The skin is the body's largest organ. It is our first line of defence against injury and infection. It contains sweat glands, which regulate our body temperature, and cells that use the sun to manufacture vitamin D.
The nerve endings close to the surface are in constant contact with the brain.
We need to be touched. Babies who don’t experience physical touch every day can quickly lag in mental and physical development.
The brain and the nervous system influence the skin's immune cells through various receptors and chemical messengers, and scientists are now investigating how these respond to psychological stress. Being under stress interferes with the immune system, affecting the skin's capacity to heal. For example, one study showed that surgical patients who felt less stressed in the month prior to surgery had less postoperative pain, and a shorter recovery time. Recent research now indicates that chronic negative stress can disrupt the function of the skin's permeability barrier, which normally keeps out harmful substances and prevents the loss of fluid from skin cell layers.
This kind of disruption is thought to be a major factor in many skin diseases.
While a skin problem should be treated medically first , before looking into its psychological aspects, people who visit clinicians for a skin condition often have a related psychological problem that can affect the way they respond to medical treatment. So a treatment approach will become more effective when combined with psychological strategies. This has lead to the development of the science of “psycho-dermatology” which aims not to substitute psychotherapy for medicine, but rather to recognise that emotional issues may also be involved, especially when a skin condition resists conventional treatment.
According to Boston clinical psychologist Dr. Ted Grossbart, emotional skin disorders can be divided into three broad categories.
Firstly, there are dermatological conditions, which are exacerbated by stress and other emotional factors. They include acne, alopecia (hair loss), various types of eczema or dermatitis (skin inflammation), herpes (oral and genital), profuse sweating, itching, psoriasis (skin scaling and redness), rosacea (skin flushing and eruption), urticaria (hives), and warts.
Keep in mind though that symptoms such as profuse sweating or itching can be caused by prescribed medications, or allergic reactions to cosmetics. In these cases, a routine check up with a dermatologist is important before considering other psychological reasons.
The second group includes cosmetically disfiguring severe skin conditions such as facial acne, psoriasis, loss of pigmentation in the skin and genital herpes, which produce feelings of shame or humiliation, erode self esteem, and cause depression and anxiety. 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.
Finally, some skin conditions can be directly related to psychiatric disorders. These include chronic hair pulling, obsession about minor skin problems or self inflicted damage to the skin. In these cases, psychiatric help is the first port of call, after which health professionals can treat the damage to the skin or the scalp.
Not everyone responds emotionally through the skin, but evidence suggests that, in some people, emotional issues have a strong effect on their skin condition. In that case treating both problems together can be the best chance of success.
Mind-body techniques helpful
Treating combined skin and psychological conditions with pharmaceutical medications is not a preferred option considering the potential side effects of the drugs, but several mind-body techniques have shown promise.
One of the most successful Western therapies so far has been hypnosis. Experiments with small groups of volunteers under hypnosis resulted in a marked decrease in their levels of stress and anxiety, as well as a reduction in levels of pain, inflammation, sweating and itching. On a deeper level, it seemed to have a significant effect on reducing self harming behaviours such as scratching, picking, or hair pulling.
A Belgian study published in the August 2006 issue of the Journal of the American Academy of Dermatology showed that 67% of patients with significant hair loss (alopecia) who underwent hypnosis (including self hypnosis) had total or partial hair regrowth during treatment, although some of them gradually began to lose their hair again during the four year follow-up period.
Another useful therapy is meditation. Muscle relaxation, breathing techniques, breathing, and mindfulness meditation can be very effective weapons against the harmful effects of stress. They increase happiness, and they can be practised any time, without any cost. We will be looking at the Oriental medical perspective to this problem next month.
Olivier Lejus BHSc.MHSc. is a registered acupuncturist and Chinese herbalist practising in Sydney. A former casual university lecturer and tutor in Oriental medicine with over 15 years experience in clinical practice, Olivier specialises in Japanese- style acupuncture for the treatment of male and female infertility, migraine, pain, and insomnia.www.olejusacupuncture.com