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SAN ANTONIO
MEDICINE
Psychodermatology:

The Significant Interaction Between the Mind and Skin

By Faraz Yousefian, DO, Liliana Espinoza, BS and Chelsea Kesty, MD

The connection between the mind and body has been studied for Because of the sensitive nature of this topic, it is vital to have a non-
many decades, and without a doubt, there is a strong link between these judgmental, positive and empathic attitude when counseling patients
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two entities. The largest and most visible organ of the body, which is who are suffering from psycho-cutaneous disorders. A multidiscipli-
immediately accessible to the public eye, is the skin. In a culture that nary approach and collaboration between health care providers includ-
emphasizes the importance of beauty, any insult to one’s physical ap- ing primary care, psychiatry, psychology and dermatology disciplines
pearance can lead to substantial psychological disturbances, or even ex- can provide and create solutions to treat different aspects of a patient’s
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acerbate them. Notably, the relationship between the mind and body disease. However, this might be a cumbersome undertaking in the
is reciprocal. As such, any disturbance in the mind can also be mani- short period of time allotted to a single patient encounter. For this rea-
fested in different body organ systems, including the skin. This suggests son, the new emergence of psychodermatology, which involves a der-
that any dermatological manifestations or psychological disorders have matologist with psychotherapy training, has started to gain more
the potential to initiate an aberrant cycle where both conditions are traction and popularity. Psychodermatology focuses on taking the nec-
worsened by the occurrence of the other. To put an end to this cycle, it essary steps to obtain or maintain skin integrity while addressing and
is important that both psychological and dermatological conditions managing a patient’s overall mental health.
are identified and treated accordingly.
It is highly recommended that health care providers conduct a psy- References
1. Psychocutaneous Disorders - Rook’s Textbook of Dermatology - Wiley On-
chological assessment of their patients in every patient encounter. This
line Library. Accessed September 8, 2021. https://onlinelibrary.wiley.com/
evaluation is particularly important in the fields of psychiatry and der-
doi/abs/10.1002/9781444317633.ch64
matology, as there are multiple conditions in one specialty that can 2. Lipari RN. Key Substance Use and Mental Health Indicators in the United
produce manifestations in the other, and vice versa. In order to ensure States: Results from the 2019 National Survey on Drug Use and Health.
the holistic health improvement of the patient, a collaborative ap- Published online 2019:114.
proach between psychology and dermatology should be implemented. 3. Jafferany M. Psychodermatology: A Guide to Understanding Common Psy-
chocutaneous Disorders. Prim Care Companion J Clin Psychiatry.
One current study suggests that approximately 33% of patients seek-
2007;9(3):203-213.
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ing dermatological care have some coexisting psychiatric disorder. This
4. Kuhn H, Mennella C, Magid M, Stamu-O’Brien C, Kroumpouzos G. Psy-
rate is higher compared to the general patient population, where 20.6% chocutaneous disease: Clinical perspectives. J Am Acad Dermatol.
of individuals are believed to suffer from a mental health disorder. 2017;76(5):779-791. doi:10.1016/j.jaad.2016.11.013
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Some psychiatric disorders that can manifest themselves via the skin 5. Koo J, Lebwohl A. Psychodermatology: The Mind and Skin Connection.
include depression, anxiety, personality disorders, body dysmorphic AFP. 2001;64(11):1873.
6. Rieder E, Tausk FA. Chapter 104. Psychocutaneous Skin Disease. In: Gold-
disorder, substance/medication-induced disorders and cutaneous body
smith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, eds. Fitz-
3,4
image dissatisfaction. For instance, psycho-cutaneous illness can be
patrick’s Dermatology in General Medicine. 8th ed. The McGraw-Hill
seen in patients suffering from obsessive-compulsive or anxiety disor- Companies; 2012. Accessed September 8, 2021. accessmedicine.mhmed-
ders. One of the unhealthy coping mechanisms exhibited by these pa- ical.com/content.aspx?aid=56055085
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tients is the constant picking of their skin or hair, which can manifest 7. Psychocutaneous Medicine. AMA Archives of Dermatology.
as excoriation and trichotillomania, respectively. 1955;72(6):598-598. doi:10.1001/archderm.1955.03730360104019
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Additionally, there are several skin disorders that can be triggered or
Faraz Yousefian, DO is an intern at the Texas Institute for Grad-
exacerbated by psychological disorders such as psoriasis, atopic dermati-
uate Medical Education and Research (TIGMER) in San Anto-
3,4
tis, alopecia areata, seborrheic dermatitis, acne and pruritus. Studies re-
nio, Texas. He is a member of Bexar County Medical Society.
port that patients experiencing dermatological illnesses such as psoriasis

were found to have a lower quality of life due to their comorbid anxiety
Liliana Espinoza, BS is currently a PhD candidate in the field
and depression. 3,4,6 In addition, stress brought on by their psychological
of neuroscience at UT Health San Antonio where she studies
disorder can exacerbate their cutaneous findings, thus initiating the afore-
the early effects of a high fat diet on the motor neurons that in-
4
mentioned aberrant cycle. This is one of the primary reasons why psy-
nervate the heart. She will be pursuing a medical degree upon completion
chological disorders are commonly evaluated and diagnosed in
of her doctoral degree.
dermatology patients. Tools such as self-administrative surveys can be
given to patients prior to their visit to aid in the detection of psycholog- Chelsea Kesty, MD is a second-year dermatology resident at
ical findings; however, referral to psychiatrists or psychologists is a very Lehigh Valley Health Network in Allentown, PA. She com-
3
sensitive topic that should be addressed in person with the patient. pleted her medical training at the University of South Florida.
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