Psychodermatology: The role of mind-skin interactions in treating dermatological disorders

IN some ways, the skin can act as a sponge, continuously absorbing all our emotions. Anger, stress, anxiety and fear can trigger acne and rosacea outbreaks, for example, and even accelerate the appearance of wrinkles, almost without our knowledge. This has been amplified in recent years by our hectic lifestyles, and even more so by the pandemic, which has often exacerbated these negative emotions.

Psychodermatology, which focuses on the psychological dimension of dermatological disorders, is now trying to remedy this through listening, discussion and preventative action.

This is a form of slow medicine practiced by Dr. Anny Cohen-Letessier, a dermatologist and member of the French Society of Dermatology, who explains the close links between the mind and the skin links in which scientists are increasingly interested.

What is psychodermatology?

It is a specialty within the specialty that can be the subject of a post-graduate diploma or simply a mode of practice. It is about taking care of the patient as a whole and his or her problems which are expressed through skin issues, and this requires time and listening.

One must always be attentive to what is hidden behind the pimple.

The skin, visually accessible, will do the speaking. We know today the impact that stress has on the triggering or the manifestation of a skin disease, and psychological care during a dermatological appointment is essential to understanding its origin.

What are the skin problems and diseases that can be the consequence of a psychological disorder?

All skin diseases can be aggravated by psychological stress, acne, eczema, psoriasis and many others through the neuromediators that ensure a permanent connection between skin and brain.

Can stress also favor the appearance of wrinkles?

Stress is one of the important parameters of the exposome, i.e., environmental factors such as diet, pollution, sun, tobacco, alcohol or sedentary lifestyle.

We do not have the age of our skin, or the skin of our age. There is a genetic clock that is passed on to us from our ancestors, but there is also what we do with our skin or our life.

These include environmental factors that will in some way modify our DNA.

The origin of eczema seems to be particularly difficult to identify. How can psychodermatology be a solution in this case?

We can't make a general case, because unfortunately not everything can be solved with a magic wand, but psychodermatology can be a valuable help in this treatment. When we try to touch on the essential factors that can be triggers, patients will be able to approach things differently, and this will help them.

That's our role. The goal is to lead the patient to finding the solutions by giving them some tools.

It is the 'psych' aspect that comes to the fore, to allow the patient to change, to unlock, what may be at the origin of their skin problem.

The goal of psychodermatology is also to anticipate potential problems by listening, and this necessarily requires time with each patient.

As for holistic beauty, can we say that beautiful, problem-free skin depends largely on what we do, eat and express on a daily basis?

Yes, of course. There's a lot of talk about sensory cosmetics, in fact, and we can see that things happen in the brain when we use a pleasant cream, for example.

But it is true that it is important to have pleasure hormones that are released in one way or another to improve one's overall health.

The immune system is impacted by stress or anxiety, so all of those things are very important. That's what we need to work on, that's where we need to act.

Could it be possible that the pandemic, which has been very trying on a psychological level, might lead to an increase in skin problems and diseases in the near future?

Yes, and this is already the case. We've seen people come back who had a very bad experience of lockdown with outbreaks of acne, rosacea, and other skin problems. In fact, there are groups of psychologists and psychiatrists that have been trained to deal with the impact of the pandemic.

We shouldn't disregard what happened, and it's something that's very visible in our specialty. Many patients were relieved to be able to physically return to the practice.

Those who express themselves through their skin and who had a negative experience of this period have developed skin problems, very clearly. And this period [in time] can foster that, if only because we are experiencing an increasingly frantic pace, a kind of acceleration of time.

From a human perspective, this is difficult to keep up with, including for young people, who are caught in a sort of diabolical whirlwind, between professional and family responsibilities.

All these factors can lead to skin problems of all kinds.

It's often said that the eyes are the mirror of the soul, but actually, isn't it the skin?

That's exactly it. The skin will speak and write its story. But what we must remember is that the skin is an organ of communication, a frontier between the outside and the inside, and that new scientific knowledge allows us to better understand the link between skin and brain on a genetic and epigenetic level specific to each individual.