Reducing Patient Anxiety in Procedural Dermatology: A Systematic Review

Patient anxiety surrounding dermatologic procedures can lead to negative outcomes, such as impaired cognitive function and prolonged postoperative pain (1-3). Herein, we systematically review the literature on pharmacologic and non-pharmacologic anxiety reducing interventions across the breadth of dermatologic procedures. A primary literature search was conducted using PubMed, CINAHL, and Cochrane on July 20th, 2022, for peer-reviewed publications. A systematic search yielded 312 references, of which 30 underwent full-text review and 23 were ultimately included. The interventions were categorized as 1) Pharmacologic, 2) Recreational, 3) Informational/Communicative, and 4) Other. Data were collected on procedure type, intervention timing (pre-operative, intra-operative, or post-operative) and change in anxiety metric. Most of the research in anxiety surrounding dermatologic procedures has been with Mohs micrographic surgery (MMS) (15), followed by lasers (3), and dermatologic procedures in general (6). Pharmacologic interventions included oral midazolam, transmucosal fentanyl citrate, and acetaminophen, and all were found to statistically decrease anxiety levels in patients (3). Recreational interventions including self-selected music, adult coloring books, and virtual reality headsets showed significant differences in anxiety metrics compared to control groups. Informational/communicative interventions such as videos, text messages, and 3D MMS models demonstrated mixed outcomes in patient anxiety reduction (3,5). Other interventions included live trance induction, diaphragmatic breathing, and muscle relaxation training (4,5). In conclusion, there are various pharmacologic and nonpharmacologic techniques that can be employed to reduce patient anxiety. Our review revealed the paucity of data on anxiety reducing intervention in non-MMS cutaneous procedures, highlighting the need for further research in these areas.