- I am site clinical lead for dermatology and skin cancer services in the Frimley Health Foundation Trust.
- I run specialist NHS psychodermatology clinics in London and Windsor.
- I was part of the winning team to receive the Dermatology Team of the Year award in 2017.
- I am the Thames Valley and Wessex Regional Representative to the British Association of Dermatologists.
Why I Wanted To Be A Dermatologist
Growing up I was very aware of skin problems. I have a strong family history of acne and hair loss, and I could see first-hand the debilitating psychological effect these conditions had on those affected. My mother developed rosacea after the death of her father and this was the first time I saw how extreme stress can impact the skin. It took a complex holistic approach for her skin to improve.
Skin positivity is something that I am a great believer of. Skin conditions do not need to be hidden and we should all do more to empower people to feel comfortable to share their skin stories. Skin travels our life journey with us and will inevitably show the signs of ups and downs, supporting people in this journey is one of the best gifts that my work as a dermatologist has given me.
I was always interested in the mind and its effect on behaviour and the body. For this reason, I decided to study Psychology with Clinical Psychology at the University of Kent, before applying for medicine. For three fascinating years I pursued my interest and graduated with first class honours.
My medical studies were completed at Barts and the Royal London School of Medicine by 2008, and I spent my four years as a junior doctor working in the Oxford deanery. By the end of my training I was sure I wanted to be a dermatologist. Prior to applying for dermatology training I worked as a clinical research fellow in Psychodermatology for a year. During that time I found I had a natural aptitude for discussing the psychosocial aspects of living with a skin condition, and this was something I wanted to build on throughout my career. I completed my Dermatology training in London, becoming a consultant in 2017. Currently I work for Frimley and Barts Health NHS Trusts.
Educating fellow healthcare professionals and championing the link between mind and skin is a particular passion. I am an honorary lecturer in Psychodermatology at the University of Hertfordshire, where I teach on a dermatology masters course. As a regular invited speaker to several international dermatology conferences, I enjoy sharing my research findings and discussing new treatments. I am also on the executive committee for Psychodermatology UK and a panel member for the Vitiligo Society, as well as a contributor to the All Party Parliamentary Group on Skin. Through these positions I hope to positively influence dermatology policy and services in the UK and abroad. I have completed a research fellowship with the UK Dermatology Clinical Trials Network and regularly use those skills to plan and conduct high quality research in psychodermatology, which I have presented internationally and published.
My specialist interest is in the psychological effects of chronic skin disease, specifically the link between the skin and stress. Feelings of emotional distress lead to the release of a stress hormone (cortisol), which is known to affect the immune system (making the skin less able to defend itself), drive allergic responses, delay healing and disrupt the skin’s natural barrier. The effects seen on the skin can vary, including feeling dry and itchy, as well as the formation of lines, wrinkles, pigmentation, signs of premature aging and dull skin. Other effects include hives, acne breakouts and hair loss.
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), conditions that are impacted by stress (e.g. eczema, psoriasis, urticaria) and complex conditions that impact mental health (e.g. chronic itch, hair pulling, skin picking, nail biting, body dysmorphia and infestations).
I am part of the Psychodermatology team based at the Royal London Hospital, Whitchapel, U.K. This clinic is specifically for people whose lives have been severely affected by their dermatological disease. I aim to provide holistic care to my patients, and strongly believe the interaction between the brain, skin and mind is key to achieving healthy skin.
What Is Psychodermatology?
Psychodermatology is the part of dermatology that considers both the mind and the skin together when seeing a person with a skin problem. As a dermatologist I know that my patients are at higher risk of developing poor psychological health, meaning they 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. In psychodermatology we recognize this link and treat not only the skin condition, but also the psychological impact is having. For example, someone with acne may be feeling anxious about being in a social environment because of their skin, so in addition to treating their acne, I will discuss techniques they can use to overcome these feelings and empower them to do the things they want. I also assess the person as a whole, we talk at length about their lifestyle, skincare regimes, work/study environment and relationships. Very few people realise how reactive their skin is to lifestyle choices.
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), to mention a few!
How Does Stress Affect Our Skin?
Stress and skin are closely linked, I often say to my patients ‘stress causes skin disease and skin disease causes stress’. Feelings of emotional distress lead to the release of a stress hormone (cortisol), which is known to affect the immune system (making the skin less able to defend itself), drive allergic responses, delay healing and disrupt the skin’s natural barrier. The effects seen on the skin can vary, including feeling red, dry and itchy, as well as the formation of lines, wrinkles, pigmentation, signs of premature aging and dull skin. The role of stress is well known to cause or drive skin conditions like eczema, psoriasis, alopecia areata, urticaria, acne and skin tumours. Short-term stress (e.g. feeling anxious before a presentation/exam) can cause temporary problems like flushing, itching and sweating. Long-term (or chronic) stress however results in the body entering a permanent ‘stress-response’ state, which can aggravate existing skin problems through a poor natural immune response and ongoing inflammation. For example, high levels of stress are associated with a higher severity of skin disease in people with psoriasis and eczema.
What sort of treatments are recommended in psychodermatology?
Firstly, it is important to correctly diagnose and treat the skin problem that my patients present with. This can include topical treatment (creams), oral and injectable medications, or other physical treatments (e.g. phototherapy). I also discuss the skin-care regime people are using and adjust this according to the skin problem they have. I spend a lot of time asking my patients how their skin impacts their daily life (e.g. mood/sleep/work/relationships) and working out how they cope with this. If I can see that they are not coping well, then I will make suggestions based on their needs. Adjunctive treatments include relaxation therapies, mindfulness, and other cognitive-behavioural therapies. In some cases, where psychological distress is severe, I will treat this with mood or anxiety-managing medications. Lifestyle choices can impact skin health, so it is important to consider the amount of sleep people are getting, their daily fluid intake, food choices, and amount spent exercising. I work closely with patients to address these choices in ways that are acceptable to them, that way they are more likely to make positive changes! Most people do not realise the impact of psychological health on skin, psychodermatology empowers patients to recognise and manage psychosocial factors at the same time as treating their skin condition.