The mind and skin are connected. How we feel, our emotions, and stressors that we experience in life can not only affect our mood, anxiety levels and physical health, but can also have a detrimental effect on our skin too. Likewise, many skin conditions/diseases can have an effect on our mental wellbeing and mental health. The connection runs so deep it stems from the fact that the skin develops from the same tissue that forms our brain and central nervous system in early foetal development.
This mind-skin link has a sub-specialist field combining Dermatology and Psychiatry known as Psychodermatology. This is a growing new area which explores the relation of mental health to skin disorders and helps to improve confidence and overcome social anxiety. The British Association of Dermatologists describes Psychodermatology as ‘the treatment of skin disease using psychological techniques. It is typically used to complement other physical therapies that directly treat the cause or symptoms of skin disease’ (1). The severity of a skin condition does not necessarily equate to the severity of psychological issues as even mild skin problems can cause marked distress and impact severely on an individual’s quality of life. Quality of life can be measured by impact on day to day functioning performing simple tasks eg. Dressing, household chores; to impact on schooling; work and career choices; relationships; social life; and physical activity. Examples of this could be body dysmorphic disorder (which also comes under the category of Psychodermatology) where individuals can suffer so much distress from their distorted view of their appearance that their time to get ready in the morning can be severely impacted; or severe dermatitis caused by frequent excessive hand washing in OCD type behaviours.
A study published by the British Journal of Dermatology in 2014 revealed that the impact on mental and physical functioning of conditions like atopic dermatitis and psoriasis are even comparable to conditions like cancer, arthritis, heart disease, diabetes and depression, affecting all aspects of quality of life (2).
Psychodermatology services available in the UK and across the world are very limited. In the UK alone, current NHS Psychodermatology services have only been employed in London and Solihull. Issues in developing more services across the UK have so far been limited to lack of resources and funding. Examples of Psychodermatology techniques employed in current services involve:
Psychotherapy
Mindfulness and CBT - to reduce stress and anxiety and develop better coping strategies
Habit Reversal Therapy - which can help break unhealthy skin habits such as scratching/picking
Relationship Therapy
Acceptance-commitment therapy
Progressive Muscle Relaxation
Here are some facts taken from the Psychodermatology UK ‘Working Party Report (2012)’. The report revealed that The British Association of Dermatologists conducted a national survey back in 2011 which showed there was a lack of Psychodermatology services, despite many Dermatologists reporting that:
“17% of patients with skin problems need psychological support to help with psychological distress caused by their skin condition.
14% of Dermatology patients have a psychological condition which worsens their skin disease.
8% of Dermatology patients have worsening mental health problems due to their co-existing skin disorders.
3% of Dermatology cases they see are actually primarily a psychiatric disorder (ie. a mental health condition that causes the patients to believe they have skin issue).
85% of patients have indicated that the psychological impact of their skin disease on their social functioning is a major component of their illness.” (3)
The All-Party Parliamentary Group on Skin which is an informal group of Members of both Houses of Parliament with a common interest in skin disease produced a report in 2020 entitled ‘Mental Health and Skin Disease’. Their survey demonstrated that ’98% of skin disease patients report that their condition affects their emotional and psychological wellbeing’ (4).
Many people with skin disease can feel isolated, embarrassed, and experience shame. Depression and anxiety are common in skin disease and suicidal thoughts can occur. Individuals can feel stigmatised, and discriminated against. People with conditions can experience bullying, and comments expressing disgust from others in society further impacting on their self esteem and confidence. There is a lack of social acceptance and understanding of skin diseases. People can experience these issues on a daily basis. The Covid-19 pandemic as well as the impact of social media should not be underestimated on their detrimental toll on mental health. Social media can also depict unrealistic expectations of ‘perfect skin’ or a ‘perfect image’, as well as the cyber bullying that occurs worldwide that many encounter leading to issues with self-acceptance, self-esteem, depression, suicidal thoughts, and anxiety, driving people to feel even more isolated.
Whilst there are plans to develop Psychodermatology services in the UK across all regions, services and resources remain scarce and accessibility is a problem for many individuals with skin issues.
(1) http://www.skinsupport.org.uk/content/psychodermatology
(2) Senra, M. and Wollenberg, A. (2014), Psychodermatological aspects of atopic dermatitis. Br J Dermatol, 170: 38-43. https://doi.org/10.1111/bjd.13084
(3) Bewley, Anthony & Affleck, Andrew & Bundy, Chris & Higgins, E & Mcbride, Sandy. (2013). Psychodermatology services guidance: The report of the British Association of Dermatologists' Psychodermatology Working Party. The British journal of dermatology. 168. 1149-50. 10.1111/bjd.12330.
(4) All-Party Parliamentary Group on Skin (2020) Mental Health and Skin
http://www.appgs.co.uk/publication/view/mental-health-and-skin-disease-2020/
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