Can Skin Problems Affect Mental Health and Vice versa?

This blog was prompted when I was asked by Zipho Ntloko, the Senior Beauty Editor at Cosmopolitan, about an overview of "Psychodermatology" and it really made me think back about my personal journey with skin problems and how it affected me psychologically.

As a teenager I had relatively good skin and was mostly pimple-free with the occasional zit here and there, and being in an all girls school in comparison it seemed like I had it easy.  It was not until my early adulthood, when I was in varsity,  that I had been plagued with acne. I used to wear what seems like a ton of foundation to cover my acne scars. To a certain extent this definitely affected my self esteem and confidence but fortunately, it did not impair my daily functioning. So the field of psychodermatology focuses on the “internal” nonvisible disease (mental health) whereas dermatology focuses on the “external” physical manifestation (appearance) of the disease. At that stage I had visited a couple of dermatologists but never actually addressed the psychological impact it had on me.

Just for the record I have degrees in psychology and medical genetics and am a neuroscientist by profession, so I am very glad that this emerged as a new sub-specialty. 

So a relatively new  field of expertise is called psychodermatology, practised by psychologists, psychiatrists and dermatologists that addresses the interaction between the mind and the skin.

The skin is the largest organ of the body and the brain, arguably, the most complex organ of the body. The skin and the human brain have common origin in the pre-embryonic life. Therefore, there is an association of dermatology with neurology, neurosciences and psychiatry.  

The neuro-immuno-cutaneous system (NICs) connects the complex interaction between the nervous system, skin, and immunity. Once the NICs is destabilised a range of inflammatory skin diseases and psychiatric conditions may occur.

Psychodermatologic Disorders can be broadly classified into 4 categories: (1) Psychophysiological disorders, (2) Psychiatric disorders with dermatological symptoms, and (3) Dermatological disorders with psychiatric symptoms (Jafferany, 2007).

An example of a (1) Psychophysiological disorder is Psoriasis. Early onset Psoriasis before the age of 40 years is more easily triggered by stress. The most common psychiatric symptoms associated with psoriasis include disturbances in body image and impairment in social and occupational functioning.

(2) Psychiatric disorders with dermatological symptoms are Anxiety and Stress.

Anxiety has potential to impair the protective outer layer of the skin, causing the skin to be more sensitive and more easily penetrated. It is also known to exacerbate an already existed skin problem. Anxiety besides making the skin more sensitive and penetrative doesn’t cause any skin disease by itself but it actually worsens an already existed skin problem due to the stress. Therefore, anxiety indirectly triggers or exacerbates the skin disorder. It is possible to develop a skin rash from anxiety, it can also cause urticaria (hives) and other kinds of lesions and trigger a flare-up of herpes simplex.

Another example of a psychiatric disorder with dermatological symptoms is Obsessive Compulsive Disorder (OCD)

OCD can be considered as a primary psychiatric condition which causes dermatological problems. Acne excoriee (picking acne) and trichotillomania (pulling hair) are behaviors of impulse control disorder and can also be classified under OCD because some patients who pick their acne are primarily obsessive compulsive in their picking. Other common symptoms of OCD causing skin damage are compulsive pulling of scalp, eyebrow, or eyelash hair; biting of the nails and lips, tongue, and cheeks; and excessive hand washing. 

An example of dermatological disorders with psychiatric symptoms is Alopecia Areata. It is an autoimmune disorder which results in an unpredictable type of hair loss.   

There is also a 4th miscellaneous group of disorders or symptoms that are not otherwise classified.

An example of this, is Cutaneous Sensory syndromes, where patients may experience itching, burning, stinging and biting or crawling skin sensations. These patients often have concomitant anxiety disorder or depression.

In conclusion,there is a wealth of knowledge to support that skin problems can affect mental health and vice versa. The extent to which mental health is affected can be "mild" enough to see a psychologist or "severe" enough to see a specialist psychiatrist. 

I always advocate ,as they also do at medical school (in the last two decades at least), to treat the patient in a biopsychosocial framework. This is a more holistic view of treatment that has been practiced in traditional Eastern medicine for centuries. 

 

References:

Jafferany, M (2007), Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders. Prim Care Companion J Clin Psychiatry 9(3): 203–213.