WHAT IS PSYCHODERMATOLOGY?

The importance of the mind and body connection should be considered when treating skin problems. Psychology plays an integral role in how many of the organs in the human body function, including the skin. Skin conditions are common throughout the lifespan, and can often be difficult to treat even after diagnosis, so understanding some of the causes of dermatology issues is important. The discipline of psychodermatology explores the connection that occurs specifically between the skin and the mind.

What causes psychodermatology?

At the molecular level, a person’s psychological state is due to chemicals called neurotransmitters such as serotonin and dopamine. These chemical messengers alter how our nerves work, which in turn can lead to changes in mood and even organ function. These messengers, including neurohormones produced by the nervous system, influence other systems of the body including the immune response.

The nervous system, the immune system, and the skin are all linked. This is known as the neuro-immuno-cutaneous system (NICS). The release of chemical messengers throughout the body impacts and causes cellular responses. It is thought that a disruption to the NICS causes problems that are manifested on the skin.

This basic process involved in the NICS and how it works is outlined below.

• Neuropeptides are proteins released by nerve cells that affect the keratinocytes of the skin. Keratinocytes are the cells found in the epidermis, the outermost skin layer.
• During stress, increased levels of neuropeptides and neurotransmitters trigger inflammation by impacting skin dendritic cells.
• These skin dendritic cells are the cells that help activate an immune response causing an influx of eosinophils.
• Eosinophils are white blood cells that are key to the inflammatory response. These cells in the skin then increase inflammation and subsequently the result is some type of skin condition.

Besides the system above, there are also neurotransmitter imbalances that lead to mental illness, which can manifest in destructive behavior with the person damaging their own skin.

Skin ailments can, in turn, trigger psychological distress due to being disfiguring. This can make people feel depressed, anxious, and self-conscious.

Skin conditions classified under psychodermatology

Dermatology problems can be divided into those caused by physiological mechanisms related to brain chemicals. These skin ailments are now also considered under the heading of psychodermatology and are known as psychophysiological dermatoses. Many common ailments fall under this category.

There are certain viral infections where an inflammatory response is provoked by the pathogen resulting in chemicals that activate a cutaneous response. These viruses are often activated by psychological distress.

There are psychiatric conditions that lead to skin problems directly through the individual patient’s behavior. This involves self-mutilation of the skin.

Skin problems also lead to psychological and social problems because unsightly patches on the skin negatively affect a person’s self-worth.

Psychophysiological dermatoses

Some important dermatoses are listed below with a brief description of the most visible signs of each condition:

• Urticaria: These are bumps that develop on the skin. They are red and often very itchy.
• Psoriasis: The skin develops large scaly red patches over parts of the head and often behind the elbows and on the outer legs.
• Rosacea: People with rosacea develop a flushed look, a red appearance on their face and the skin feels dry and rough to the touch.
• Eczema: This condition is also known as atopic dermatitis and it causes dry, cracked skin and brown and red itchy skin patches.
• Lupus: This is an autoimmune condition with a rash on the face being the most visible symptom.

Viral dermatoses

Certain herpes viruses cause a type of skin rash or blister. The nature of the skin problem varies depending on the virus.

• Stress increases the likelihood of shingles (herpes zoster) and herpes simplex virus activation, showing once more the connection between the mind and the body.
• Once infected these viruses remain dormant for long periods of time until stress causes a reactivation and symptoms then reappear.

Psychopathology of the skin due to psychiatric disorders

There are some conditions that are primarily psychiatric disorders that cause skin irritation and issues because of the person’s behavior. Such conditions are classified under psychodermatology but the psychiatric problems are more dominant. Examples are listed below with a brief description of each.

• Neurotic excoriations: This is when a person picks pieces of their own skin off. It can be due to neuroses or anxiety or any type of psychological stress.
• Dermatitis artefacta: The person picks at their skin causing sores, or they cut themselves with blades. This is a condition that is seen in patients who have a borderline personality disorder.

Treatment for psychodermatology problems

The type of skin condition and psychological factors should be established before a treatment plan is designed. Since the mind-skin connection is now recognized as relevant, it is possible that treating psychological problems can be beneficial for many people.

• Tropical creams and ointments containing corticosteroids can be used to dampen the immune response.
• Oral medications that can be given include immunosuppressants, anti-inflammatories, and antibiotics (where an infection has set in).
• Psychiatric medication can be helpful for patients who have also been diagnosed with anxiety, depression, or other psychological issues.
• A combined approach of medication and therapy can help where a person is harming their skin.
• Relaxation techniques, biofeedback, or yoga can reduce the stress that aggravates skin ailments.
• Therapy or counseling can help people cope with stressful life events that could worsen skin problems.

Conclusion

Psychodermatology is a new field of medical study in which the interaction of the nervous system and skin is investigated. Knowledge learned about how the skin and mind interact, provides new avenues for diagnosing and treating patients who suffer from disfiguring and irritating skin issues.

There may be a vicious cycle of skin problems and mental distress, with each issue worsening the other. This is a good reason for considering a multifaceted approach to treatment to help heal both the mind and the skin and to prevent any further worsening of the person’s health.

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Sources:

• Gaspar, N. K., & Aidé, M. K. (2016). Atopic dermatitis: allergic dermatitis or neuroimmune dermatitis? Anais Brasileiros de Dermatologia, 91, 479-488. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999107/
• Gattu, S., Rashid, R. M., & Khachemoune, A. (2009). Self-induced skin lesions: a review of dermatitis artefacta. Cutis, 84(5), 247-251. https://cdn.mdedge.com/files/s3fs-public/Document/September-2017/084050247.pdf
• Jafferany, M. (2007). Psychodermatology: a guide to understanding common psychocutaneous disorders. Primary care companion to the Journal of clinical psychiatry, 9(3), 203. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911167/
• Koblenzer, C. S., & Gupta, R. (2013). Neurotic excoriations and dermatitis artefacta. , 32, 2, 32(2), 95-100. https://www.ingentaconnect.com/contentone/fmc/scms/2013/00000032/00000002/art00008
• Koo, J., & Lebwohl, A. (2001). Psychodermatology: the mind and skin connection. American family physician, 64(11), 1873. https://pubmed.ncbi.nlm.nih.gov/11764865/
• Misery, L. (1996). Neuro-immuno-cutaneous system (NICS). Pathologie-biologie, 44(10), 867-874. https://pubmed.ncbi.nlm.nih.gov/9157366/

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