AMSTERDAM — Patients with first-episode psychosis (FEP) and concurrent dermatologic symptoms (DSs) had worse outcomes after psychiatric treatment compared to psychosis patients without skin problems, a new study showed.

After 4 weeks of treatment with the atypical antipsychotic amisulpride, 25% of patients with initial complaints of rash, itching, photosensitivity, or other skin problems had suicide ideation or attempts compared to 7% of those without DSs.

Investigators said the findings are the first to suggest an association between skin conditions and FEP and could help clinicians identify patients at risk for poor outcomes.

“Our findings suggest that dermatologic symptoms may represent a marker of illness severity and poor short-term outcomes in the early stages of psychosis, potentially identifying a subgroup of patients with a poorer clinical prognosis who may benefit from early tailored interventions,” lead investigator Joaquín Galvañ, MD, psychiatrist at the Instituto de Investigación Sanitaria Gregorio Marañón in Madrid, Spain, said in a press release.

The findings were presented on October 14 at the 38th European College of Neuropsychopharmacology Congress (ECNP) 2025.

Useful Information

Between 30% and 60% of people with skin conditions have psychiatric symptoms, researchers noted, and DSs have been linked previously to primary psychiatric disorders. However, data on the prevalence of DSs in patients with FES were scarce.

“What we have done is look at things from the opposite direction; do people with mental health problems have skin conditions, and if so, can this tell us anything useful?” Galvañ said.

Investigators used data from the phase 1 OPTiMiSE trial, which included 481 adult patients with FEP aged 18-40 years from 14 European countries and Israel.

All patients met Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for schizophrenia, schizophreniform, or schizoaffective disorder, and had a duration of psychosis < 24 months, with minimal (≤ 2 weeks at baseline) or no prior antipsychotic exposure.

DS was defined as a score of ≥ 1 on cutaneous items 4.1-4.4 of the UKU Side Effect Rating Scale “other symptoms” subscale. Overall, 14.5% of patients had DSs at baseline, with a significantly higher predominance in females compared with males (24% vs 10%; P < .001).

Pruritus was the most common skin condition (6%), followed by photosensitivity (4%), rash (3%) and increased pigmentation (0.3%).

There was no significant difference in DS prevalence between patients with minimal and no prior exposure to antipsychotics (18% vs 13%; P = .154).

For the analysis, investigators controlled for age, sex, race, substance use, concomitant medication, cumulative dose of antipsychotic, and baseline DSs.

A Predictive Marker?

After 4 weeks of antipsychotic treatment, those with baseline DSs had significantly more severe depressive symptoms than those with no DS, as measured by the Calgary Depression Scale for Schizophrenia (P < .001 ).

Baseline DS was also associated with poorer post-treatment outcomes than no baseline DS measured on a number of other scales, including the general and total Positive and Negative Syndrome Scales (PANSS-G, P = .013 and PANSS-T, P = .031), the Clinical Global Impression scale (P = .046), the Personal and Social Performance scale (P = .032), and the Subjective Well-Being scale (P = .009).

“These results suggest that maybe looking at the skin in patients with first episode psychosis can serve as a predictive marker of poor outcomes,” Galvañ told Medscape Medical News.

“But if you can identify a subgroup of patients with a poor prognosis, for instance, if you know that a certain subgroup of patients will have a higher risk of suicide or more severe depressive symptoms, you can focus on them and try to do some tailored intervention such as more frequent follow-up appointments or strategies to prevent suicide, or treat not just their psychosis, but also depression,” he said.

Although the exact link between skin disorders and psychosis is unknown, researchers noted that the skin and neurologic system are both derived from ectoderm and have common inflammatory pathways. Additional study is needed to explore that connection further, Galvañ said.

“We also need to understand if this link applies also to a range of other psychiatric conditions, such as bipolar disorder, attention-deficit/hyperactivity disorder, anxiety, or depression,” he added.

More Study Needed

Commenting on the findings for Medscape Medical News, Eric Ruhé, MD, PhD, professor in Difficult-to-Treat Depression at the Radboud University, Nijmegen, Netherlands, said the study is interesting, but needs to be replicated in different patient groups.

“I don’t think at this moment you can say what is cause and what is consequence, I think the association that they see is interesting, but it doesn’t say anything about causality,” he said.

Asked for comment, John Koo, MD, professor of dermatology at the University of California San Francisco Medical Center and a board-certified psychiatrist, said the findings are not surprising given the growing body of evidence showing a skin-brain connection.

“Both the skin and the brain have a common embryonic origin — the ectoderm,” he told Medscape Medical News. Cytokines such as TNF, interleukin (IL) 13, IL-6, and IL-23 are involved in both chronic and inflammatory skin diseases — such as psoriasis and atopic dermatitis — as well as in depression without skin disease, he said.

Elevated levels of these cytokines decrease in patients who are successfully treated for skin conditions and in patients whose depression improves with antidepressant therapy, he added.

“In fact, when they do not come down in psychiatric patients with no skin disease who suffer from depression, this can predict poor response to antidepressant therapy,” Koo said. “In the future, it is likely such insights may lead to better therapeutic strategies to help patients with both skin and psychiatric problems.”

Galvañ reported receiving a grant from Instituto de Salud Carlos III, Spanish Government cofounded by the European Union (Río Hortega contract 2023) and honoraria or travel support from Janssen, Lundbeck, and Rovi. Ruhé and Koo reported having no conflicts.