Emotional Impact of Dry Skin -The symptoms of eczema, psoriasis, and acne go beyond the epidermis.

Emotional Impact of Dry Skin -The symptoms of eczema, psoriasis, and acne go beyond the epidermis.
everydayhealth

By Kate Lowenstein
Medically Reviewed By Sanjai Sinha, MD

Because skin is visible, people are often embarrassed by skin problems including, psoriasis, eczema, and acne. "People look at them funny, don't want to touch them, and that affects how they see themselves and their role in the world. It causes a feeling of helplessness," Jessie Cheung, MD, Assistant Professor of Dermatology at NYU Medical Center.

Indeed, in a 2005 study at Radboud University Nijmegen Medical Center in The Netherlands, 128 patients with psoriasis and 120 patients with atopic dermatitis were asked to complete questionnaires about the effects of their disease. At least 30% had heightened levels of anxiety and depression. It was found, based on the questionnaires, that the distress stemmed in large part from factors relevant to all people with chronic conditions: high levels of fatigue, less perceived support, and a sense of helplessness. Not surprisingly, this reduced quality of life can thwart the effects of dermatological treatments, creating a vicious circle of problem skin and psychological distress.

Numerous studies over the past three decades have found that the skin problems most consistently associated with depression, anxiety, and other psychological distress are psoriasis, acne, and atopic eczema. In a study of 239 atopic dermatitis patients aged 4 to 70, those with the disease (a common type of eczema) scored notably lower on quality of life measures than members of the general population, and aspects of their mental health scores were even inferior to people with other chronic conditions, like hypertension and type 2 diabetes.

Emotional triggers of problem skin

While in many cases it's the discomfort and self-consciousness of skin disease that lead to psychological issues, there is also a purely physical link between the emotions and the skin. This is most evident with acne, which is directly related to hormone levels. "We release cortisol when we're stressed out," says Dr. Cheung. "It circulates in the blood and leads to increased oil production, which clogs the pores and causes acne."

Stress-induced breakouts aren't the only instances in which psychological factors can trigger a skin problem. "In 30 to 60 percent of people, emotional issues are likely to affect the skin," says Ted Grossbart, MD, assistant clinical professor at Harvard Medical School and author of "Skin Deep: A Mind-Body Program for Healthy Skin". "The skin seems to have a unique ability to both respond to our emotions and stir up our emotions. It's the one suit that we wear all the time, but we change it to fit our moods as much as anything else we wear."

Dry skin and eczema are the prime examples of the mind-skin connection. "60 to 70 percent of the population experiences some degree of dry skin," says Dr. Grossbart. "What I've found is that the most common cause of severe dry skin is suppressed or unacknowledged anger. The skin is doing a slow burn — it's raging because the patient is not able to." Interestingly, the skin and the brain come out of the same tissue in fetal development, perhaps one of the many reasons why these two vital organs are so closely linked.

"As dermatologists, we have to empathize with patients," says Dr. Cheung. "We put them on treatment plans, in support groups or send them to psychiatrists and social workers if they need to talk about it." Meanwhile, Dr. Grossbart often prescribes a combination of relaxation, hypnosis, focused psychotherapy and biofeedback meditation to put a buffer between the triggering stress and the skin. "If we don't cry or rage," he says, "then our skin gets to do it for us."

Last reviewed: October 8, 2008 | Last updated: October 10, 2008
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