Skin conditions can affect mental health

Skin disorders may have a profound psychological impact. finds out more

S kin disorders are often associated with appearance-based symptoms like rashes, patching and scarring, along with discomfort, soreness and pain. But beyond the physical, they can have a significant psychological and emotional impact too – although we might not tend to talk about that as much.

“The psychological or psychosocial distress associated with skin conditions is often minimised,” says Dr Andrew Thompson, professor of clinical psychology at Cardiff University and spokesperson for British Skin Foundation (BSF; britishskinfoundation.org.uk), who says that although things are improving in certain regions, there’s still a “gap in services”.

There’s been growing emphasis among healthcare professionals on the need to address these gaps. Right now though, Thompson notes things are “patchy”, and in a BSF survey of 245 dermatologists last year, 87% agreed that people with skin conditions in the UK do not have sufficient access to psychological support.

“Skin disorders” cover a range of conditions, Thompson notes, and some involve complex systemic symptoms. “There’s a whole range of symptoms that can cause distress,” he explains. “Many skin conditions affect appearance – and appearance is important to us all. That can be associated with additional worry of what people might think and your perception of yourself due to having an altered appearance or noticeable condition.”

“Many are associated with some degree of pain,” he says, “and many are itchy – which in itself can be distressing and can also attract attention, which can then be additionally distressing.”

These feelings are far from being vain or superficial – appearance is deeply connected with our human sense of identity, belonging and self-worth.

“Anything considered detrimental to our appearance is going to have an impact on our self-image,” says Dr Elena Touroni, consultant psychologist and co-founder of My Online Therapy (myonlinetherapy.com).

“If a skin condition leaves physical marks, it might make us feel self-conscious, spurring on feelings of defectiveness. Because it’s something we can’t necessarily ‘hide’, it can feel exposing and shaming.”

Everybody is different and the extent of these experiences can vary hugely – but there’s certainly no shame if your mental wellbeing is affected. In fact, it’s very common.

In 2018, Allergy UK and Sanofi surveyed people living with eczema: 80% of respondents said the condition had a direct impact on their mood, with many saying they experience anxiety and around 70% saying they felt depressed as a result.

However, he acknowledges that worrying about being seen to be “not coping” can be an “additional strain” in itself.

“Especially if you’re worried about the visual side of it and people seeing that as vain,” he says.

This is why raising awareness of the mental wellbeing overlap can be so important – acknowledging these things are real and very common can be a huge weight off your shoulders, as well as being the first step towards seeking support or finding ways to address it.

“It is a common experience and it’s understandable that there might be psychological consequences,” says Touroni.

“It’s important to acknowledge this so people receive the appropriate support, and learn strategies for managing any psychological difficulties that come up.”

While access to specialist psychological support via dermatology services can be hit and miss, if you are experiencing depression and/or anxiety, or any form of psychological distress that’s impacting your life, it’s always worth having a chat with your GP who can refer you for talking therapy, such as cognitive behavioural therapy (CBT) or counselling.

Understandably, finding effective treatments for physical symptoms is often a primary concern but Thompson stresses there is strong evidence around the benefits of psychological therapies.

Therapy is just part of the picture though. Thompson says there’s growing availability of online support too.

The British Association of Dermatologists has been developing a range of resources people can access via their Skin Support website (skinsupport.org.uk) – and self-help measures can make a world of difference.