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 recognise 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!

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.

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.