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What is psychodermatology?

 

Depending on who you speak to, skin diseases are much more than an affliction of the skin, but also affecting the mind of individuals and their families. Psychodermatology is a relatively new area of study and increasingly demonstrating the value of treating the mind in order to support the body.

The discipline seeks to explain the connection between psychological issues and skin disease, specifically how stress factors into the equation. While psychodermatology is a relatively new concept in the US, it’s been well established in parts of Europe for quite some time..

Psychophysiological Disorders

Psychophysiological disorders are defined as diseases of the skin caused by stress or made worse by stress. Diseases falling in to this category include psoriasis, atopic dermatitis and acne, with psoriasis being the most common affliction. According to a recent article published in the Psychiatric Times, Psychodermatology: When the Mind and Skin Interact, 40% of patients say they experienced stress prior to the onset of their first symptoms of skin disease, with 80% reporting stress before recurring flare-ups.

According to another article, written by Mohammad Jafferany, M.D called Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders, and published in thePrimary Care Companion To The Journal of Clinical Psychiatry, the psychiatric symptoms associated with this skin disorder fall into five categories which impact socializing and work relationships. Feelings of shame, fear of rejection and secretiveness are three ways psoriasis affects sufferers.

Hyperhidrosis is another disease that falls into this category. The primary characteristic of hyperhidrosis is excessive perspiration caused by emotional states. Sufferers of this disease experience high levels of rage, tension and fear, which can wreak havoc both in the workplace and at home.

Next on the list of psychophysiological disorders is urticaria. This condition is related to stress in two ways. According to The Primary Care Companion to the Journal of Clinical Psychiatry's article,Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders, stress is believed to contribute to urticaria in 68% of cases. Depression and anxiety are two of the emotional symptoms that factor into urticaria.

A common skin disease is atopic dermatitis. With an well established connection to stress, 70% of the time atopic dermatitis is preceded by stressful situations, according to The Primary Care Companion to the Journal of Clinical Psychiatry. The severity of the outbreak is often related to family stress. Biofeedback, behaviour, mediation and relaxation techniques have been used to successfully treat the disease.

Psychiatric Disorders and Related Skin Diseases

These disorders are serious as they have been associated with depression and suicide. They often manifest through lack of impulse-control and eating disorders. Somatoform disorder as well as factitious and anxiety disorders also fall in this category.

Dermatitis Artefacta is considered to be a factitious disorder where patients inflict harm on themselves. Typically, the lesions are located strategically close to the dominant hand. Lesions are induced by picking, biting, scratching, punching, cutting, and rubbing, to name but a few causes. Conditions often associated with this disorder are borderline personality disorder, depression, OCD, and psychosis.

Trichotillomania is a condition where a person compulsively pulls their hair out. It is categorized as an impulse-control disorder. In many cases, trichotillomania stems from trauma during childhood or emotional neglect. Associated symptoms are depression, dementia, mood disorders and anxiety.

Skin Diseases and Related Psychiatric Symptoms

Skin diseases are often linked to psychiatric disorders caused as a result of the mental toll of diseases that impact self-esteem. Emotional problems plague many people with skin diseases. Anxiety and depression are common. Social interactions and work problems are also likely.

Vitiligo is a skin disorder of the epidermis where depigmentation occurs. According to the Primary Care Companion to the Journal of Clinical Psychiatry, from a social perspective this disorder is considered to be among the most embarrassing. As reported by The Primary Care Companion to the Journal of Clinical Psychiatry, one study found that 56% of patients suffered from adjustment disorder, with 29% also dealing with depression.

Pseudopsychodermatologic disease is often reported as strange, unexplainable skin problems with no obvious physical cause or associated disease. This disease is similar to other skin conditions and can be confused with dermatitis artefacta, hypothyroidism, folliculitis, and vitamin B12 deficiency.

Treatment Approach

Patients with skin diseases can now reach out and be treated by a team of professionals. A dermatologist, therapist, and psychiatrist can work together to provide a comprehensive approach to complicated issues. There are many benefits to this approach, with the mental health of the patient always taking center stage.

Conclusion

Psychodermatology is a combination of psychiatry and dermatology. Utilizing all the tools available to treat skin diseases means the patient will be treated in a comprehensive instead of segmented way. The connections between stress and skin conditions are undeniable, just as the connection between poor mental health and chronic skin conditions is clear. Psychodermatology represents a new way forward for the treatment of both in a harmonious fashion for the sake of struggling patients.

 

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