MUDS: In Search of Medically Unexplained Dermatological Symptoms

by David J. Elpern, M.D.

Medically unexplained symptoms (MUS) are relatively well-known in the literature but not discussed in any dermatology journal. A recent book, Is It All In Your Head?: True Stories of Imaginary Illness, by by the neurologist Suzanne O”Sullivan is a readable and accessible resource.

image from Royal College of Psychiatry article on MUS

image from Royal College of Psychiatry article on MUS

While studied in primary care, neurology and rheumatology, our PubMed review found no mention of medically unexplained symptoms in a major dermatology journal. Yet two surveys conducted in my office, each of of 100 consecutive dermatology clinic patients, found that ~ 20% had some form of MUDS. This rate is congruent with the estimated prevalence of MUS.  It appears that MUDS are more common than we might suspect, yet these patients are ignored by dermatologists.  We are preparing an opinion piece on this topic.

Skin Clinic Williamstown Studies:
MUDS 1st Survey Table 1

MUDS Survey 2

From comparing the two surveys, it is clear to me that this concept is more complex than I had previously thought. If one is in a rush, one just focuses on the patient’s chief complaint and will not recognize these patients. Listening and digging deeper, the unexplained features become more evident. Some of the patients have MUS > MUDS. One of my patients had a moving story of his son’s MUS (chronic disabling arm pain, unexplained after numerous neurological consults at a world-class facility).

The subject of MUS/MUDS is present in every dermatology practice with greater frequency than we recognize—yet it is in the shadows because we are not looking for it. It is a soft topic that we cannot comfortably address and have no good explanation for. Many of the patients with MUS/MUDS are disiabled or retired. They have plenty of time to ruminate on their symptoms which then become a lifestyle. They may be a subset of the population. We have noticed that more of them are on opioids than one would expect.  This, too, needs to be addressed.

This study is in its earliest chapters..

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