The psychiatric aspects of skin disorders

Abstract

The skin is recognized as an important mode of communication between the external and the internal psychic and biological processes [1]. The skin and the psyche are closely related from historical, embryologic, biological, psychological developmental and cultural perspectives.The importance of the skin is that it is literally the initial point of contact between the external and internal environments. Exposure to external pollutants, toxins, allergens and other noxious environmental elements find symptomatic expression through the skin.Embryologically, the shared origins of brain and skin are well recognized. Both are developed from the same embryologic germ layer (ectoderm) and two-way communication influences seem to persist throughout the life cycle.Biologically, the contribution of stress to skin diseases is backed by neuroendocrine and immunologic sciences. Emotional factors influence many skin diseases, and the correlation between stressful life events and disease flares is well-recognized in dermatology [2]. Flares of psoriasis, herpes simplex and atopic eczema are influ enced by proinflammatory cytokines, which are also modulated by psychosocial stressors [3]. The cytokines regulate immunologic responses and also mediate inflammatory processes, with recurrent hormonal secretion leading to central biologic changes in mood, anxiety and vegetative conditions [4].Psychologically, the internal psychological factors and emotional suffer ing may eventually find the skin a suitable organ for a visible expression of turmoil. This close relationship between the skin and the psyche has long been recognized in the sci entific literature. On 7 July 1949, AW Watt read an article at the 25th annual meeting of the British Association for Dermatology and Syphilology in London (UK) in which he encouraged dermatologists to consider psycho logical factors related to dematologic conditions [201].In addition to Watt, there were many proponents of the concept of intercon nection between the skin and the psyche with proposed modelsThe skin and the psyche are linked from embryologic, biological, psychological and cultural perspectives. Both the skin and the brain are developed from the same ectodermic germ layer. New evidence in psychoneuroimmunology suggest that both the skin and the psyche are affected by immunologic vulnerabilities and endocrine reactions. Emotional stress may exacerbate many chronic dermatoses and can initiate a vicious cycle referred to as the 'itch-scratch cycle'; therefore, treatment of such cases may be difficult without addressing stress. The dynamic interaction between the skin and the psyche is also manifest in cosmetic behavior, whereby the psychological state of the individual is altered through the widely utilized cosmetics and cosmetic procedures. The motives for seeking cosmetic procedures may include a desire to enhance selfconfidence, body image and self-empowerment. Individuals of both genders are becoming concerned about their physical appearance and are increasingly seeking cosmetic procedure...

Psychiatric Comorbidity in Patients with Psoriasis, Vitiligo, Acne, Eczema and Group of Patients with Miscellaneous Dermatological Diagnoses

“…Several dermatological conditions have been reported in association with psychological stress such as psoriasis, alopecia areata, atopic dermatitis, lichen planus, pruritus and rosacea. Moreover, emotional stress may exacerbate many chronic dermatologic conditions and can also lead to initiation of a vicious cycle referred to as "itchscratch cycle" [1] [2]. Psychiatric and psychological factors are thought to play a role in at least 30% of dermatologic disorders [3].…”

Depression, Anxiety and Stress among Saudi Arabian Dermatology Patients: Cross-sectional study

“…[1][2][3] An international multicentre cross-sectional study across 13 European countries found that 10.1% and 17.2% of dermatology patients suffered from depression and anxiety, respectively. 4 When compared to healthy controls or the general population, dermatology patients are more likely to suffer from anxiety and depression; in a Norwegian study, 13% versus 3.7% and 5.8% versus 0.9% of dermatology patients versus controls suffered from anxiety and depression, respectively.…”

Evaluation of anxiety, depression and suicidal ideation among dermatology patients with cosmetic concerns: A pilot cross sectional study in Ind

“…The fact that we studied cosmetology patients could also account for high psychological morbidity as cosmetic concerns can lead to self -derogatory feelings, embarrassment and social isolation. 1 Majority of the patients in the current study had a college degree and belonged to urban areas. This indicates that higher the education and awareness, more is the concern regarding physical appearance leading to medical consultation.…”

“…The psychological effect of cosmetic concerns on patients can include embarrassment, frustration, low self-esteem, dissatisfaction with appearance, difficulty in social interactions with the opposite gender, shyness in appearances in public and reduced employment opportunities. 1,2 Psychodermatology is an emerging arena in dermatology which deals with its interface with psychiatry. How a patient reacts to a dermatological or cosmetic concern can be an interesting and complex interaction between the dermatological lesion, internal factors such as patients' attitude or personality traits and external factors such as social stigma or life stressors.…”