Dermatologic conditions can affect the mind, and vice versa

Key Points

San Francisco - Although dermatologic conditions most apparently affect the skin, dermatologists commonly encounter three types of psychodermatologic disorders where the mind and skin may interact, according to John Koo, M.D., professor and vice chairman, department of dermatology, University of California, San Francisco Medical Center.

In psychophysiologic disease, the mind negatively impacts the skin, with emotional stress causing skin conditions to flare. With secondary psychiatric conditions, the skin negatively impacts the mind directly, with the patient feeling stigmatized socially and experiencing diminished self-esteem.

Additionally, with some primary psychiatric disorders, the mind impacts the skin indirectly, with patients exhibiting self-inflicted lesions, says Dr. Koo, who is board-certified in both psychiatry and dermatology.

Common manifestations

An array of common skin diseases reacts to a person's emotional state. Stress from anxiety or depression causes many common skin conditions to flare, including eczema, psoriasis, acne, seborrheic dermatitis, lichen planus, alopecia areata, and many others, Dr. Koo says.

"Many skin conditions, especially the ones that are chronic inflammatory skin conditions, frequently are worsened by emotional stress," he says. "In fact, with one of the most common conditions, psoriasis, if you ask the patients what makes your psoriasis flare, one of the most common answers is emotional stress. That's the mind negatively affecting the skin."

Conversely, disfiguring skin conditions can be devastating for patients, causing depression, anxiety or social phobia. As a result, patients are afraid to socialize because they feel unattractive. "Patients with skin disease are hit with a double whammy - they are affected both physically and psychologically," Dr. Koo says.

"That's the unique aspect of dermatological disease. Many other medical conditions such as diabetes and high blood pressure can make people uncomfortable from symptoms of pain, itching, disability and so forth. Skin problems can do that, too, but on top of discomfort, skin conditions also can destroy self-image and, hence, self-esteem," Dr. Koo says.

Furthermore, patients may have a mental illness - such as psychosis - that falsely leads patients to believe they have a skin disease when their skin is actually normal. Skin damage that occurs is self-induced, Dr. Koo says.

Dermatitis artefacta, which leads patients to damage their own skin, and delusions of parasitosis, in which patients believe they have parasites on their skin, are ways in which skin conditions can be self-caused.

"They are absolutely fixated on this idea, so you cannot talk them out of their delusion," Dr. Koo says.