HEALTHSkin

Consider a woman who, the day after a farewell handshake with a beloved teacher, developed an inflammatory skin disease on the palm of her right hand. The connection between skin and emotion is not always so symbolic: But it is extremely common.

Some 30 to 75 percent of patients who show up in dermatologists' offices have an emotional component to their disease, contends Carolyn S. Koblenzer, M.D. One of the country's few dermatologist psychiatrists, she told a recent meeting of the American Psychiatric Association how the skin and the brain are intimately connected.

For starters, said Koblenzer, of Philadelphia, both are derived from the same embryonic tissue. Then, of course, skin is the visible, physical boundary of the self.

As a result, it is a prime medium for psychosomatic expression. But there's a difference between patients who take their condition to the dermatologist and those who see a shrink. "Dermatologists' patients usually have a single, circumscribed psychiatric symptom, while they function relatively well in other aspects of their lives. By 'choosing' skin disease, they can deny their psychopathology," Koblenzer reports.

In addition, the skin is a full- fledged immunological organ; every type of immune cell is represented in its precincts. The immune system, scientists now know, is disruptable by stress and emotions.

Persons born with a genetic predisposition for skin disease are more vulnerable to an outbreak when in emotional turmoil. Psoriasis, eczema, warts, or even chronic acne are just a few conditions that can be triggered or exacerbated by stress. And their unsightliness can itself create stress, generating a vicious cycle.

What makes the skin a psychosomatic battlefield? Koblenzer contends that touch is the first form of communication between mother and child. The way a new moth er handles her child and the emotional vibes she gives off while doing it influence skin sensitivity for life.

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