“The idea of ‘healthy mind, healthy body’ can be extended to include the skin. Psychodermatology supports evidence-based suggestions for lifestyle changes that can promote healthy skin. As people are more interested in their own bodies and the effect that their mind is having on their health, it is only natural that the most visible organ (i.e. the skin) should get more focus,” says Dr Alia.
Why is it an important field in skin health right now?
“Psychodermatology has always been important but there is a growing voice from patients about the importance of psychological wellbeing as well as the importance of skin wellbeing. The skin and the brain are closely linked through the nerves in the skin. Patients are often told that it is ‘only your skin’ and ‘just a skin disease’ and can feel very disempowered by those kind of statements,” explains Dr Anthony.
“Patients want to find ways of making sure their skin disease is taken seriously and not dismissed,” he adds. “There is a body of research showing that patients tell us that living with skin disease (for them) is as bad as living with cancer or heart disease. I have a patient with breast cancer and psoriasis and she says that she would rather live with cancer than live with psoriasis,” he explains.
“So, patients are increasingly demanding to have holistic patient-centric skin and general health management and that is why psychodermatology is so important.”
For those who are skeptical of mindfulness and mentions of “energy” and “chakras”, how is this field grounded in medicine and in proven efficacy?
“As with any medical treatment, the psychological treatments suggested by doctors should be grounded in evidence. There are studies that look at the effect of mindfulness-based stress reduction techniques in dermatology, and although some of the results are positive, more robust evidence and well-designed studies are required. The techniques of mindfulness that are offered by widely available apps (e.g. HeadSpace) may be useful for some individuals and I do advise their use if I feel it will benefit. There is no ‘one size fits all’ and some psychological therapies are more suited to one individual compared to another. It can take time to find the best approach,” explains Dr Alia.”
What kind of stress-related eczema and dry skin conditions are you seeing in your clinical practice?
“All dermatologists will see inflammatory skin diseases such as eczema and dry skin. We know dermatologists are aware that any stress can lead to exacerbation of skin disease. Stress can be psychological in nature (such as relationship or work issues or moving house or bereavement), or can be physically related (such as sleeplessness, tiredness, overworking), or can be related to lifestyle (such as over use of alcohol or recreational drugs). We know that stress causes skin disease but also living with a skin disease can be very stressful,” says Dr Anthony.
What is the relationship between our mind and itching?
“We know that because the brain and the skin are very closely connected through the nerves in the skin, that itching is very debilitating. People who are itchy are very aware of the relentless irritation of the itch they experience. Also we know that stress can lead to increased itch. But we do know also that relaxation and mindfulness and medication can really help reduce itch (usually together with physical treatments such as medication aimed at switching off the cause of the itch),” explains Dr Anthony.
Does exercise make it better or worse?
“Certainly moderate exercise will really help with psychological wellbeing and also improves the function of the skin. Exercise will also help with the immune system within the skin and so moderate exercise is always a great way of helping with both skin and psychological distress,” says Dr Anthony.
What sort of treatments are recommended in psychodermatology and what would an appointment with a psychodermatologist roughly look like?
“When seeing a psychodermatologist, a person’s skin condition will be diagnosed by taking a thorough history and conducting investigations. In addition to this, time will be spent asking patients about how they are coping, including questions about mood, appetite, sleep, study, work and relationships. If it is felt that psychological distress is being expressed then this can be managed using a number of strategies,” says Dr Alia.