Are we ignoring the psychological impact of skin conditions?

Woman looking into mirror

If you had acne as a teenager, you’ll likely know that skin problems aren’t just a cosmetic issue, they can also massively affect your self-esteem. And chronic dermatological conditions, from psoriasis to eczema can have a huge impact on psychological health.

But until recently, this hasn’t been talked about much. The British Association of Dermatologists considers the need for more psychological support for dermatology patients to be pressing. But with many trusts facing significant budget cuts, this is proving a tricky prospect.

There’s a lot of stigma around certain skin conditions, often due to a lack of knowledge, which needs to be challenged.

“Some people with psoriasis are still asked to leave swimming pools because people still think they might be infectious. Skin conditions can have a huge effect on how people view themselves, the relationships they choose and even the jobs they might pursue,” points out dermatologist Dr Susannah Baron, from St Thomas’ hospital in London.

Stress and skin conditions: a vicious cycle

It doesn’t help, of course, that stress and emotional trauma can also affect our skin and aggravate existing conditions. Our physical and emotional health are actually closely linked. It’s not surprising that living with a skin condition can take its toll on the mind, but what we’re starting to understand is that stress and anxiety can make existing conditions even worse, creating a vicious cycle. The growing field of psychodermatology recognises this and places emphasis on the often unmet need for patients with skin problems to get the psychological support they require.

Examples of psychodermatology techniques and resources might include:

  • Mindfulness – to reduce stress or anxiety in patients with skin disease. This might be general mindfulness, aimed at reducing stress, or mindfulness tailored to specific conditions such as psoriasis.
  • Habit reversal – many conditions can lead people to develop harmful repetitive behaviours, such as scratching or skin picking. Habit reversal looks at how to reduce or break these habits.
  • Relationships – relationships, platonic or sexual, are central to our lives. Living with a skin condition can sometimes make forming new relationships difficult. Psychodermatology can help build confidence and overcome social anxiety, as well as giving practical advice on the matter.
Woman with good skin cleanses her face in mirror

Skin conditions are often trivialised

But even though they can be very hard to live with, skin conditions are often trivialised by people who haven’t experienced them. Dr Baron says this is quite apparent in the patients she treats for adult acne.

“I quite often have ladies in their 50s and 60s and they’re so apologetic and the acne has affected their whole life. They feel that they shouldn’t be bothering people about it which is also going to have a negative effect on their self-esteem. Eczema too is very often trivialised. It has a massive impact on quality of life. Sometimes whole families don’t sleep for years because of it.”

It’s estimated that over half of us (54%) experience a skin condition in any given 12-month period. Skin worries account for around 20% of a GP’s workload. It’s the most frequent reason for patients to visit their doctor with a new problem.


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