Psycho Dermatology: Understanding the Mind-Skin Connection

Psychodermatology is a new discipline in psychosomatic medicine. It is the treatment of skin disorders using psychological and psychiatric techniques. Psychodermatology is the interaction between the mind and skin.

At the embryonal level, these two disciplines, i.e. the mind and skin are interconnected through the ectoderm. A complex interplay remains between the skin and the neuroendocrine and immune systems. Our skin responds to both exogenous and endogenous stimuli; it senses and integrates environmental cues and transmits intrinsic conditions to the exterior world.

Although the exact prevalence of psychological factors affecting skin disease is unknown, it is estimated to be 25% to 33% in several studies. ⁽¹⁾ Research shows that stimuli received in the skin can influence the endocrine, immune, and nervous systems at the local as well as central levels.

Approximately 30% to 40% of patients seeking treatments for skin disorders are found to have an underlying psychiatric or psychological issue that either causes or exacerbates a skin complaint. ⁽¹⁾ Research suggests that stress and various psychological events impact skin health and cause several skin disorders. ^{(2) (3)}

Psychodermatological disorders can be classified into four main categories: psychophysiological disorders, primary psychiatric disorders, secondary psychiatric disorders, and cutaneous sensory disorders.

The term “psychophysiological disorder” refers to true dermatologic diseases like psoriasis, acne, atopic dermatitis, eczema, and hyperhidrosis that are exacerbated by emotional stressors.

These disorders do not have real skin disease, but, instead, have severe psychopathy. Delusions of parasitosis, trichotillomania, and dermatitis artefacta are some of the classic examples of primary psychiatric disorders. Patients with primary psychiatric disorders often present after visiting multiple doctors and have peculiar atypical skin lesions, beliefs, stories, and samples for examination. So, basically, these are the disorders in which psychologic is the primary problem, while the skin manifestations are self-induced.

Secondary psychiatric disorders affect people with significant psychological problems that harm their self-esteem or body image. Vitiligo, alopecia areata, acne, psoriasis, and hidradenitis suppurativa are all dermatological conditions that can impact a person’s emotional health and well-being. Many patients develop psychological distress because of the severity of their diseases.

Cutaneous sensory disorders are related to chronic pain syndrome. Many times these disorders might be present with or without psychiatric disturbances, however, anxiety and depression are the most common comorbid conditions. These disorders are unpleasant sensations of stinging, biting, burning, and itching without any clear etiology.

Skin, psyche, and immune system are somehow connected anatomically, ontogenically, and physiologically. The skin and nervous system originate from the same germinal layer and neuroectoderm, which leads to a dense network of free nerve endings in the skin, and this association is the basis for psychoneuroendocrinoimmunological mechanisms involved in the pathogenesis of dermatoses.

• To investigate the emotional impacts of the skin condition of a patient.
• To reduce the threat posed by the emotional impacts.
• To help the patient cross over these emotional impacts.
• To help the patient learn and develop coping mechanisms for if and when occurs a recurrence.

Comprehensive management of psychodermatologic disorders should be an empathetic approach toward the patient and a team approach with dermatologists, psychiatrists, therapists, and social services.

Reducing physical distress, and sleep disturbances, and improving symptoms of psychiatric disorders are the primary goals of psychodermatology.

For dermatoses that are induced or worsened by psychological stress, and/or psychopathology as the primary elements, management of the condition should always commence with psychoeducation about the role of psychological aspects in dermatoses, which aids the patient in better coping with realistic goals. ⁽⁴⁾ Based on the syndromal diagnosis of depression, anxiety, obsessive-compulsive disorder, or psychosis, a comprehensive plan for the treatment should be prepared by a team of specialists.

Apart from the medication to treat various psychologic and dermatological disorders, several nonpharmacological treatments can also be used. CBT, hypnosis, supportive psychotherapy, biofeedback, relaxation techniques, stress management, and guided imagery are some of the nonpharmacological treatments.

Psychodermatology is the treatment of skin disorders using psychological and psychiatric techniques. Understanding the connection between mental health and skin conditions can be helpful in preparing a more effective treatment plan, addressing both physical and psychological aspects of an individual’s health and well-being.

References

1. Picardi A, Abeni D, Melchi CF, et al. Psychiatric morbidity in dermatological outpatients: an issue to be recognized. Br J Dermatol. 2000;143:983-991.
2. Humphreys F, Humphreys MS. Psychiatric morbidity and skin disease. What dermatologists think they see. Br J Dermatol 1998’ 139:679-81[Google Scholar]
3. Capoore HS, Rowland Payne CM, Goldin D. Does psychological intervention help chronic skin conditions? Postgrad Med J 1998; 74:662-4 [Google Scholar]
4. Jafferany M, Ferreira BR, Patel A. The essentials of psychodermatology. Cham, Switzerland: Springer International Publishing; 2020. p. 29–34.