PS39 Chronic lymphoedema complicated by chemical and electromagnetic hypersensitivity syndromes: a psychodermatology perspective

Abstract

Bodily distress disorder includes electromagnetic hypersensitivity and multiple chemical sensitivities, which are characterized by medically unexplained symptoms and contested aetiology. The WHO recognizes the symptoms as real and potentially disabling; however, there is no standardized diagnostic criterion. These syndromes significantly influence illness behaviour, treatment engagement and outcomes in chronic dermatological disease. Their intersection with complex skin conditions is under-­recognized within routine dermatological practice. The aims of this study were to highlight the psychodermatological complexities arising when hypersensitivity syndromes coexist with chronic lymphoedema, and to present a literature review of bodily distress disorder. We explore the impact of illness beliefs and avoidance behaviours on dermatological management. We present the case of a 62-year-old woman with chronic bilateral lower-limb lymphoedema and recurrent ulceration. Clinical records were reviewed to assess disease course, comorbidities, treatment responses and psychosocial factors that influenced management. Analysis included the patient’s self-reported attribution of symptoms, health-related behaviours and treatment avoidance. Furthermore, a literature review of bodily distress syndromes was conducted using PubMed and Web of Science. The patient’s lymphoedema was deemed multifactorial, complicated by obesity, type 2 diabetes mellitus and chronic venous insufficiency. Disease control remained suboptimal despite standard management. The clinical course was significantly shaped by coexisting functional hypersensitivity syndromes. Our case attributed exacerbation of symptoms to electromagnetic exposure and chemical agents, leading to extensive avoidance of pharmacological therapies and electrically mediated medical devices. These beliefs restricted treatment options, limited activities of daily living and contributed to recurrent infection and psychological distress. This case illustrates how bodily distress disorders and associated illness beliefs can interact with organic dermatological disease, complicating management and outcomes. A holistic psychodermatological approach is essential, with clear communication and multidisciplinary collaboration. Increased awareness of bodily distress disorder within the healthcare community may support more effective, holistic care for patients with complex chronic skin disease and prompt referral to specialized psychodermatological services.