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Skin Health Q2 2023

The real reason why people with skin disease need psychological support

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Dr Eleanor Chatburn

Clinical Psychologist, Self London & British Skin Foundation ambassador

Skin conditions can have a devastating impact on a person’s emotional state, mental health and wider wellbeing. Dermatology patients often report feeling distressed; without proper treatment, this distress can be more acute.

Imagine that you live with a chronic medical condition that is largely out of your control. It is painful or itchy, disrupts your sleep and takes up your time through appointments, applying creams and bandages or taking medications. It alters your appearance, and people may stare or react with fear that the condition is ‘contagious’ — or minimise it as ‘only cosmetic.’ This is the reality of millions of people in the UK with chronic skin conditions.

Skin conditions can make daily life difficult

Many people find that their skin condition impacts their personal, sexual and work relationships; social isolation is, sadly, common. People also tend to reduce activities they previously found enjoyable and may drop out of sports. Some people must completely change their diet. These lifestyle changes can impact a person’s physical, psychological and social wellbeing.

Studies have shown that people with skin conditions have a poorer quality of life and a higher risk of developing depression, suicidal ideation, low self-esteem, stress, anxiety and body image problems.

When people become distressed about their skin, their skin condition becomes even worse.

How mental health affects the skin

The psychological burden of skin disease seems clear, but fewer people realise that the link between our skin and mental health is bi-directional. The latest biomechanical research suggests that there is a ‘brain-skin axis’ through which psychological and environmental stress is translated from the brain to the skin and vice versa.

This explains why stress is a common trigger for inflammatory skin conditions (such as psoriasis, rosacea and eczema). It also explains why, when people become distressed about their skin, their skin condition becomes even worse. Without support, people can get trapped in this stress-flare cycle.

Psychological interventions and psychodermatology

Patients with a skin disease must be offered psychological support. Thanks to hard campaigning work from charities, dermatologists, researchers and other groups, some positive action has been taken. Specially trained psychologists and psychiatrists work closely with dermatologists to treat the mind and the skin together (an area of practice called ‘psychodermatology’).

Several specialist NHS psychodermatology services are now funded, although provision is still patchy. Psychological interventions, such as cognitive-behavioural therapy, have benefited people with skin conditions. We’ve taken positive steps to support the psychological needs of people with skin conditions. Current projects are exploring the potential benefits of therapy groups or digital self-help interventions. However, there is a way to go.

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