Authors Yadav, Narang, and Kumaran in a recent review on psychodermatology report that a significant portion of patients who seek care from a dermatologist has "…an underlying psychiatric or a psychological problem that either causes or exacerbates a skin complaint." The relationship between the mind and the skin may have their link in embryology, with brain and skin sharing development from the ectoderm's end plate, according to the linked article. Psychodermatologic disorders are categorized by Yadav and colleagues into psychophysiological disorders (skin disease is affected by the patient's psychological state), primary psychiatric disorders (skin complaints are secondary to a psychological pathology) or a disorder of dermatological beliefs (rare occurrence of incorrect belief that skin is infested.) For a clinical example of psychophysiologic skin issues, we can consider the affect that stress can have on creating skin disruptions from the herpes virus. Primary psychiatric disorders might include anxiety or depression, comorbidities from which many of our patients suffer.
In addition to pointing out the necessary medical management of any skin condition, the article notes that there are other recognized approaches that can assist a patient in healing well and in avoiding exacerbations. For example, biofeedback training is listed as a helpful modality for hyperhidrosis, Raynauds phenomenon, dermatitis, psoriasis, lichen planus, urticaria, and post herpetic neuralgia. Certainly many of our patients are dealing with these and other comorbidities, and many therapists are also aware of the value in teaching stress-management techniques such as breathing, using biofeedback, and avoiding catastrophizing. The article concludes the following: "Awareness and pertinent treatment of psychodermatological disorders among dermatologists will lead to a more holistic treatment approach and better prognosis in this unique group of patients."
In addition to being helpful for dermatologists, this information may serve pelvic rehabilitation providers and their patients. For example, if mast cells in the skin can be impacted by stress hormones, can this same stress affect through neuroendocrine pathways the skin of the genital area? Research in conditions of chronic pelvic pain have asked this question, in relation to mast cells and other mediators of potential pain sources, with inconclusive results. Regardless of the source of the pain, this article reminds us to look beyond the matter to the mind, and to be helpful to our patients in considering the effects of either. If a patient presents with a skin condition, can we direct him or her to a dermatologist or discuss the potential benefits of managing stress with specific strategies to minimize the impact of the skin issue? If you are interested in learning specific strategies in stress management, check out the Institute's continuing education courses on Meditation as well as on Mindfulness-Based Biopsychosocial Approach to the Treatment of Chronic Pain. We are still scheduling these courses this year- if your facility would like to host either (or both!) of these courses, please contact us at the Institute.