A large proportion of the patients I see have Rosacea. This is a chronic condition with a large psychological impact. The relatively less well understood subtype (‘Neurogenic Rosacea’) is also a focus of this post as so many people…
What is Psychodermatology?
There is a growing voice from dermatology patients telling me that their skin is impacting the way they feel and vice versa. Research shows that patients with the dermatological disease have higher levels of psychological and psychiatric issues than those with other chronic diseases (1). In fact, 85% of dermatology patients feel the psychosocial aspects of their skin disease are a major component of their illness, with 17% needing psychological support to cope (2). Thirty percent of people with skin disease have high levels of psychological distress (3, 4).
Psychodermatology is the part of dermatology that considers both the mind and the skin together when seeing a person with a skin problem. It combines aspects of dermatology, psychology, and psychiatry. People with skin conditions are more likely to feel embarrassed, low, anxious, have body image issues, and feel socially isolated. These feelings can then impact their skin and it can turn into a vicious cycle. For example, someone with acne may be feeling anxious about being in a social environment because of their skin, this makes them feel stressed, resulting in increased oil production and inflammation (both implicated in acne) and so their acne becomes worse. My job as a Psychodermatologist is to treat their acne, but also discuss techniques they can use to overcome negative feelings and empower them to do the things they want. I assess the person as a whole, talking at length about emotions, lifestyle, skincare, work/study environment, and relationships.
The patients I see include those with chronic skin disease (e.g. acne, rosacea, vitiligo) that has a psychological impact (e.g. low self-esteem/body confidence, anxiety, and depression) and those conditions that are impacted by stress (e.g. eczema, psoriasis, urticaria). In addition, I see patients whose skin problems are rooted in psychiatric or psychological distress (e.g. chronic itch, hair pulling, skin picking, nail-biting and body dysmorphia).
Typically a psychodermatology appointment is longer (45-60mins), this is to allow me enough time to assess both the physical and psychological health of the patient, as well as spend adequate time discussing treatment options.
How did I become a Psychodermatologist?
I was always interested in psychology, so I completed a BSc in Psychology with Clinical Psychology, this is where I learned about the connection between the mind and body, specifically the effect of stress on the skin. I trained as a medical doctor for 9 years (including 5 years at medical school) and then completed 5 years of training in dermatology (including a year spent in psychodermatology research). Practicing psychodermatology was the perfect way to combine both of my passions!
3 years for Batchelor of Science Degree (Psychology with Clinical Psychology)
5 years at Medical School
4 years as a junior doctor in General Medicine
1 year as a Research doctor in Psychodermatology
4 years training in Dermatology
Total 17 years! (this did surprise me I must say..time flies)
How do I access a Psychodermatologist?
Please do not allow your skin condition to be trivialized. Speak up and ask to be seen by an expert. The usual NHS pathway is to see your GP, who can then refer you to a general dermatologist or psychodermatologist. You should try to tell your GP how you are feeling about having a skin condition and how it impacts your quality of life, this will help them to decide who to refer you to. Don’t suffer in silence! Psychological health is as important as physical health.
A psychodermatologist, like me, is a medically qualified doctor with expertise in dermatology, who is also able to manage mental health issues. There is no harm in being asked to be directly referred to psychodermatology if possible. Your GP or dermatologist can refer to the nearest Psychodermatology clinic, but this may be outside of your immediate area. A recent survey showed that 45% of dermatologists had to refer patients outside of their region (in press). You can also see a psychodermatologist privately if able.
For additional support, keep in touch with national organizations for your condition via their websites/social media for emotional support and to have your voice heard. I would encourage anyone with symptoms of psychological distress associated with having a skin condition to seek appropriate support via their GP, dermatologist, or psychodermatologist.
I work in both the NHS and private sector. The NHS trusts I work for are Frimley Health NHS Foundation Trust and Barts Health NHS Trust, your GP is welcome to refer to me directly.
To book a private consultation: https://thepsychodermatologist.com/contact-us/
Please follow me on IG! You can also access my videos and interviews on my profile:
www.skinsupport.org.uk (set up by the British Association of Dermatologists)
- Gupta MA, Gupta AK. Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management. Am J Clin Dermatol. 2003; 4:833-42.
- Working Party Report on Minimum Standards for Psycho-Dermatology Services 2012. http://www.bad.org.uk/Portals/_Bad/Clinical%20Services/Psychoderm%20Working%20Party%20Doc%20Final%20Dec%202012.pdf (Accessed 01/02/2019)
- Gupta MA, Gupta AK. Psychodermatology: an update. J Am Acad Dermatol 1996; 34: 1030–46
- 4.Picardi A, Abeni D, Melchi CF, et al. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol 2000; 143: 983–91