darier disease. While the body
of literature on this topic continues to grow, the exact na-
ture of this association remains to be clarified. Large-scale,
longitudinal study designs using representative samples
with validated diagnoses and comparison groups are need-
ed to draw inferences concerning the temporal nature of
this association and to identify underlying mechanisms.
Further, consideration of family disease comorbidity may
help to elucidate potentially shared etiologic pathways.
The underlying pathophysiology of the association be-
tween schizophrenia and skin disease is currently un-
known. Immunological hypotheses have become increas-
ingly popular in the field of psychiatry and offer one
possible explanation for the relationship between schizo-
phrenia and immune-mediated skin diseases (see Strous
and Shoenfeld [85] for a review of this hypothesis) [86];
studies have found increased concentrations of inflamma-
tory cytokines in the blood and central nervous system of
individuals with schizophrenia [87]. A disruption in the
blood-brain barrier in patients with autoimmune disease
may activate the Th17 pathways in the brain, in turn in-
creasing vulnerability to schizophrenia [26]. Interestingly,
a recent nationwide population-based study from Den-
mark found that a prior autoimmune disease increased the
risk of schizophrenia by 29% [21], further lending support
to the immunological hypothesis as a possible explanation
for the increased prevalence of autoimmune and inflam-
matory skin disease in schizophrenia. However, the low
prevalence of schizophrenia and many autoimmune disor-
ders makes it a challenge to study them empirically, even
when utilizing large national databases. As it currently
stands, more studies with greater methodological rigor are
required to lend credence to this hypothesis. Studies look-
ing more specifically at a shared etiopathogenic mecha-
nism between schizophrenia and various dermatologic
diseases are warranted.
While the role of genetics has been well established in
the etiology of schizophrenia, the mode of inheritance is
rather complex, making it difficult to identify specific
genes that increase susceptibility. It has been suggested that
the ATP2A2 gene may be responsible for the association
between Darier disease and schizophrenia [74], though the
role of mutations in the ATP2A2 gene remains inconclu-
sive and further investigations are required to verify this
hypothesis. Moreover, common genetic variants have also
been suggested among patients with psoriasis and schizo-
phrenia; several variants in the human leukocyte antigen
gene region have been implicated in conferring risk for
both diseases [16]. The aforementioned research supports
Schizophrenia and Skin Disease
that there is some current evidence for a shared genetic ba-
sis between schizophrenia and certain skin diseases.
There is an important feedback loop between skin dis-
ease and stress, whereby stress can lead to skin exacerba-
tions, and skin disease can in turn lead to further stress
[88]. Chronic stress diminishes the HPA axis and upregu-
lates sympathetic-adrenal-medullary responses, stimulat-
ing proinflammatory cytokines [89]; high levels of proin-
flammatory cytokines connect psoriasis, inflammatory
comorbidities of psoriasis (such as atherosclerosis), and
psychiatric conditions [25]. Additionally, acute and chron-
ic stressors such as trauma and poor housing situations,
both of which are common stressors experienced by pa-
tients with schizophrenia [90], may lead to increased risk
and exacerbation of skin disease [12]. As schizophrenia
may be associated with greater levels of psychosocial stress
compared to the general population, there may be higher
levels of stress-induced skin disease in patients with schizo-
phrenia.
The existence of confounding factors may also contrib-
ute to the observed association between schizophrenia and
skin disease. For example, comorbid chronic health condi-
tions are common among individuals with schizophrenia
[35], and studies have shown that schizophrenic patients
with diabetes or obesity are at increased risk for infectious
skin diseases [35, 91]. Medications such as psychopharma-
cological agents may increase susceptibility to skin diseas-
es [35], while systemic corticosteroids may cause neuro-
psychiatric side effects, including psychosis [92]. Lifestyle
and hygiene may also pose as an important confounding
factor for future studies, as patients with schizophrenia are
at increased risk of skin infections [93, 94]. However, non-
specific inflammation is unlikely to be the reason for the
apparent link between schizophrenia and skin disease, as
schizophrenia is well known to be negatively associated
with rheumatoid arthritis, one of the most common
chronic inflammatory conditions [95].
Conclusions
In summary, the association between skin disease and
schizophrenia appears to be strongest for inflammatory
dermatoses such as psoriasis, HS, and atopic dermatitis.
Weaker associations and contradictory results, like those
seen for alopecia areata and rosacea, require further inves-
tigation. More robust studies with larger sample sizes and
adequate methodology are warranted. Clinicians who care
for dermatologic patients and/or patients with schizophre-
nia should be aware of the overlapping comorbidities in
Dermatology 11
DOI: 10.1159/000508868
order to ensure that patients receive appropriate referral
and management. Specifically, dermatologists may play a
key role in limiting the burden of skin disease and improv-
ing quality of life for those living with schizophrenia.
Key Message
Our review found emerging support for an association between
schizophrenia and various skin diseases.
istration/travel – Sanofi-Genzyme (World Congress of Dermatol-
ogy – Milan 2019). No direct conflicts of interest are noted for this
article.
Funding Sources
There are no funding sources to declare. The authors received
no specific grant from any funding agency in the public, commer-
cial, or not-for profit sectors.

Conflict of Interest Statement
M.G.K. has the following disclosures: speaker bureau/honorar-
ia – AbbVie, Janssen, Leo, Novartis, Pfizer, UCB, and Sanofi-Gen-
zyme; consulting fees – AbbVie, Celgene, Eli Lilly, Janssen, Leo,
Novartis, Pfizer, UCB, and Sanofi-Genzyme; and conference reg-
Author Contributions
M.L.M. and A.C.B. are joint first authors and equal contribu-
tors to the work. M.L.M., A.C.B., and M.G.K. all contributed to
drafting and revision of the manuscript and approved the final ver-
sion for submission.

References
  1 Charlson FJ, Ferrari AJ, Santomauro DF, Di-
minic S, Stockings E, Scott JG, et al. Global
Epidemiology and Burden of Schizophrenia:
Findings From the Global Burden of Disease
Study 2016. Schizophr Bull. 2018 Oct; 44(6):
1195–203.
 2 Thompson JL, Pogue-Geile MF, Grace AA.
Developmental pathology, dopamine, and
stress: a model for the age of onset of schizo-
phrenia symptoms. Schizophr Bull. 2004;
30(4):875–900.
  3 Lataster J, Myin-Germeys I, Lieb R, Wittchen
HU, van Os J. Adversity and psychosis: a 10-
year prospective study investigating syner-
gism between early and recent adversity in
psychosis. Acta Psychiatr Scand. 2012 May;
125(5):388–99.
  4 Iwata M, Ota KT, Duman RS. The inflamma-
some: pathways linking psychological stress,
depression, and systemic illnesses. Brain Be-
hav Immun. 2013 Jul;31:105–14.
  5 Mitchell AJ, Vancampfort D, Sweers K, van
Winkel R, Yu W, De Hert M. Prevalence of
metabolic syndrome and metabolic abnor-
malities in schizophrenia and related disor-
ders–a systematic review and meta-analysis.
Schizophr Bull. 2013 Mar;39(2):306–18.
  6 Mitchell AJ, Malone D. Physical health and
schizophrenia. Curr Opin Psychiatry. 2006
Jul;19(4):432–7.
 7 Leucht S, Burkard T, Henderson J, Maj M,
Sartorius N. Physical illness and schizophre-
nia: a review of the literature. Acta Psychiatr
Scand. 2007 Nov;116(5):317–33.
  8 Saha S, Chant D, McGrath J. A systematic re-
view of mortality in schizophrenia: is the dif-
ferential mortality gap worsening over time?
Arch Gen Psychiatry. 2007 Oct;64(10):1123–
31.
 9 Capasso RM, Lineberry TW, Bostwick JM,
Decker PA, St Sauver J. Mortality in schizo-
phrenia and schizoaffective disorder: an Olm-
sted County, Minnesota cohort: 1950-2005.
Schizophr Res. 2008 Jan;98(1-3):287–94.
10 Karimkhani C, Dellavalle RP, Coffeng LE,
Flohr C, Hay RJ, Langan SM, et al. Global Skin
Disease Morbidity and Mortality: An Update
From the Global Burden of Disease Study
2013. JAMA Dermatol. 2017 May; 153(5):
406–12.
11 Bridgman AC, Block JK, Drucker AM. The
multidimensional burden of atopic dermati-
tis: an update. Ann Allergy Asthma Immunol.
2018 Jun;120(6):603–6.
12 Foggin E, Cuddy L, Young H. Psychosocial
morbidity in skin disease. Br J Hosp Med
(Lond). 2017 Jun;78(6):C82–6.
13 Ahmed A, Leon A, Butler DC, Reichenberg J.
Quality-of-life effects of common dermato-
logical diseases. Semin Cutan Med Surg. 2013
Jun;32(2):101–9.
14 Parisi R, Symmons DP, Griffiths CE, Ashcroft
DM; Identification and Management of Pso-
riasis and Associated ComorbidiTy (IM-
PACT) project team. Global epidemiology of
psoriasis: a systematic review of incidence and
prevalence. J Invest Dermatol. 2013 Feb;
133(2):377–85.
15 Eaton WW, Byrne M, Ewald H, Mors O, Chen
CY, Agerbo E, et al. Association of schizo-
phrenia and autoimmune diseases: linkage of
Danish national registers. Am J Psychiatry.
2006 Mar;163(3):521–8.
16 Yin X, Wineinger NE, Wang K, Yue W, Nor-
gren N, Wang L, et al. Common susceptibility
variants are shared between schizophrenia
and psoriasis in the Han Chinese population.
J Psychiatry Neurosci. 2016 Oct; 41(6): 413–
21.
17 Pouget JG, Han B, Wu Y, Mignot E, Ollila
HM, Barker J, et al.; Schizophrenia Working
Group of the Psychiatric Genomics Consor-
tium. Cross-disorder analysis of schizophre-
nia and 19 immune-mediated diseases identi-
fies shared genetic risk. Hum Mol Genet. 2019
Oct;28(20):3498–513.
18 Benros ME, Pedersen MG, Rasmussen H, Ea-
ton WW, Nordentoft M, Mortensen PB. A na-
tionwide study on the risk of autoimmune
diseases in individuals with a personal or a
family history of schizophrenia and related
psychosis. Am J Psychiatry. 2014 Feb; 171(2):
218–26.
19 Yu S, Yu CL, Huang YC, Tu HP, Lan CE. Risk
of developing psoriasis in patients with
schizophrenia: a nationwide retrospective co-
hort study. J Eur Acad Dermatol Venereol.
2017 Sep;31(9):1497–504.
20 Chen SJ, Chao YL, Chen CY, Chang CM, Wu
EC, Wu CS, et al. Prevalence of autoimmune
diseases in in-patients with schizophrenia:
nationwide population-based study. Br J Psy-
chiatry. 2012 May;200(5):374–80.
21 Benros ME, Nielsen PR, Nordentoft M, Eaton
WW, Dalton SO, Mortensen PB. Autoim-
mune diseases and severe infections as risk
factors for schizophrenia: a 30-year popula-
tion-based register study. Am J Psychiatry.
2011 Dec;168(12):1303–10.
22 Leisner MZ, Riis JL, Schwartz S, Iversen L,
Østergaard SD, Olsen MS. Psoriasis and Risk
of Mental Disorders in Denmark. JAMA Der-
matol. 2019 Jun;155(6):745–7.
23 Ahn HJ, Shin MK, Seo JK, Jeong SJ, Cho AR,
Choi SH, et al. Cross-sectional study of psy-
chiatric comorbidities in patients with atopic
dermatitis and nonatopic eczema, urticaria,
and psoriasis. Neuropsychiatr Dis Treat. 2019
May;15:1469–78.

12 Dermatology McPhie/Bridgman/Kirchhof
DOI: 10.1159/000508868
24 Ungprasert P, Wijarnpreecha K, Cheungpas-
itporn W. Patients with schizophrenia have a
higher risk of psoriasis: A systematic review
and meta-analysis. Psychiatry Res. 2018 Jan;
259:422–6.
25 Ferreira BR, Pio-Abreu JL, Reis JP, Figueiredo
A. Analysis of the Prevalence of Mental Dis-
orders in Psoriasis: The Relevance of Psychi-
atric Assessment in Dermatology. Psychiatr
Danub. 2017 Dec;29(4):401–6.
26 Tu H, Yu C, Lan C, Yu S. Prevalence of schizo-
phrenia in patients with psoriasis: a nation-
wide study. Dermatologica Sin. 2017; 35(1):
1–6.
27 Raikhy S, Gautam S, Kanodia S. Pattern and
prevalence of psychiatric disorders among
patients attending dermatology OPD. Asian J
Psychiatr. 2017 Oct;29:85–8.
28 Schmitt J, Ford DE. Psoriasis is independent-
ly associated with psychiatric morbidity and
adverse cardiovascular risk factors, but not
with cardiovascular events in a population-
based sample. J Eur Acad Dermatol Venereol.
2010 Aug;24(8):885–92.
29 Eaton WW, Pedersen MG, Nielsen PR,
Mortensen PB. Autoimmune diseases, bipo-
lar disorder, and non-affective psychosis. Bi-
polar Disord. 2010 Sep;12(6):638–46.
30 Parisi R, Webb RT, Kleyn CE, Carr MJ, Kapur
N, Griffiths CE, et al. Psychiatric morbidity
and suicidal behaviour in psoriasis: a primary
care cohort study. Br J Dermatol. 2019 Jan;
180(1):108–15.
31 Miyaoka T, Seno H, Inagaki T, Ishino H, Ueda
D, Ohno T, et al. Schizophrenia associated
with psoriasis vulgaris: three case reports.
Schizophr Res. 2000 Jan;41(2):383–6.
32 Silverberg JI, Garg NK, Paller AS, Fishbein
AB, Zee PC. Sleep disturbances in adults with
eczema are associated with impaired overall
health: a US population-based study. J Invest
Dermatol. 2015 Jan;135(1):56–66.
33 Barbarot S, Auziere S, Gadkari A, Girolomoni
G, Puig L, Simpson EL, et al. Epidemiology of
atopic dermatitis in adults: results from an in-
ternational survey. Allergy. 2018 Jun; 73(6):
1284–93.
34 Schmitt J, Romanos M, Pfennig A, Leopold K,
Meurer M. Psychiatric comorbidity in adult
eczema. Br J Dermatol. 2009 Oct;161(4):878–
83.
35 Wu BY, Wu BJ, Lee SM, Sun HJ, Chang YT,
Lin MW. Prevalence and associated factors of
comorbid skin diseases in patients with
schizophrenia: a clinical survey and national
health database study. Gen Hosp Psychiatry.
2014 Jul-Aug;36(4):415–21.
36 Hsu DY, Smith B, Silverberg JI. Atopic Der-
matitis and Hospitalization for Mental Health
Disorders in the United States. Dermatitis.
2019 Jan/Feb;30(1):54–61.
37 Larsen JB, Iversen VC, Reitan SK. Association
of psychosis, affective disorders and diseases
affecting the immune system. Nord J Psychia-
try. 2018 Feb;72(2):145–9.
38 Khandaker GM, Zammit S, Lewis G, Jones
PB. A population-based study of atopic disor-
Schizophrenia and Skin Disease
ders and inflammatory markers in childhood
before psychotic experiences in adolescence.
Schizophr Res. 2014 Jan;152(1):139–45.
39 Weber NS, Cowan DN, Millikan AM, Niebuhr
DW. Psychiatric and general medical condi-
tions comorbid with schizophrenia in the Na-
tional Hospital Discharge Survey. Psychiatr
Serv. 2009 Aug;60(8):1059–67.
40 George A, Girisha BS, Rao S. A perspective
study of cutaneous manifestations in primary
psychiatric disorders in a tertiary care hospi-
tal. Indian J Psychiatry. 2018 Apr-Jun; 60(2):
213–6.
41 Chen YH, Lee HC, Lin HC. Prevalence and
risk of atopic disorders among schizophrenia
patients: a nationwide population based
study. Schizophr Res. 2009 Mar; 108(1-3):
191–6.
42 Alikhan A, Lynch PJ, Eisen DB. Hidradenitis
suppurativa: a comprehensive review. J Am
Acad Dermatol. 2009 Apr;60(4):539–61.
43 Jemec GB. Clinical practice. Hidradenitis
suppurativa. N Engl J Med. 2012 Jan; 366(2):
158–64.
44 Patel KR, Rastogi S, Singam V, Lee HH, Amin
AZ, Silverberg JI. Association between hi-
dradenitis suppurativa and hospitalization
for psychiatric disorders: A cross-sectional
analysis of the National Inpatient Sample. Br
J Dermatol. 2019 Aug;181(2):275–81
45 Huilaja L, Tiri H, Jokelainen J, Timonen M,
Tasanen K. Patients with Hidradenitis Sup-
purativa Have a High Psychiatric Disease
Burden: A  Finnish Nationwide Registry
Study. J Invest Dermatol. 2018 Jan;138(1):46–
51.
46 Tzur Bitan D, Berzin D, Cohen AD. Hidrad-
enitis suppurativa and schizophrenia: a na-
tionwide cohort study. J Eur Acad Dermatol
Venereol. 2020 Mar;34(3):574–9.
47 Sund R. Quality of the Finnish Hospital Dis-
charge Register: a systematic review. Scand J
Public Health. 2012 Aug;40(6):505–15.
48 Shavit E, Dreiher J, Freud T, Halevy S, Vinker
S, Cohen AD. Psychiatric comorbidities in
3207 patients with hidradenitis suppurativa. J
Eur Acad Dermatol Venereol. 2015 Feb;29(2):
371–6.
49 Bridgman AC, Fitzmaurice C, Dellavalle RP,
Karimkhani Aksut C, Grada A, Naghavi M, et
al. Canadian Burden of Skin Disease From
1990 to 2017: Results From the Global Burden
of Disease 2017 Study [Formula: see text]. J
Cutan Med Surg. 2020 Mar/Apr; 24(2): 161–
73.
50 Gether L, Overgaard LK, Egeberg A, Thyssen
JP. Incidence and prevalence of rosacea: a sys-
tematic review and meta-analysis. Br J Der-
matol. 2018 Aug;179(2):282–9.
51 Singam V, Rastogi S, Patel KR, Lee HH, Sil-
verberg JI. The mental health burden in acne
vulgaris and rosacea: an analysis of the US Na-
tional Inpatient Sample. Clin Exp Dermatol.
2019 Oct;44(7):766–72.
52 Spoendlin J, Bichsel F, Voegel JJ, Jick SS, Mei-
er CR. The association between psychiatric
diseases, psychotropic drugs and the risk of
Dermatology
DOI: 10.1159/000508868
incident rosacea. Br J Dermatol. 2014 Apr;
170(4):878–83.
53 Wertenteil S, Garg A, Strunk A, Alloo A.
Prevalence estimates for pemphigoid in the
United States: A sex-adjusted and age-adjust-
ed population analysis. J Am Acad Dermatol.
2019 Mar;80(3):655–9.
54 Wertenteil S, Garg A, Strunk A, Alloo A.
Prevalence Estimates for Pemphigus in the
United States: A Sex- and Age-Adjusted Pop-
ulation Analysis. JAMA Dermatol. 2019 May;
155(5):627–9.
55 Försti AK, Jokelainen J, Ansakorpi H, Sep-
pänen A, Majamaa K, Timonen M, et al. Psy-
chiatric and neurological disorders are associ-
ated with bullous pemphigoid - a nationwide
Finnish Care Register study. Sci Rep. 2016
Nov;6(1):37125.
56 Chen YJ, Wu CY, Lin MW, Chen TJ, Liao KK,
Chen YC, et al. Comorbidity profiles among
patients with bullous pemphigoid: a nation-
wide population-based study. Br J Dermatol.
2011 Sep;165(3):593–9.
57 Ren Z, Hsu DY, Brieva J, Silverberg NB, Lan-
gan SM, Silverberg JI. Hospitalization, inpa-
tient burden and comorbidities associated
with bullous pemphigoid in the U.S.A. Br J
Dermatol. 2017 Jan;176(1):87–99.
58 Sim B, Fook-Chong S, Phoon YW, Koh HY,
Thirumoorthy T, Pang SM, et al. Multimor-
bidity in bullous pemphigoid: a case-control
analysis of bullous pemphigoid patients with
age- and gender-matched controls. J Eur
Acad Dermatol Venereol. 2017 Oct; 31(10):
1709–14.
59 Kridin K, Zelber-Sagi S, Comaneshter D, Co-
hen AD. Association between schizophrenia
and an autoimmune bullous skin disease-
pemphigus: a population-based large-scale
study. Epidemiol Psychiatr Sci. 2019 Apr;
28(2):191–8 .
60 Lee HH, Gwillim E, Patel KR, Hua T, Rastogi
S, Ibler E, et al. Epidemiology of alopecia area-
ta, ophiasis, totalis, and universalis: A system-
atic review and meta-analysis. J Am Acad
Dermatol. 2020 Mar;82(3):675–82.
61 Singam V, Patel KR, Lee HH, Rastogi S, Sil-
verberg JI. Association of alopecia areata with
hospitalization for mental health disorders in
US adults. J Am Acad Dermatol. 2019 Mar;
80(3):792–4.
62 Chu SY, Chen YJ, Tseng WC, Lin MW, Chen
TJ, Hwang CY, et al. Psychiatric comorbidi-
ties in patients with alopecia areata in Taiwan:
a case-control study. Br J Dermatol. 2012
Mar;166(3):525–31.
63 Kim JC, Lee ES, Choi JW. Impact of alopecia
areata on psychiatric disorders: A retrospec-
tive cohort study. J Am Acad Dermatol. 2020
Feb;82(2):484–6.
64 Jarukitsopa S, Hoganson DD, Crowson CS,
Sokumbi O, Davis MD, Michet CJ Jr, et al.
Epidemiology of systemic lupus erythemato-
sus and cutaneous lupus erythematosus in a
predominantly white population in the Unit-
ed States. Arthritis Care Res (Hoboken). 2015
May;67(6):817–28.
13
65 Tiosano S, Farhi A, Watad A, Grysman N,
Stryjer R, Amital H, et al. Schizophrenia
among patients with systemic lupus erythe-
matosus: population-based cross-sectional
study. Epidemiol Psychiatr Sci. 2017 Aug;
26(4):424–9.
66 Wang LY, Chen SF, Chiang JH, Hsu CY, Shen
YC. Autoimmune diseases are associated with
an increased risk of schizophrenia: A nation-
wide population-based cohort study.
Schizophr Res. 2018 Dec;202:297–302.
67 Mack A, Pfeiffer C, Schneider EM, Bechter K.
Schizophrenia or Atypical Lupus Erythema-
tosus with Predominant Psychiatric Manifes-
tations over 25 Years: Case Analysis and Re-
view. Front Psychiatry. 2017 Jul;8:131.
68 Funauchi M, Yamagata T, Nozaki Y, Sugiya-
ma M, Ikoma SY, Kinoshita K, et al. A case of
systemic lupus erythematosus that manifest-
ed in the course of schizophrenia. Scand J
Rheumatol. 2002;31(6):374–6.
69 Cremaschi L, Kardell M, Johansson V, Isgren
A, Sellgren CM, Altamura AC, et al. Preva-
lences of autoimmune diseases in schizophre-
nia, bipolar I and II disorder, and controls.
Psychiatry Res. 2017 Dec;258:9–14.
70 Zhang Y, Cai Y, Shi M, Jiang S, Cui S, Wu Y,
et al. The Prevalence of Vitiligo: A Meta-
Analysis. PLoS One. 2016 Sep;11(9):e0163806.
71 Patel KR, Singam V, Rastogi S, Lee HH, Sil-
verberg NB, Silverberg JI. Association of vit-
iligo with hospitalization for mental health
disorders in US adults. J Eur Acad Dermatol
Venereol. 2019 Jan;33(1):191–7.
72 Darier F. De la psorospermose folliculaire vé-
gétante. Ann dermatologie syphilographie.
1889. vol 10. p 597.
73 Takagi A, Kamijo M, Ikeda S. Darier disease.
J Dermatol. 2016 Mar;43(3):275–9.
74 Cederlöf M, Bergen SE, Långström N, Lars-
son H, Boman M, Craddock N, et al. The as-
sociation between Darier disease, bipolar dis-
order, and schizophrenia revisited: a popula-
tion-based family study. Bipolar Disord. 2015
May;17(3):340–4.
75 Tang C, Chan M, Lee J, Hariram J. Darier’s
disease and schizophrenia. East Asian Arch
Psychiatry. 2010 Dec;20(4):190–2.
14 Dermatology
DOI: 10.1159/000508868
76 Dodiuk-Gad RP, Cohen-Barak E, Khayat M,
Milo H, Amariglio-Diskin L, Danial-Faran N,
et al. Darier disease in Israel: combined evalu-
ation of genetic and neuropsychiatric aspects.
Br J Dermatol. 2016 Mar;174(3):562–8.
77 Gordon-Smith K, Green E, Grozeva D, Tava-
dia S, Craddock N, Jones L. Genotype-pheno-
type correlations in Darier disease: A focus on
the neuropsychiatric phenotype. Am J Med
Genet B Neuropsychiatr Genet. 2018 Dec;
177(8):717–26.
78 Shibley H, Pelic C, Kahn DA. A case of para-
noid schizophrenia complicated by scleroder-
ma with associated esophageal dysmotility. J
Psychiatr Pract. 2008 Mar;14(2):126–30.
79 Wu MC, Liao YC, Chao SC. Mutation Analy-
sis of the ATP2C1 Gene in Taiwanese Patients
with Hailey-Hailey Disease. Zhonghua Pifuke
Yixue Zazhi. 2010;28(2):59–63.
80 Malik A, Amer AB, Salama M, Haddad B, Al-
rifai MT, Balwi MA, et al. X-linked ichthyosis
associated with psychosis and behavioral ab-
normalities: a case report. J Med Case Re-
ports. 2017 Sep;11(1):267.
81 Mahiques L, Febrer I, Vilata JJ, Fortea JM. A
case of dyskeratosis congenita associated with
schizophrenia and two malignancies. J Eur
Acad Dermatol Venereol. 2006 Oct; 20(9):
1159–61.
82 Raznahan A, Joinson C, O’Callaghan F, Os-
borne JP, Bolton PF. Psychopathology in tu-
berous sclerosis: an overview and findings in
a population-based sample of adults with tu-
berous sclerosis. J Intellect Disabil Res. 2006
Aug;50(Pt 8):561–9.
83 AlZamil NA, Alkhalifa EA, Azzoni F. A
39-year-old man with schizophrenia and tu-
berous sclerosis with a delusion of being a
pregnant woman-A case report. Clin Case
Rep. 2018 Nov;7(1):152–4.
84 Kam M, Massare J, Gallinger S, Kinzie J,
Weaver D, Dingell JD, et al. Peutz-Jeghers
syndrome diagnosed in a schizophrenic pa-
tient with a large deletion in the STK11 gene.
Dig Dis Sci. 2006 Sep;51(9):1567–70.
85 Strous RD, Shoenfeld Y. Schizophrenia, auto-
immunity and immune system dysregulation:
a comprehensive model updated and revisit-
ed. J Autoimmun. 2006 Sep;27(2):71–80.
86 Müller N, Schwarz MJ. Immune System and
Schizophrenia. Curr Immunol Rev. 2010 Aug;
6(3):213–20.
87 Kirkpatrick B, Miller BJ. Inflammation and
schizophrenia. Schizophr Bull. 2013 Nov;
39(6):1174–9.
88 Peters EM. Stressed skin?—a molecular psy-
chosomatic update on stress-causes and ef-
fects in dermatologic diseases. J Dtsch Der-
matol Ges. 2016 Mar;14(3):233–52.
89 Lin TK, Zhong L, Santiago JL. Association be-
tween Stress and the HPA Axis in the Atopic
Dermatitis. Int J Mol Sci. 2017 Oct;
18(10):E2131.
90 Lim C, Chong SA, Keefe R. Psychosocial fac-
tors in the neurobiology of schizophrenia: a
selective review. Ann Acad Med Singapore.
2009 May;38(5):402–6.
91 Mookhoek EJ, Van De Kerkhof PC, Hovens
JE, Brouwers JR, Loonen AJ. Skin disorders in
chronic psychiatric illness. J Eur Acad Der-
matol Venereol. 2010 Oct;24(10):1151–6.
92 Dubovsky AN, Arvikar S, Stern TA, Axelrod
L. The neuropsychiatric complications of glu-
cocorticoid use: steroid psychosis revisited.
Psychosomatics. 2012 Mar-Apr; 53(2): 103–
15.
93 Moftah NH, Kamel AM, Attia HM, El-Baz
MZ, Abd El-Moty HM. Skin diseases in pa-
tients with primary psychiatric conditions: a
hospital based study. J Epidemiol Glob
Health. 2013 Sep;3(3):131–8.
94 Kawai M, Suzuki T, Hiruma M, Ikeda S. A ret-
rospective cohort study of tinea pedis and tin-
ea unguium in inpatients in a psychiatric hos-
pital. Med Mycol J. 2014;55(2):E35–41.
95 Euesden J, Breen G, Farmer A, McGuffin P,
Lewis CM. The relationship between schizo-
phrenia and rheumatoid arthritis revisited:
genetic and epidemiological analyses. Am J
Med Genet B Neuropsychiatr Genet. 2015
Mar;168B(2):81–8.
McPhie/Bridgman/Kirchhof