Psychodermatology: Treating Psoriasis and the Mind
A relatively new field examines the role that stress and other psychological issues play in conditions affecting the skin.
By Erinn Connor
Medically Reviewed by Ross Radusky, MD
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The physical effects of psoriasis are usually easy to spot. Common symptoms of the chronic disease include red patches of skin covered with silvery scales known as plaques, and thickened or pitted nails. Not as obvious, but no less severe, is the disease’s emotional and psychological toll.
Simon Jury knows what it means to struggle with the psychological side of psoriasis. Jury’s psoriasis affected 80 percent of his body when it was diagnosed. “It’s very easy to think people are put off by your psoriasis,” says Jury, who started a blog to write about his life with psoriasis. “A lot of this can be your mind playing tricks on you, making you feel insecure and anxious.”
Feelings of stress, anxiety, and depression are common among people with psoriasis. Studies suggest that the proportion of psoriasis patients who believe stress affects their condition is as high as 78 percent.
According to a study published in July 2019 in theInternational Journal of Molecular Sciences, the disease was associated with depression in 38 percent of patients and social anxiety in 46 percent of patients.
Stress and depression in people with psoriasis can become a vicious cycle, with one triggering the other. A study published in September 2013 in theJournal of the European Academy of Dermatology and Venereology, for example, found that severely depressed women were twice as likely to develop psoriasis.
Psychodermatology is a relatively new field investigating the role that stress and other psychological issues play in conditions affecting the skin, such as psoriasis, acne, and eczema. According to the American Academy of Family Physicians, a psychodermatologic disorder is a condition that involves an interaction between the mind and the skin.
“It’s really about how the mind, psyche, and external stressors affect the skin,” says Kristina Gorbatenko-Roth, PhD, a psychology professor at the University of Wisconsin-Stout in Menomonie.
Diseases Can Affect the Skin and Mind in Different Ways
The study of psychodermatology covers three areas, according to Dr. Gorbatenko-Roth: “One is how disfiguring conditions affecting the skin cause psychological issues. Another is psychiatric disorders that manifest themselves via a skin-related condition, such as trichotillomania (hair-pulling disorder) or Morgellons disease (crawling sensations that feel like insects on the skin accompanied by rashes or sores). The last and main part of the field concerns the way common psychiatric problems such as anxiety and depression cause or exacerbate conditions like psoriasis.”
For Gorbatenko-Roth, the mind-skin connection is a very personal one. “While dealing with my own hair loss from , I found that depression, anxiety, and other psychological conditions were common among people with the disease,” she says. “This seemed like such an unexplored area where patients are experiencing a lot of emotional distress that’s affecting their skin, but the mental and emotional aspect isn’t being addressed.”
Treating the Whole Patient Through Psychology and Dermatology
One of the first researchers in the field of psychodermatology, Gorbatenko-Roth is working with European psychologists to develop training materials for healthcare professionals. The problem, she says, is that many patients with conditions like psoriasis aren’t being treated in a holistic way.
“It’s not about just finding a treatment for your skin,” Jury agrees. “We need to be treated as a whole because of the mental health issues that come hand in hand with this disease.”
Psychodermatology integrates psychology into the dermatology practice. “Most dermatologists are only able to address the skin. They just don’t have the resources or the time to really delve deep into potential stressors,” Gorbatenko-Roth says. “If patients are coming in to see their dermatologist for psoriasis or alopecia, and they can see a psychologist in the same visit — even if it’s only for 15 minutes — it could give them techniques to better manage stress or other mental conditions that may be aggravating their condition.”
What Can I Do if Psoriasis Affects My Mental Health?
So what should patients do if they feel that psychological aspects of their psoriasis aren’t being treated? Gorbatenko-Roth stresses the importance of being open with your doctor.
“You shouldn’t be afraid to ask your dermatologist for help,” she says. “A good doctor will take the time to listen and should be able to refer you to a psychologist.”
“So many people with chronic skin issues are dealing with these psychological issues,” Gorbatenko-Roth says.
Video: The Mind-Skin Connection: understanding the psycho-biological impact of stress on skin health
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