Psychodermatologic disorders usually fall into three broad and sometimes overlapping categories:
- Psychophysiological. These are skin problems that have a physiological basis but can be exacerbated by stress and other emotional factors. They include, among others, acne, alopecia areata (hair loss), various types of eczema or dermatitis (skin inflammation), herpes (oral and genital), hyperhidrosis (profuse sweating), pruritis (itching), psoriasis (skin scaling and redness), rosacea (skin flushing and eruption), urticaria (hives), and warts. Some, such as profuse sweating and itching, can be symptoms of other medical conditions or reactions to medications — which is why a workup by a medical clinician and standard dermatological treatment are crucial before considering psychological factors. “Rosacea responds quickly to topical medications and will not respond to psychotherapy or one’s attempts to manage stress,” explains dermatologist Dr. Suzanne M. Olbricht.
- Secondary psychiatric. A cosmetically disfiguring or potentially socially stigmatizing skin disorder such as severe acne, psoriasis, vitiligo (the loss of pigmentation in the skin), or genital herpes can produce feelings of shame or humiliation, erode self-esteem, cause depression and anxiety, and in general lower quality of life. There is much evidence of a correlation between skin disorders and depressive symptoms. One study, for instance, found that patients with severe psoriasis and acne were twice as likely to be suicidal as general medical patients. However, in such cases, it can be hard to distinguish cause from effect.
- Primary psychiatric. Some skin difficulties are symptoms of a psychiatric disorder, such as chronic hair-pulling (trichotillomania), the belief that the body is infested with organisms (delusional parasitosis), preoccupation with and distress about an imagined or minor defect (body dysmorphic disorder), and self-inflicted damage to the skin (dermatitis artefacta). Such illnesses require psychotherapy and sometimes psychiatric medications. But a dermatologist, who may be the first health professional the individual sees, can treat damage to the skin or scalp.
