Eczema is a chronic condition that causes red and itchy skin that tends to flare periodically and may be accompanied by asthma or hay fever symptoms. All forms of eczema have been linked with mental health disorders such as anxiety and depression, due at least in part to the often visible and annoying nature of the skin-related symptoms, according to Melissa Piliang, MD, a dermatologist at the Cleveland Clinic. As a result, taking care of your mental health is incredibly important if you have a skin disorder, she says. “Eczema is usually with you for life. If the disease is making you miserable, [increasing] your stress and anxiety, or leading to depression and poor social relationships, finding somebody who can help you manage those parts of it can be a huge help,” Dr. Piliang notes.
What Is a Psychodermatologist?
Psychodermatology focuses on the interaction between the mind, skin, and body, says Mohammad Jafferany, MD, executive director of the Association for Psychoneurocutaneous Medicine of North America (APMNA) and a psychodermatologist in Saginaw, Michigan. A psychodermatologist can not only help by improving the condition of the skin, but they also work with patients on how to manage stress and gain some acceptance around their condition, according to a review published in the July 2020 issue of the journal Dermatologic Therapy. Professionals in this specialty are trained in dealing with the psychological and psychiatric aspects of skin disease, Dr. Jafferany notes. “This is usually a dermatologist who has special training or interest in psychiatry and he or she can combine and utilize their knowledge in both fields to treat psychodermatology disorders,” he adds. A study of more than 500,000 adults with atopic eczema published in January 2020 in The Journal of Allergy and Clinical Immunology: In Practicefound that the people with eczema were more likely to develop new depression and anxiety than people without eczema. It also found that individuals with more severe eczema were more likely to have depression and anxiety than people with less severe eczema.
Eczema Can Negatively Impact Quality of Life
All skin disease can be difficult to deal with, but that’s especially true for people with eczema, says Piliang. “Eczema can impact school performance and work performance, as well as relationships with your family and friends — it can have big impact on quality of life,” says Piliang. “People with eczema report a worse quality of life than people with other kinds of chronic diseases, such as heart disease or hypertension, and they report a worse quality of life than people with other types of skin diseases, such as acne or alopecia. This is especially true if they have moderate to severe eczema,” she adds. In addition, living with eczema can be isolating for many people, in part due to the physical appearance of the rash, according to Piliang. “People with eczema can feel embarrassed or uncomfortable to go outside,” she says. This is compounded by the fact that any physical activity can make eczema worse in some people, she says. “When they go out into the heat and they start sweating it can make the itching go crazy,” she says. Worse, the itching caused by eczema is also very disruptive to sleep, according to Piliang. “People with eczema tend be itchier at night and it can keep them up or wake them. Poor sleep can lead to irritability, inattention, drowsiness — you just feel awful,” she says.
How a Psychodermatologist Can Help You Manage Your Eczema
While psychologists are very good at dealing with mental health, bringing in a psychodermatologist who also understands the skin aspect of the condition can be really beneficial, Piliang notes. “They can help you get to a point of acceptance about your disease and the routines you have to go through to manage your disease; that can help with stress, anxiety, and depression,” she says. “Knowing you have someone you can turn to and trust when you have a flare or you’re experiencing mental health issues related to your disease is incredibly important.” In a typical dermatological visit, your doctor focuses on the skin disease — they look, examine and treat. A consultation with a psychodermatologist complements the standard dermatology exam, focusing on the mental and emotional side of the condition, in addition to the physical side, Jafferany says. A psychodermatology visit includes a detailed interview that focuses on the patient’s psychosocial history with full examination of the skin, according to Jafferany. “That includes what is going on in their work life, family life, and social life. I ask about any marital or relationship problems and work-related stress because all these things can directly or indirectly affect skin disease,” he says. Any kind of stress can lead to an inflammatory response, which can cause eczema to get worse, he adds.
How Frequently Do You See a Psychodermatologist?
How often you see a psychodermatologist can vary, says Jafferany. It depends on the patient and whatever issues they have, he adds. Jafferany holds a monthly clinic, but people can make appointments outside of that on any day. However, regular consultations may be better. According to a paper published in the December 2018 issue of the International Journal of Women’s Dermatology, monthly psychodermatology visits can make getting treatment for the skin-related psychological issues easier for patients and perhaps carry less stigma for people who are reluctant to see a mental health professional.
Psychodermatology Can Address the Internal and External Aspects of Eczema
Ideally, regular consultation with a psychodermatologist should: Help identify and provide strategies around managing symptoms. If you have certain behaviors you want to stop, such as picking at your skin or scratching, a psychodermatologist can create a plan to help reduce or eliminate them, says Jafferany. Improve sleep hygiene. A psychodermatologist can work with you to identify the issues that may cause poor sleep. Improving sleep may help reduce stress, depression, and anxiety, says Piliang. Complement cognitive behavioral therapy (CBT). CBT can be useful in some people who have a distorted thought process that exacerbates anxieties and needs to be addressed, says Jafferany. “We work to change those negative thought patterns so that the person doesn’t act on them. Cognitive behavioral therapy can be used to manage stress as well,” he adds. Break the cycle of stress that can make eczema more severe. There can be a cycle of stress that occurs in people with eczema, according to Jafferany. “Eczema causes stress, not only because it is visible but because it can cause itching and disruptions in sleep. That stress can lead to increased inflammation, which further worsens the disease, which can go and on,” he says. A psychodermatologist can work with you to help get flares under control through medication and by giving you tools to manage day-to-day stressors, he says. Include medications to treat anxiety or depression, as needed. In some cases, a psychodermatologist may prescribe medications such as an anti-anxiety medication or antidepressant to treat skin-related psychological issues, says Jafferany.
