Skin and mental health are intertwined. This is evident embryologically, as we know that the skin and brain are derived from ectoderm, forming a skin-brain axis. Furthermore, scientific pathophysiology has shown that conditions such as acne, psoriasis, and atopic dermatitis are directly influenced by mood.
Whether you are a patient, a provider, or an aesthetics professional, be aware that treating skin should also include treating mental health when needed. Ignoring that a patient could benefit from mental health treatment when attempting to improve the skin is a lost opportunity to help the patient.
Given that a patient’s mood can be affected should the patient have a highly visible skin condition like alopecia, a large facial hemangioma, albinism, or facial scarring. Such conditions could lead to generalized or situational anxiety and depressive symptoms, ultimately resulting in low self-esteem, low work productivity, and overall poor quality of life. Yet, concomitant treatment with a psychiatrist can help to alleviate self-deprecation and employ tools for positive self-actualization.
Additionally, sometimes a patient may have a primary psychiatric condition that results in skin problems, such as skin picking, hair pulling, nail biting, body image distortion. In these examples, it is the impulsive behavior or recurrent urges that have led to skin lesions. In these scenarios, treating the skin lesions without addressing the mental condition would result in countless visits to the skin care professional without very many gains. This is a costly exercise for the patient (mentally, physically, financially) and the third-party payer, as it is nearly impossible to treat these primary psychiatric conditions with skin treatments only.
However, a patient may seek a skin provider before opting to see a mental health professional because 1) skin is visible to all, 2) is ashamed to have a mental condition or 3) is unaware of the benefits of achieving mental empowerment. Therefore, such professionals should inquire about a patient’s perceived mental state and refer to a psychiatrist if the patient is willing.
A referring skin care provider could ease the patient’s concern by informing that patient that the initial appointment with a psychiatrist offers an extended amount of time to discuss concerns. Psychiatrists are trained to include and exclude potential diagnoses and will render a potential treatment plan. If symptoms are mild, perhaps therapy or supplemental treatments, such as exercise or biofeedback, would be warranted. If symptoms are a little more prevalent, such that they interfere with the patient’s ability to “be the best they can be,” then perhaps psychopharmacology with or without the other aforementioned modalities would serve the patient best. If medication is employed, there are many types to choose from, ranging from daily use medication to being used on an “as needed” basis.
There are many types of mental health providers/professionals; however, it is the psychiatrist that is trained to make this level of assessment and decision-making. By adequately treating both the skin and the mental health concern concomitantly, the patient’s overall satisfaction is optimized as one condition is no longer negatively impacting the other.
Erika Balfour is a psychiatrist and dermatopathologist.
