The Psychology Of Dermatology

There exists a rapidly expanding medical field, termed psychodermatology, which encompasses the interactions between mind and skin. Read on to see what research says about it.

The Field of Psychodermatology

Scientists have begun to explore a specific area of psychodermatology termed psychoneuroimmunology, which looks into how the mind, the chemical functions of the brain, and our immune systems interplay in various disease states. It is thought that these intricate and complex physiologic mechanisms may cause psychological skin disorders and psychosocial aspects of skin disease.^[1] In other words, this subspecialty of dermatology integrates dermatology with psychiatry, psychology, neuroscience, and immunology.^[2]

In psychodermatology, clinicians focus on improving skin function, reducing physical distress, addressing and diagnosing depression and anxiety in patients with skin disorders, managing social isolation, and improving patient self-esteem.^[1] Researchers have concluded that patients with psychodermatological disease improve most when being treated by a multidisciplinary psychodermatology team.^[2] However, these types of healthcare teams take time to establish globally.^[2]

Psychodermatology in Practice

The treatment of psychocutaneous disorders may involve a variety of modalities, including pharmacologic and psychological interventions.^[1] Studies are now measuring the likelihood of patients who seek dermatologic care to experience co-existing psychiatric disorders. One assessment estimates this to be three times as likely.^[3] Given this estimate, it is crucial that dermatologists adequately assess their patients for potential psychiatric comorbidity. This highlights the need for dermatologists to become comfortable with diagnosing and treating psychiatric disorders.^[3]

One concept within the field of psychodermatology is related to the obsessive-compulsive aspect of psychology. This considers such things as constant picking at the skin (excoriation, or skin picking disorder) or constant picking at the hair (trichotillomania). Other psychologically-based conditions include body dysmorphic disorder and cutaneous body image dissatisfaction, which can be found in 9-15% of dermatology patients.^[4] 

Research in the Field

A research group conducted a survey in Turkey assessing the awareness, knowledge, practice guidelines, and attitudes of psychodermatological conditions among dermatologists.^[5] According to the 115 dermatologists surveyed, acne was the most frequent skin condition associated with psychiatric involvement.^[5] Furthermore, patients with psoriasis, alopecia areata, and pruritis were most often referred out by dermatologists to psychiatrists.^[5] The researchers of the survey highlight the importance of collaboration between primary care, psychiatry and psychology, and dermatology disciplines in creating new treatment solutions for those suffering with psychocutaneous disorders.^[5]

One cross-sectional study in India sought to determine the prevalence of depression and anxiety among patients with psoriasis. A positive correlation between severity and duration of psoriasis and psychological disordered characteristics was determined.^[6] The researchers also determined that the more severe a patient’s psoriasis, the lower he/she rated his/her social relationships.^[6] Overall, patients experiencing psoriasis with comorbid psychological disturbance (anxiety or depression) were found to have lower quality of life than the other studied groups.^[6] Because of these findings, the researchers emphasized the importance of screening all dermatology patients for comorbid psychiatric distress.^[6]

Future Directions

It is advised that practitioners assess their patients for psychiatric outcome measures when performing dermatology visits.^[4] Dermatology practitioners are suggested to detect psychological disorders in patients as early as possible.^[7] Tools such as simple, self-administered questionnaires may be used in dermatology visits to initiate psychological assessment, mostly for anxiety and depression.^[7] However, referral to psychiatrists or psychologists where appropriate is paramount for best patient outcome.^[7]