‘SKIN CONDITIONS CAN BE TRAUMATIC’
New NHS guidelines recommend that those badly affected by acne should be offered mental health support. Dr C says skin complaints can severely impact lives and urges sufferers to seek help
Think back to when you were a teenager – if you had a spot, you were convinced that everybody was staring at it all day. Imagine how it must feel as an adult to have a spotty face or back, or arms and legs that are covered in scaly patches. Whether it’s acne, psoriasis, scarring, eczema or rosacea, skin conditions can leave a person feeling embarrassed, isolated and vulnerable. It’s about time we recognised the mental health impacts of living with a skin condition, and these guidelines are long overdue. In the meantime, here are some helpful ways to manage your skin condition and the impact it has on your life, both physically and mentally.
TRUST YOUR GP
A skin condition can stop people living a full life, so they avoid certain activities or struggle to have relationships. I see it with my patients in the way they style their hair to cover their face and it can feel like a difficult moment when I ask them to remove their makeup and put their hair back so that I can examine their skin. As a doctor, the last thing you want to do is add to a patient’s distress, but if you’ve got a skin condition that is making you feel selfconscious, please do get proper help.
USE MINDFULNESS
If your GP isn’t currently offering mental health support, don’t be afraid to ask them for it. For example, psychodermatology, the treatment of skin disease using psychological techniques, is available on the NHS. It includes things like mindfulness and CBT to change your thought patterns around your skin condition, as well helping to break harmful repetitive behaviours such as scratching or skin picking.
Sadly, a lot of the time people don’t access such treatments because of their fear of showing someone their skin.
SEEK SUPPORT
Some people aren’t affected on their face, but their back and chest can be covered in spots.
These are often eye-wateringly painful and can stop them from getting into relationships or dressing how they want, leaving a person feeling vulnerable and isolated. The aftermath of facial acne can also leave bad scarring, for which people should receive psychological support plus help to improve its appearance. You can also go to skinsupport.org.uk for help and advice.
TAKE CARE WITH SOCIAL MEDIA
Thanks to filters and clever lighting, we can end up looking at a stream of “perfect” faces on social media all day – and then wonder why our own skin is “imperfect”. It’s so important to remember that what you see online often isn’t the reality in real life. There’s also a skin positivity movement, where people share pictures of their acne, scars, stretch marks or psoriasis. It’s great if someone feels confident to share those pictures and that it helps them. But some people could never do that and that’s perfectly understandable, too. I know it comes from a good place, but some sufferers might feel the message is to “get over” their skin condition, which isn’t helpful. Then there’s the risk that among the nice comments, some people will post something nasty and you only need one of those to really distress you. Social media can also be a force for good, though – professionals like consultant dermatologists often break down myths, share helpful articles and do live chats where they answer followers’ questions [Dr Anjali Mahto, pictured left, is one such expert, @anjalimahto]. Work out what’s good for you and what isn’t and use social media with awareness about how it impacts your confidence.
IGNORE DIET MYTHS
“You are what you eat” isn’t always strictly true – and that’s particularly the case for skin conditions. Acne is an intrinsic
hormonal imbalance – it’s not down to poor diet or hygiene. Similarly, psoriasis has no connection to diet. Eczema could be related to dairy, but that’s something you can work though with a dermatologist. However, if you have rosacea, alcohol, spicy foods, cheese, caffeine and hot drinks can trigger flare-ups.
ASK FOR A REFERRAL
If you’re struggling with a skin complaint that your GP hasn’t been able to resolve, ask to be referred to a dermatologist. Creams can work on some acne but they might not be effective on a more extreme case. There’s a lot of discussion around whether the acne medication isotretinoin (commonly known as Roaccutane) is safe, but I think it’s life-changing. People can have a hard time when they’re on it because it can cause severe side effects, such as extremely dry eyes and nose bleeds, but all of those are very well known. Suicidal thoughts are also listed as a potential side effect, which is why it’s viewed as a controversial treatment. Roaccutane tends to make acne worse at first and I have long thought this could be the cause of suicidal thoughts rather than the drug itself. As long as the risks are explained, I have found that my patients with severe acne are very glad they went on it – and it often clears their skin for life.
DON’T GIVE UP
We should have been taking the distress caused by skin conditions far more seriously. Anything a patient says distresses them, whether it’s psoriasis, eczema, rosacea or acne, should be listened to. If you or a loved one are going through this, ask your GP if you can be referred for specialist help, be it psychological or practical, through a dermatologist. Nobody should be prevented from enjoying life because of their skin.