¹Faculty of Medicine Universitas Brawijaya, Department of Psychiatry, Malang, Indonesia, ²Universitas Brawijaya Hospital, Department of Psychiatry, Malang, Indonesia, ³Saiful Anwar General Hospital, Psychiatry, Malang, Indonesia, ⁴Faculty of Medicine Universitas Brawijaya, Dermatovenereology, Malang, Indonesia, ⁵Universitas Brawijaya Hospital, Dermatovenereology, Malang, Indonesia

Background: Bipolar disorder is increasingly conceptualized as a systemic condition involving neurobiological, circadian, and inflammatory dysregulation. Growing evidence suggests shared immunological and stress-related pathways between affective disorders and inflammatory skin diseases such as atopic dermatitis. The brain–skin axis represents a bidirectional interaction in which psychological stress and mood instability may exacerbate dermatologic inflammation, while chronic somatic symptoms may worsen psychiatric outcomes. Understanding this interaction has important implications for neuropsychopharmacological management.

Aims & Objectives: This case aims to illustrate the clinical and neurobiological interaction between bipolar affective disorder and atopic dermatitis and to highlight the role of mood stabilization and sleep regulation in managing psychodermatological presentations.
Objectives:

1. To describe psychiatric manifestations associated with chronic dermatologic illness.
2. To explore neuroimmune and circadian mechanisms linking bipolar disorder and atopic dermatitis.
3. To demonstrate the clinical relevance of integrated psychopharmacological treatment.

Method: This is a single-patient clinical case analysis conducted in a psychiatric outpatient setting. Clinical data were obtained through psychiatric interview, mental status examination, and review of medical history. Diagnostic formulation followed standard clinical criteria for bipolar affective disorder. Treatment interventions included supportive psychotherapy, psychoeducation, and pharmacological mood stabilization.

Results: A 26-year-old female presented with persistent pruritus treated for 3 years by a dermatovenereologist and was being treated with cetirizine and amitriptyline. She was referred to a psychiatrist because of a suspicion of stress. When she met the psychiatrist, she complaint decreased need for sleep, increased energy, rapid speech, and affective instability. She had a history of atopic dermatitis and early-life psychosocial adversity. Mental status examination revealed increased psychomotor activity, labile affect, accelerated thought processes, and impaired impulse control.
The patient was diagnosed with bipolar affective disorder (current episode moderate depression), comorbid with atopic dermatitis. Treatment with divalproex extended-release and anxiolytic medication, alongside psychotherapy and psychoeducation, was initiated. Clinical formulation suggested that sleep disturbance and emotional dysregulation contributed to worsening dermatologic symptoms.

Discussion & Conclusions: This case supports emerging evidence linking bipolar disorder with inflammatory processes and neuroimmune dysregulation. Early-life stress may sensitize the hypothalamic–pituitary–adrenal axis, increasing vulnerability to both mood instability and inflammatory conditions. Sleep disruption appears to function as a shared mediator between psychiatric relapse and dermatologic exacerbation. Mood stabilizers may exert therapeutic effects not only through affect regulation but also via indirect modulation of inflammatory pathways.
The findings emphasize the importance of recognizing somatic complaints as potential expressions of affective dysregulation and highlight the relevance of the brain–skin axis in neuropsychopharmacology.
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​Bipolar disorder may present with prominent psychodermatological manifestations mediated by neuroimmune and circadian mechanisms. Integrated psychiatric treatment focusing on mood stabilization and sleep regulation may improve both psychiatric and dermatologic outcomes. Interdisciplinary approaches are essential in managing complex mind–body interactions.