What is Psychodermatology?
Psychodermatology is a field of medicine that explores the effect of psychocutaneous conditions or disorders on the health of your skin, hair, and/or nails. The field is not yet widely researched, but is reported to be somewhat common. In fact, according to a study on Psychodermatology by Brown et.al, one-third of patients who’ve suffered from dermatologic diseases have underlying psychiatric conditions and the field of psychodermatology could suggest that the two conditions may be directly related, where one causes or worsens the other [1].
How does the way we look affect the way we feel?
In Dr. Linda Papadopoulos’ TED talk, ‘Psychodermatology: More Than Skin Deep’ , Papadopoulous describes her findings that people’s skin conditions often occur because of stressful life events, which can be explained by the embryological connection between nerve endings and the skin giving chronic stress the ability to “disrupt the function of skin’s permeability.” [2]
In the paper Psychodermatology: When the Mind and Skin Interact, Dr. Mohammad Jafferany goes more in-depth with the relationship between stress and skin and explains how stress activates both the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system pathways [3]. External stress causes these two pathways to release catecholamines and cortisol, both of which have a significant effect on the immune system by going through a series of activities which conclusively “tilts the balance toward humoral immunity and activates B cells, mast cells, and eosinophils, with a consequent increase in allergic inflammatory response” [3].
This inflammatory response then leads to issues in the skin, most of which can be distinguished by three types, as outlined by Koo and Lee [4].
First, psychophysiological disorders are skin diseases that appear to be precipitated or exacerbated by stress. Disorders classified within this group take an especially relevant emotional and social toll on patients, as their self-view becomes significantly harmed, and they become much less likely to practice self-care and seek social interaction [4].
Second, psychiatric disorders with dermatological symptoms include disorders that are purely self-inflicted, through actions which include scratching, picking at the skin, or hair-pulling, due underlying psychopathology [4].
Lastly, diseases can be classified as dermatological disorders with psychiatric symptoms which affect patients who have emotional problems due to having skin disease. These skin diseases tend to be more serious than the others, with much more severe physical symptoms that are more likely to be fatal or have life ruining effects [4].
The Resulting Cycle
For a patient, the interwovenness between stress, or mental health, and the severity of skin conditions creates a never-ending cycle. On a personal level, this essentially being “the worse my skin gets, the worse I feel and the worse I feel, the worse my skin gets” [2]. Disrupting the moment in the cycle where we deny ourselves care, could allow doctors to acknowledge the root of the issue instead of treating its symptoms, and patients could be given tools to help avoid defining themselves by their skin condition, reducing stress and increasing the chance of healing or decreasing the chance of it worsening. Dr. Jaffereany specifically states solutions of “separate psychodermatology clinics, training opportunities for physicians and residents in psychiatry and dermatology residency programs, and family education” to do so [3].
References:
[1] Brown, G. E., Malakouti, M., Sorenson, E., Gupta, R., & Koo, J. Y. (2015). Psychodermatology. Advances in psychosomatic medicine https://doi.org/10.1159/000369090 (accessed Nov 6, 2020)
[2] Papadopoulos , L. Psychodermatology: More Than Skin Deep. TEDxUniversityofManchester.https://www.youtube.com/watch?v=ELHrtqvmu6Q&ab_channel=TEDxTalks (accessed Nov 8, 2020)
[3] Jafferany M. (2007). Psychodermatology: a guide to understanding common psychocutaneous disorders. Primary care companion to the Journal of clinical psychiatry https://doi.org/10.4088/pcc.v09n0306 (accessed Nov 7, 2020)
[4] Nguyen, C. M. K.; Danesh, M.; Berokhim, K.; Sorenson, E.; Leon, A.; Koo, J. Psychodermatology: A Review. Practical Dermatology (2015) https://practicaldermatology.com/articles/2015-may/psychodermatology-a-review (accessed Nov 8, 2020)
[5] DeFino, J. The Burgeoning Field of Psychodermatology Explores the Link Between Mental Health and Skin. https://fashionista.com/2019/06/psychodermatology-mental-health-skin-care (accessed Nov 7, 2020).