Simple physiological reactions such as blushing from embarrassment or turning red with anger are the most obvious connections between the psychological state of the mind and physiologic expression through the skin. But there are many deeper and more complicated pathways that are only starting to be explored, and the more professionals understand these connections, the better they can treat the conditions and ease patients’ anxieties.
At the eighth annual SDPA Dermatology Symposium in San Francisco, Dr. John Koo, director of the Psoriasis, Phototherapy and Skin Treatment Clinic, discussed how some skin conditions like acne, psoriasis, eczema and hives are not simply physical, but psychological as well. As we learn more about how emotions such as stress, anxiety, and anger can influence certain skin conditions, we further confirm most people’s experience: namely, that our emotions impact our skin.
If the mind and body are intimately connected, the professionals in contact with patients suffering from skin issues play a vital role in this intersection between dermatology and psychology. The way in which a professional approaches the patient and the skin condition often shapes the patient’s future ability to deal with the condition. This means when patients meet with their dermatologist or any professional to discuss skin issues, each interaction influences the experience living with the condition.
Many patients report feeling tremendous support and relief from professionals even if their conditions are persistent or reoccurring. They express how fortunate they feel to have someone in their corner. Conversely, if their skin conditions are trivialized, it can further ingrain their deepest fears — that the problem is them, not their skin. Occasionally, I see patients suffering from skin picking disorder (excoriation) or hair pulling disorder (trichotillomania) who report they have been told if they could just stop skin picking or hair pulling then the problem would be solved.
Imagine that you are struggling with an issue that feels so embarrassing you have been waiting years — and in some cases decades — to develop the courage to share it. After desperately hoping to find help, instead, you feel confused and more fearful. The added anxiety increases your tendency to pick or pull. The lesson learned is that it is emotionally safer to conceal your secret instead of seeking help. Spending a few minutes to simply listen to someone’s experience — expressing compassion in the form of sympathy or empathy — can have a profound effect on someone’s relationship with their skin.
Understanding someone’s history can be a useful tool to help manage the condition. It’s not uncommon for people to tell me that the skin issue either started at a particularly stressful time or got worse when the stress level changed. And it can go both ways. Eczema and psoriasis are examples of skin conditions that are thought to have underlying immunologic and/or inflammatory causative pathways influenced by stress and emotions. So, in turn, they can result in stress and anxiety, initiating a cyclical pattern. As a psychotherapist, I help people break the cycle. If professionals better understand the psychological connections to these conditions, they can better treat the patient.