What do your skin and men­tal health have in com­mon? More than you think. Here, we take a closer look and talk to the ex­perts.

Canadian Living - - Contents - TEXT AMANDA SCRIVNER

Treat­ing skin con­di­tions and men­tal health to­gether

Liv­ing with a skin con­di­tion such as eczema, rosacea, pso­ri­a­sis or acne can be dif­fi­cult enough, but in re­cent years, stud­ies have shown that peo­ple who have one of these skin dis­or­ders are also, in se­vere cases, more likely to suf­fer from, or are at a higher risk for de­vel­op­ing, psy­cho­log­i­cal is­sues. Un­der­stand­ing the con­nec­tion be­tween your skin and men­tal health is the first step to­ward re­lief, and luck­ily, there’s a field of medicine that bridges the gap be­tween psy­chol­ogy and der­ma­tol­ogy. Psy­cho der­ma­tol­ogy pro­vides folks with so­lu­tions for their skin con­di­tions while help­ing them through their own emo­tional stres­sors. Read on to learn about the prac­tice and hear from the ex­perts about what you can do to treat your skin and your mood.


We’ve all been there: break­ing out dur­ing our pe­ri­ods or when we’re su­per stressed out. But for any­one who has ever had a chronic skin con­di­tion— acne, rosacea, eczema, der­mati­tis or vitiligo, for ex­am­ple—find­ing a treat­ment can be men­tally and emo­tion­ally drain­ing. A 2018 study in the Bri­tish Jour­nal of Der­ma­tol­ogy shows that peo­ple with acne are more likely to de­velop de­pres­sion, and a 2014 sur­vey by the Illi­nois-based Na­tional Rosacea So­ci­ety of 1,675 pa­tients with rosacea (which causes fa­cial red­ness and re­lated symp­toms) demon­strated that 90 per­cent of the re­spon­dents re­ported low­ered self-es­teem and self-con­fi­dence.

While most skin con­di­tions aren’t con­ta­gious or life-threat­en­ing, many are vis­i­ble—on the face, the chest or the arms, for in­stance—and so­cially stig­ma­tiz­ing. Dr. Julie Pow­ell, pe­di­a­tri­cian­der­ma­tol­o­gist at Cen­tre hos­pi­tal­ier uni­ver­si­taire Sainte-jus­tine in Mon­treal and past-pres­i­dent of the Cana­dian Der­ma­tol­ogy As­so­ci­a­tion, notes that there are many as­pects to skin con­di­tions, in­clud­ing the im­pact of the disease it­self on the psy­chol­ogy of the per­son and how the skin con­di­tion can or will in­ter­fere with the per­son’s re­la­tion­ships, self­es­teem, so­cial­iza­tion or, in se­vere cases, at­tempts to find work. “All too of­ten, skin dis­eases are per­ceived to be more be­nign be­cause they’re not nec­es­sar­ily life-threat­en­ing,” says Dr. Pow­ell, ex­plain­ing that peo­ple may ig­nore tak­ing care of them be­cause they think the con­di­tions are solely a cos­metic con­cern and don’t con­sider the men­tal and emo­tional im­pacts. With more and more in­di­vid­u­als com­ing for­ward with their sto­ries, Dr. Pow­ell hopes that peo­ple will get to know their choices, not­ing, “We now have many good treat­ment op­tions for a lot of skin dis­or­ders.” There are also rare in­stances when the skin disease is a re­sult of an un­der­ly­ing psy­cho­log­i­cal dis­or­der or wors­ened by stress or trauma. In these sit­u­a­tions, there’s usu­ally a clear as­so­ci­a­tion be­tween the stress and the ex­ac­er­ba­tion of the disease. In cases of pso­ri­a­sis, for ex­am­ple, pa­tients of­ten re­port feel­ing stress be­fore the ini­tial flare-up, then dis­tur­bances of body im­age at­trib­uted to the flare-up it­self. It’s a vi­cious cy­cle of stress caus­ing a flare-up, which leads to stress and poor self-es­teem, then more flare-ups.


Psy­cho der­ma­tol­ogy ex­plores the re­la­tion­ship be­tween our skin and our mood. Dr. Ben­jamin Barankin, med­i­cal di­rec­tor and founder of the Toronto Der­ma­tol­ogy Cen­tre, notes that the field has been around for more than 25 years, al­though there are cur­rently just five psy­cho der­ma­tol­o­gists found in the U.S. and none in Canada. (The prac­tice

is well es­tab­lished in Europe.) “Der­ma­tol­o­gists want to treat peo­ple’s skin is­sues se­ri­ously, promptly and with the right care be­cause we know that not only can we im­prove their skin con­di­tion but we can also make them feel bet­ter,” says Dr. Barankin. The aim of psy­cho­der­ma­tol­ogy is not to sub­sti­tute psy­chother­apy for medicine but, rather, to rec­og­nize that emo­tional is­sues may also be in­volved, es­pe­cially when a con­di­tion re­sists con­ven­tional treat­ment. While it’s im­por­tant to eval­u­ate and treat a skin prob­lem med­i­cally be­fore look­ing into its psy­cho­log­i­cal as­pects, some­times a drug or other med­i­cal ap­proach that doesn’t work on its own be­comes more ef­fec­tive when com­bined with psy­cho­log­i­cal strate­gies.

Psy­cho­der­ma­tol­ogy prac­ti­tion­ers treat skin the way a psy­chother­a­pist treats be­hav­iour—by learn­ing how it re­sponds to emo­tional and en­vi­ron­men­tal stres­sors and help­ing mod­er­ate those re­sponses. Some treat­ment plans can in­clude med­i­ca­tion, ther­apy and/or stress-re­duc­tion tech­niques. Pa­tients may also be in­tro­duced to cog­ni­tive be­havioural ther­apy, med­i­ta­tion and hyp­no­sis to help re­duce stress and, in turn, im­prove their skin con­di­tions. Each per­son’s treat­ment plan is sub­jec­tive based on his or her con­di­tion and the rec­om­men­da­tions of the per­son’s med­i­cal team. So al­though you may feel trapped by your skin disease, take a deep breath and know that there are so­lu­tions to man­age the break­out and im­prove your mood, too.

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