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Psychiatry

The Mind-and-Skin Connection

Dermatology and psychiatry team up.

Key points

  • The emerging field of psychodermatology encompasses all conditions involving the mind and the skin.
  • It is imperative that clinicians heighten their awareness of the relationship between cutaneous and psychiatric disorders.
  • A combined biopsychosocial approach is vital in understanding and managing psychodermatological conditions.
  • Multidisciplinary teams are needed to provide holistic treatments for individuals with psychocutaneous disorders.

Anyone who has ever noticed that their skin breaks out more when they’re feeling stressed can attest to the connection between the mind and the skin. But this connection runs much deeper than scientists had previously thought. Thanks to an emerging specialty called psychodermatology, we’re discovering that many skin disorders are more than meets the eye. So dermatologists and primary care clinicians (PCPs) are teaming up with mental health practitioners to treat skin conditions from the inside out. Let’s explore what we know and what it could mean for you.

What Is Psychodermatology?

Psychodermatology is simply the study of the relationship between the mind and skin. It is a field that encompasses all the conditions involving the skin and brain. Dermatologists with this specialty look at how skin disorders can affect mental health and how mental health affects our skin. Other clinical specialties can liaise with dermatologists, psychiatric-mental health practitioners, or clinical psychologists when managing complex psychosomatic dermatoses.

Although we’ve known about the connection between the skin and the psyche for generations, the field has recently gained prominence on the heels of research showing that patients who experience serious skin conditions have a higher prevalence of depression, anxiety, and other psychiatric illnesses than the general population.

For example:

For years, primary care practitioners (PCPs) have referred patients with skin conditions to dermatologists, and dermatologists have treated the issue as if it fell solely within the realm of the body. Now, clinicians are starting to ask: If we treat the mind, will the skin condition also improve? Increasingly, we’re seeing that the answer is yes.

Signs That a Skin Disorder May Be Linked to Mental Health

The main function of the skin — a sensory organ and the largest structure of the body — is to protect internal tissues from the external environment. But the skin also gives us vital feedback about our emotional well-being. Psychological stressors stimulate the release of hormones that can disrupt the protective function of the skin, leading to inflammation, for example.

So what are the signs to look for linking skin disorders to mental health? This is a difficult question to answer because psychodermatologic disorders manifest differently in individuals:

1. A skin condition can affect psychological or social symptoms. Skin disorders that cause cosmetic disfigurement, like vitiligo, psoriasis, or severe acne, can lead to feelings of shame, anxiety, depression, and the loss of self-esteem. Although some skin conditions with visible disfigurement may not be life-threatening, because of their visibility they have been referred to as “life-ruining.” These individuals have trouble getting jobs and face discrimination, especially if the condition is perceived to be contagious and can lead to psychiatric disorders such as anxiety, depression, social phobia, and avoidance behaviors.

2. A severe psychiatric condition can manifest through the signs of a skin condition. Some skin conditions, such as chronic hair-pulling (trichotillomania), self-inflicted skin damage (dermatitis artefacta or factitious disorder), and a belief that the body is infested with parasites (delusions of parasitosis), are symptoms of an underlying psychiatric disorder. Individuals with these conditions require both dermatologic assessment and psychosocial support. They tend to seek multiple consults with PCPs and dermatologists, but seldom seek psychiatric consults since they generally have little or no insight into what is causing the problem.

3. A skin condition can be affected by emotional factors. Many skin conditions, like acne, alopecia areata (hair loss), psoriasis, urticaria (hives), rosacea, eczema, herpes simplex virus, and hyperhidrosis (profuse sweating), can be traced to a physiological cause, but are known to be exacerbated or triggered by stress and other emotional factors.

One dead giveaway that a skin disorder may be related to mental health is, well, that you can identify a psychological factor. If you notice a flare-up after a job loss, a death in the family, or even with an increase in work-related stress, you may want to look into psychodermatologic treatment.

Another sign is when a prescription medicine or other physiological treatment that was once working well to control the condition stops working. If you notice this happening, it’s worth considering whether you’ve experienced any changes in your mental health.

Treatment

Because the manifestation of psychodermatologic conditions varies from person to person, treatment options also vary. Some patients need more of an emphasis on psychiatry, while others need more of an emphasis on the dermatology side. What is clear is that treatment for these conditions should include an empathetic, collaborative, multidisciplinary team approach with a treatment plan focused on improving overall functioning.

To successfully manage stress or emotionally exacerbated skin conditions, patients and clinicians should consider behavioral management approaches as well as prescription medication, when necessary.

Behavior management techniques could include:

Depending on the patient’s history and other factors, treatment could include:

If you believe your mental health could be related to a particular skin condition, first talk to your primary care provider (PCP) and do your research. From there, you may be referred to a dermatologist and you could also reach out to a mental health specialist. Be aware, though, that while some clinicains are aware of the connection between the skin and the mind, they may not be prepared to treat a psychiatric condition in order to improve your skin condition.

Your best bet for getting the appropriate treatment is to ask your PCP or look for an expert specializing in psychodermatology. Treating skin conditions may start with treating the flare-ups, but researchers on the cutting edge of psychodermatology are finding success treating the person as a whole.

References

Ghosh, S., Behere, R.V., Sharma, P.S.V.N., et al. (2013). Psychiatric evaluation in dermatology: An overview. Indian Journal of Dermatology, 58(1):39–43. https://doi.org/10.4103/0019-5154.105286

Goldin, D. (2020). Concepts in Psychodermatology: An overview for primary care providers. The Journal for Nurse Practitioners, 17(1), 93-97. Published online, July 10, 2020. https://www.npjournal.org/article/S1555-4155(20)30235-X/abstract

Gupta, M. A., & Gupta, A. K. (2014) Current concepts in psychodermatology. Current Psychiatry Reports, 16(6), 449. https://doi.org/10.1007/s11920-014-0449-9

Yang, H., & Zheng, J. (2020). Influence of stress on the development of psoriasis. Clinical and experimental dermatology, 45(3), 284–288. https://doi.org/10.1111/ced.14105

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