Should You Be Seeing a Psychodermatologist for Your Psoriasis?

The Link Between Skin and Mental Health

The skin and the nervous system are embryologically connected, explains board-certified psychiatrist Mohammad Jafferany, M.D., executive director for the Association for Psychoneurocutaneous Medicine of North America and clinical professor of psychodermatology at Central Michigan University College of Medicine. This is because both are derived from ectoderm, the top layer of cells or tissue of an embryo in early development.

Skin conditions can exacerbate anxiety and mood disorders, and certain psychiatric conditions can actually manifest as symptoms on the skin, explains Evan Rieder, M.D., a board-certified dermatologist and psychiatrist at NYU Langone Health in New York City. Plus, almost all dermatology visits have some sort of psychological component. “For many of us, our appearances are intimately linked to how we feel, how we present ourselves, and how others respond to us,” Rieder points out.

“The brain has a stress-activated pathway that causes the release of various chemicals and hormones that drive inflammation both in the body and the skin,” says Alia Ahmed, a psychodermatologist and consultant dermatologist based in England, U.K.

As Ahmed explains, feelings of emotional distress lead to the release of a stress hormone called cortisol, which is known to affect the immune system (making the skin less able to defend itself), drive allergic responses, delay healing, and disrupt the skin’s natural barrier. “The effects seen on the skin can vary, including making it feel dry, scaly, and itchy, as well as leading to the formation of lines, wrinkles, pigmentation, signs of premature aging, and dull skin,” she explains.

In recent years, a more in-depth exploration of the connection between skin and mental health has led to the new healthcare practice known as psychodermatology. Psychodermatology wasn’t formally recognized as an important subspecialty of dermatology until the mid-20th century onward, says Ahmed.

What Is a Psychodermatologist and Who Do They Treat?

“A psychodermatologist is a medically qualified doctor with expertise in dermatology, who is also able to manage mental health issues,” says Ahmed, who completed a degree in psychology before studying medicine.

Psychodermatology isn’t just for people with psoriasis. People can also benefit if there’s an emotional component to their skin condition, which is also very common in acne, eczema, and hair loss, or if their psychological state might be causing a skin condition, like trichotillomania (hair-pulling disorder), skin picking disorder, or body dysmorphic disorder, says Rieder.

People with psoriasis are very likely to benefit because this condition tends to evoke strong emotions. A study conducted in Italy in 2009 showed that psoriasis can elicit anger and annoyance in people because it poses so much inconvenience. Also, more than half of the people in the study felt that they needed to be listened to by the doctor treating them.

“I would encourage anyone with a skin problem that is affected by stress to seek advice from a healthcare professional to see if they would benefit from a psychodermatological approach,” Ahmed adds.

What to Expect from a Psychodermatologist Visit

Although every provider structures their practice in their own way, you may expect a psychodermatologist to discuss your personal history in detail—likely in greater detail than a dermatologist would, to give them a clearer sense of how a skin problem may have been affected by or developed in reaction to psychological stress.

Ahmed says her psychodermatology consultations typically last for 45 to 60 minutes. “This is to allow me enough time to assess both the physical and psychological health of the patient, as well as spend adequate time discussing treatment options,” she says. “I spend a lot of time asking my patients how their skin impacts their daily life—for example, mood, sleep, work, and relationships—and working out how they cope with this.”

If she can see that they’re not coping well, she’ll make suggestions based on their needs, such as relaxation therapies, mindfulness, and other cognitive-behavioral therapies. “In some cases, where psychological distress is severe, I will treat this with mood- or anxiety-managing medications,” she adds.

Lifestyle choices can impact skin health, so a psychodermatologist is also likely to consider their patient’s daily fluid intake, food choices, amount of time spent exercising, and quality of sleep. Sleep is very important and can be challenging for people with psoriasis. In a recent study, 39 percent had regular sleep disturbances—33 percent of those with disturbances said their nighttime awakenings were mostly due to itching.

“I work closely with patients to address these choices in ways that are acceptable to them—that way they are more likely to make positive changes,” says Ahmed. “Most people do not realize the impact of psychological health on skin, and psychodermatology empowers people to recognize and manage psychosocial factors at the same time as treating their skin condition. Often, very simple changes can make big differences in my patients’ lives.”

A recent study published in Dermatologic Therapy found that 21 of 30 people improved psoriasis after two months of relaxation therapy with standard dermatology treatment compared to a group that had dermatology treatment without relaxation therapy. This suggests that psychological interventions may really help improve psoriasis.

How to Find a Psychodermatologist

In North America, the representative association of psychodermatology is the Association for Psychoneurocutaneous Medicine of North America. The APMNA website provides names of its members who practice dermatology, making it a good place to start looking for a professional in your area. However, you may notice the list isn’t long. If there isn’t a psychodermatologist within traveling distance of your home, you can inquire about whether they do remote consultations over Zoom, Skype, or FaceTime. You can also ask your dermatologist to refer you to a psychologist who specializes in helping people who are living with skin conditions.

You might just find that seeking a professional who can care for both your mental and physical health pays off. As Ahmed says, “The interaction between the brain, skin, and mind is key to achieving healthy skin.”

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