What it psychodermatology?

As the name suggests, psychodermatology is a niche branch of dermatology that acknowledges how our psychological states affect our skin. Under the umbrella of the mind-body connection, there is now a greater understanding of how our mental health, particularly when responding to stress, can affect the skin. Psychodermatologists bridge the gap between the internal and external, examining both the skin and the person to decipher the root cause of problems.

As the number of people suffering from stress, anxiety and depression increases, our skin is often the lesser-known victim of a sudden rise in the stress hormone, cortisol. “From a biochemical perspective, we all have a stress-axis in our brain, so when we feel emotionally distressed, it triggers a number of processes which increase inflammation,” explains consultant dermatologist Dr Alia Ahmed, who is pioneering psychodermatology in the UK. She says that the inflammatory response caused by an increased cortisol release can compromise the skin's immune system, reduce the ability of the protective skin barrier to defend itself and minimise the amount of oil the skin can produce. “These combined responses can not only contribute to dryness, itchiness, acne breakouts and premature ageing, but there's also enough evidence to say that stress causes skin disease and skin diseases causes stress,” Ahmed adds. For those living with chronic skin conditions, it’s a vicious cycle, as their conditions can trigger a lack of self-esteem and worry, which then fuel anxiety and depression, further exacerbating the original skin concern.

Why has psychodermatology been overlooked?

Although older healing methods such as the ancient Indian practice of Ayurveda and traditional Chinese medicine have used a 360-degree approach to health for centuries, the principles of psychodermatology have been largely overlooked by Western medicine. “Be it medical professionals or the general public, most people simply don’t take skin conditions seriously. Patients are often very apologetic when they first visit me, and play their situation down,” says Ahmed. “There’s a general feeling that if it's not going to kill you, then it doesn't matter and you don't have to go to your doctor about it.” This lack of awareness is partly due to a severe lack of dermatology training in medical school, which Ahmed says often ranges from two weeks to a maximum of three months during a GP’s initial five-year degree. “They rarely delve deeper into skin problems, because they don’t know what they’re dealing with.” If a patient manages to successfully be referred to a dermatologist, the typical consultation time is then only 15 minutes, as opposed to at least 30 minutes in a psychodermatology appointment

What happens when you see a psychodermatologist?

Alongside several questions about diet, exercise and sleep, which Ahmed says can often reveal if something is awry, expect to be asked a lot of psychological questions. “I’ll ask my patients if they’re feeling anxious or low, and how they feel on a daily basis,” she adds. “They can be difficult conversations, but I have to ask if they’ve thought about hurting themselves because there is a high proportion of patients with chronic skin issues that have admitted to having suicidal behaviours.” Topical or oral medication may be prescribed for the skin, alongside support ranging from meditation and mindfulness to antidepressants, depending on the nature of the psychological trauma. “The name ‘psychodermatology’ can sound scary, but we want to help in every way. I’ve found that even those with a very mild skin condition can be affected,” says Ahmed. “The severity of the condition doesn't dictate the psychological impact.”

What happens when you see a psychodermatologist?

Alongside several questions about diet, exercise and sleep, which Ahmed says can often reveal if something is awry, expect to be asked a lot of psychological questions. “I’ll ask my patients if they’re feeling anxious or low, and how they feel on a daily basis,” she adds. “They can be difficult conversations, but I have to ask if they’ve thought about hurting themselves because there is a high proportion of patients with chronic skin issues that have admitted to having suicidal behaviours.” Topical or oral medication may be prescribed for the skin, alongside support ranging from meditation and mindfulness to antidepressants, depending on the nature of the psychological trauma. “The name ‘psychodermatology’ can sound scary, but we want to help in every way. I’ve found that even those with a very mild skin condition can be affected,” says Ahmed. “The severity of the condition doesn't dictate the psychological impact.”

How can you get an appointment with a psychodermatologist?

As an emerging sphere in dermatology, getting an appointment with a psychodermatologist can be challenging, given that there are only seven NHS-funded psychodermatology clinics in the UK. For those that are unable to visit a private clinic, Ahmed says that she does accept NHS patients from any part of the country (some have taken a two-hour taxi to see her), but admits it’s not a viable option for everyone. Alongside other experts in the field, she is developing educational courses on skills such as communication to better equip established consultant dermatologists to venture into this new field. “We’re just beginning to scratch the surface with proven links between the brain and the skin, and the task at hand now is to educate medical practitioners to better support the needs of their patients,” she says.

The quickest solution is to visit a psychodermatologist privately, with prices starting at £150 for an initial consultation and several clinics now also offering virtual appointments. Most importantly, if your skin is affecting your psyche, know that you’re not alone. Being mindful that your stress level is having a detrimental effect on your skin is often the first hurdle, and it can help to create a toolkit to balance your emotional triggers and instil some semblance of balance into your life. Meditation, exercise and deep breathing are often what a psychodermatologist will prescribe, so by implementing them into your life, you’ll be one step closer to taking back control of your skin.

Lead image by: Arun Sharma