Have you ever wondered why your hands sweat right before a big test? Or why you blush when you’re embarrassed? How about the reason behind the goosebumps you get while watching that scary scene in a horror movie? Well, not surprisingly, all of these situations involve some level of stress, which manifests itself through your skin. This link between our emotions and our skin is what the emerging field of psychodermatology aims to explore.
Specifically, psychodermatology is an umbrella term that describes a range of conditions that involve the interaction between our mind and our skin. As a medical subspecialty, it’s a cross between the well-established fields of dermatology and psychiatry.
You might be wondering, “how can these two body systems with such distinct functions be so closely related?” Well, during development, an embryo is made up of three primary cell layers which then specialize into different tissues that go on to become our bodily systems. It just so happens that one of these layers, the ectoderm or outer layer, is the one that later develops into the nervous system and skin. This interconnectedness at the embryonic stage is believed to account for the mind-skin interaction later on in life, and one’s potential predisposition to psychodermatology disorders, along with other individual factors.
Psychodermatologic disorders can be classified into one of three categories: psychophysiological disorders, primary psychiatric disorders, and secondary psychiatry disorders. These categories differ in the ways that the sensation of stress manifests through our skin.
The first category, psychophysiological disorders,refers to primary skin conditions that worsen in severity when the individual experiences overwhelming emotional stress. Psoriasis, eczema, and atopic dermatitis are among the most common conditions within this category. People with these conditions often find that emotional triggers are what cause their skin to flare-up. From a physiological standpoint, emotional stress leads to the activation of a neuronal pathway that involves our brain and stress glands, and leads to the production of a chemical called cortisol. Cortisol then negatively impacts the permeability of the skin and its antimicrobial properties, making it more susceptible to a flare up.
Primary psychiatric disorders, however, are self-induced skin lesions that are accompanied by an underlying psychological cause. A commonly known condition is dermatillomania or “skin picking disorder”, in which individuals experience urges to repetitively scratch, pick or dig at the skin on their face, hands, fingers, arms or legs. Trichotillomania or hair-pulling disorder, is another condition in this category that affects about 1% of the population. Individuals with such disorders are also likely to suffer from anxiety or depressive disorders, since hair-pulling or skin-scratching are emotional-coping behaviours. Consequently, individuals often report that engaging in such behaviours brings them relief from any underlying psychological distress.
Finally, secondary psychiatric disorders describe instances where skin disorders are the cause of psychological distress such as depression, lower self-esteem, or social phobia. One such example is psoriasis. Indeed, a recent population based cohort study found that psoriasis patients were at a significantly increased risk of depression, anxiety, and suicide. Moreover, as Christopher Griffiths, a dermatologist at the University of Manchester puts it, “treating a patient with psoriasis is not just treating the skin, it’s treating the individual.” This statement holds true indeed, as several studies suggest that about 60% of individuals seeking medical attention for a skin condition also experience an underlying psychiatric condition.
When it comes to treating these various conditions, psychosocial and psychological factors should be thoroughly examined. Not everyone reacts the same way to a skin problem and nor do they all seek and adhere to treatment in the same way.
Since there is a psychological underpinning behind these diseases, patients should undergo treatment regimes similar to those prescribed by psychotherapists treating psychological concerns. Most importantly, it means that dermatologists, psychotherapists, and psychiatrists have to collaborate on these cases to ensure the highest quality of care.
Unfortunately, this may currently be hard to achieve, due to shortages in dermatologists and psychiatrists across Canada. For instance, in Prince George, British Columbia, there is only one dermatologist serving a population of 300, 000. Meanwhile in Ontario, the average waiting time to see a psychiatrist is about 20 weeks. Since general practitioners are not trained to the same rigor as specialists, patient care may subsequently be compromised. Moreover, the lack of availability and stigma associated with psychiatry referrals may act as additional roadblocks to obtaining optimal care.
Thus, going forward, there is a strong need for the general population and primary care physicians to become more aware of the emerging field of psychodermatology. Increased awareness would allow patients to access appropriate care, such as psychotherapeutic interventions. Just as we are making strides in other branches of the medical field, it’s about time we also take psychodermatologic conditions head on.
By Ritika Arora
Please note that opinions expressed are the author’s own. They do not necessarily reflect the views and values of The Blank Page.
