Potential Psychological Effects of Dermatologic Diseases

Since the late 1940s, many studies have shown that the negative effects of dermatologic diseases such as acne, psoriasis, rosacea, eczema, and chronic urticaria can have negative impacts on the psychological well-being of both men and women. Every aspect of daily lives including work functioning, social functioning, home life, and intrapsychic functioning can be disrupted because of the anxiety, depression, feelings of stigmatization, confusion, social withdrawal, and difficulties at work and that are common in patients with these diseases. Unfortunately, these impacts are often difficult for clinicians and even patients to identify.

“One of the most important things that we can express today  is that the psychological and functional impact of skin disease is often not ‘worn right on their sleeves’ of the sufferer,” said Richard Fried, MD, PhD, of Yardley Dermatology Associates in Yardley, PA. “The patient often is not very forthcoming and often not even aware of how much their psychosocial function has been impacted.”

Thus, clinicians should be vigilant and empathic  with their patients, both men and women, in order to assess their psychological status and well-being living with dermatologic disease.

“The take home here is never assume that objective clinical severity necessarily correlates with psychosocial and intrapsychic impact. Furthermore, never presume that by the ‘first round of questioning,’ you’re getting the honest answer,” stated Dr Fried.

Strategies to Identify and Alleviate the Psychological Impacts

“Open eyes, open ears, and open heart” clinician-patient interaction and communication are likely the most sensitive methods to assess the psychological impacts of dermatologic disease.  The detrimental effects of dermatologic disease can be gradual and cumulative, leaving affected patients largely unaware of the sometimes protean negative affects of their skin disease on their functional status and life engagement.

Dr Fried recommended asking patients how much their skin disease is stopping them from doing the things they want to do or have to do; how much has it impacted their emotional life (overall happiness, ehthusiasm, zest for life and activities, intimacy, anxiety, or depression levels); if their skin disease impacts their relationships and health; and how much time do they spend thinking about their skin condition.

Helping patients to gain insights regarding the impact of their skin disease can aid the patient and clinician in making optimal treatment decisions. Interventions such as biologics will likely improve their short-term quality of life while simultaneously minimizing other comorbidities such as heart disease, metabolic syndrome, and joint destruction. Gaining more predictable control over disease severity and frequency of flares can reduce the anticipatory anxiety and angst of living with a capricious skin disease.

“The big three players in the brain are serotonin, norepinephrine, and dopamine,” said Dr Fried. “When they get sucked down by stress, genetics, illness, and inflammation, we’re more likely to experience anxiety, depression, irritability, and lethargy. Ameliorating the physiologic and psychological stresses of psoriasis can help restore healthier levels of neurotransmitters the brain.”

Dr Fried recommended a clinician OSEA, or an Objective/Subjective Emotional  Assessment, to aid clinicians and researchers in determining and assessing the psychological impact of skin disease which complements the valuable data obtained from standardized measurement instruments such as the Psoriasis Area Severity Index or the Eczema Area and Severity Index.

Further Research and Improvements for Evaluating Psychosocial Effects: Critical Mass

Analogous the critical mass that is necessary to initiate nuclear reactions, there appears to be a “critical mass” necessary to initiate a cascade that leads to severe and/or irreversible emotional reactions and scarring. Further research is critical to identify the severity of psychosocial and intrapsychic impact of dermatologic disease in each affected individual. Treatment algorithms for each patient should include assessment of “critical thresholds” in order to minimize the likelihood of irreparable harm to the psyche and “full life functionality” of the individual. Dr Fried expressed hope that future research will combine  patient/clinician objective and subjective reports with functional magnetic resonance brain imaging studies and more localized skin studies of neuropeptides and other psycho-neuro-immuno molecules.

“In summary, we have arrived at a critical and exciting juncture in the mind-body “playground”. An ever-evolving plethora of data support the bi-directional effects of psychophysiological interactions and skin/emotional/physiological well-being.  Clinicians now, more than ever, have an evolving and very powerful position  as health care providers,” said Dr Fried. “We do not necessarily need to be a psychiatrist, psychologist, psychotherapist, or a social worker to make this happen. What I’m calling for is a call to arms. A mobilization of our “power of position”,  power of education/training”, “power expertise”, or ‘power of humanity’. An extra 15 to 30 seconds spent with our patients expressing a caring and compassionate word and/or gesture can be life changing or lifesaving."

“Sometimes just looking at them and saying, ‘I understand how difficult this can be. I feel motivated and obligated to do everything I can as quickly as I can to make this better.”