Reciprocal Interaction Between Skin and Emotion

Dr Fried discussed common dermatologic conditions and their effects on the psyche, as well as psychological disorders leading or contributing to dermatologic manifestations during his presentation on “Potential Psychosocial Effects of Dermatological Diseases,” at Dermatology Week 2023.

Richard G Fried, MD, is a dermatologist and clinical psychologist at the Yardley Clinical Research Center. Dr Fried is also the clinical director of Yardley Dermatology Associates.

Dr Fried began by establishing the deep connection between the brain, mind, and skin. He spoke of the psychological cascade that begins with stress, leading to the onset and worsening of skin disease, which leads to more stress, causing the skin disease to worsen. “It all activates with one wrong move, and everything is cyclical from there,” he explained.

Psychodermatology delves into diagnosing various psychiatric issues, such as obsessive-compulsive disorders, depressive disorders, anxiety disorders, body dysmorphic disorders, delusional parasitosis, and cosmeceutical traumatic stress disorders to name a few.

Moving on to the category of self-destructive behaviors, Dr Fried spoke of picking (acne excorie), pulling (trichotillomania), scratching (neurotic excoriations), rubbing (lichen simplex chronicus), outside jobbing (acids and power sanders), and frank self-mutilation.

Dr Fried concluded by outlining strategies to bring down the insidious cost of dermatology care. Some interventions include physician support in the form of empathy; antidepressants, antihistamines, and antipsychotics; encouraging a healthy lifestyle and alternative behaviors; and indulgence therapies.

Dr Fried spoke of improved clinical outcomes, happier patients and physicians, less time burden on physicians, and revenue enhancement as the ultimate goals.

“Stress is the final subjective experience of biologic predisposition and conditioned response patterns,” Dr Fried said. “It really does lie in the eyes of the beholder.”

Reference
Fried R. Potential psychosocial effects of dermatological diseases. Presented at: Dermatology Week; May 3–6; Virtual.