Dermatology: The link between the mind and the skin |18 November 2021

Many of us can remember our skin breaking out in pimples during times of high stress, like when we were sitting exams, and most probably wondered to ourselves as to why this was happening.

We learn more about Psychodermatology today, an area of medicine which addresses this interaction between the mind and the skin.

Below is our interview with Dr Dusan Stojilkovic, MD, PgDIP Dermatology, at Panafricare Clinic.

Seychelles NATION: Psychodermatology is a fairly new term being used in skincare. Can you explain to us what it is about?

Dr Dusan Stojilkovic: Psychodermatology is a relatively new area of medicine that represents the link between the mind and the skin itself. We are aware of this link and as health professionals we can see it in daily practice. When it comes to psychosomatic and skin related problems, Seychelles is not an exemption.

Relatively often, excessive psychological or emotional stress can lead to or exacerbate already present skin problems. To understand better, we can classify psychodermatological disorders into three groups. First, where stress already aggravates current skin disease, such as eczema or psoriasis. Second, primary psychological conditions that can result with skin symptomatology. And last but not least, the case where an actual skin problem leads to the psychological problems such as depression.

Seychelles NATION: Can you tell us more about these three groups of psychodermatological disorders?

Dr Dusan Stojilkovic: Stress in general, no matter being external or internal, has tremendous impact on our quality of life and health. Once the stress is present, we can cope with the pressure in order to protect our inner harmony and what we call homeostatic balance. If that balance is disturbed, we can expect different presentations and manifestations of stress. Unfortunately, the skin is not spared.

We know a lot about stress impact on cardiovascular diseases, but not that much about the impact on the skin. Yes, you might think that skin problems don’t carry high risk for our health, but on the other hand poor quality of life becomes long term problems. That is why, these patients are caught in what we call a vicious circle of physiological stress and physical, symptomatic presentation of the same on the skin.

If we talk about very common conditions such as eczema, acne and psoriasis, it is well known that emotional stress causes significant aggravation of the symptoms. Flares, itchiness and disturbed quality of life along with aesthetic appearance become very common problems. It is frequently present in young adults during exam periods at school or during any emotional disturbances in life. The mechanism is still not fully known.

What we know is that during stress, high levels of stress hormones, especially cortisol and epinephrine, can aggravate the skin that is already sensitive. Similar is in psoriasis. Children and adults who have eczema, asthma or any other so-called atopic diseases, are known to be more sensitive, empathetic and emotional through their lives.

On the other hand, again during certain psychological disorders such as obsessive compulsive disorder or acute stress, people, especially teenagers, can experience certain skin issues or rather cause secondary skin problems.

For example, acute allergic reactions, rash, Urticaria, however you call it, can be the results of excessive stress. And continuous stress can only aggravate the problem. Generalised itchiness or pruritus is very common as well and can lead to actual scarring on the skin as a result of scratching.

In obsessive compulsive behaviour, another problem that can be skin related is self-induced acne due to mechanical irritation of the face. Hair pulling (Trichotillomania) is less common and is seen mostly in girls. Compulsive skin picking is rather present in boys. Another example is in people who develop irritant skin dermatitis due to excessive and compulsive hand or face washing.

You can see that the problem actually exists and if we see statistics globally, the numbers are not low. Approximately 3-4% of people are affected with skin related obsessive compulsive behaviour.

The last group that is important to mention is psychological problems triggered by primary skin issues. Teenagers with severe acne, adults with psoriasis affecting a large portion of the skin, Vitiligo, just name it. Every patient has an individual emotional approach and we need to understand every single complaint in order to provide complete treatment and support. That is what we call a multi-disciplinary approach. Often, these patients require psychologist support during the course of treatment with the dermatologist.

Seychelles NATION: What is your advice for preventing or managing skin conditions that are related to emotional stress?

Dr Dusan Stojilkovic: Of course once all other possible underlying causes are excluded, sometimes a conversation with a therapist can help, in order to achieve long term stability of current skin conditions or to prevent further complications. Most important is to find the underlying causes of stress and anxiety to deal with the same, and indirectly quality of life and skin conditions improve.

In Seychelles, I am personally happy that my patients can have good professional psychological support from both psychiatrists and psychologists from the Ministry of Health and the private sector. At the end of the day, a holistic and multidisciplinary approach remains essential in every field, not only in psychodermatology.

Apart from medical therapy, there are many other alternative solutions that patients choose individually and these help them to achieve that balance that is highly needed (for example hiking, meditation and yoga, art, music etc).

Psychosomatic symptomatology, both skin and non-skin related is very common, especially since the pandemic hit our society. High levels of anxiety and panic attacks, aggravation of previously well controlled skin problems, different undefined symptomatology that keep patients in constant stress is on the rise. We need to work together and share our views in order to help our community to heal and to progress with better quality of life.

For more information, contact Panafricare Clinic:

-           Telephone: 4 321 310

-           Email: info@panafricare.com

-           Follow ‘Panafricare Clinic by Dr. Todorovic’ on Facebook

F.P.