It’s our largest organ and the stuff that separates us from our decidedly hairier ape cousins, so it’s perhaps not surprising that our skin is so intrinsically linked to the human psyche.
Forget bad hair days, a bad skin day is much more likely to induce feelings of despair, and there’s no ‘toss your hair in a topknot and handle it’ equivalent for a misbehaving epidermis. And yet according to Mintel more than 44% of us have suffered a skin condition in the last 12 months, which makes for a whole lot of skin misery.
But while legions of products claim to make our complexions ‘flawless’, there are also innumerable conditions that no amount of ‘radiant’ cover-up will ever transform. It’s for cases like these where psychodermatology could be the key to making you love the skin you’re in.
‘People have known about psychodermatology for centuries, but it’s only in the last 10 years that it’s starting to become more widely known in the immediate dermatology community. If you compare it to other sub-specialties it’s still relatively new,’ says psychodermatologist at Eudelo, Dr Alia Ahmed. ‘Thanks to more scientific evidence and robust studies, there’s finally a real acknowledgement in the medical community that chronic skin conditions such as acne or psoriasis can have a huge impact on people’s lives. Treating the skin itself isn’t enough, you have to look at people’s emotions and their relationship with their skin too,’ she adds. ‘To put it simply, chronic skin conditions can make people unhappy, and feeling unhappy can make your skin condition worse – so the mind-skin link is much more established at a biochemical level.’
It’s something that California-based clinical psychotherapist Dr Matt Traube heard first-hand from his father Dr Ted Grossbart, who was a pioneer in the field. ‘My father was in grad school at Harvard when he noticed that a patient who had presented with rashes all over his body got significantly better with psychological intervention. Until then he hadn’t realised it was a ”thing” and ended up spending the next 45 years practising in it.’ As Dr Traube explains, our skin is one of the first things we notice about someone, and as social animals we’re primed to want to fit in. ‘Most people want to feel like they don’t look too far off-centre from where the rest of the population is, and having a visible skin condition can often make people feel very uncomfortable psychologically; like they’re somehow not fitting in.’
Speaking of fitting in, is the fact that we’re scrutinising our faces more than ever messing with our skin’s mojo? ‘Social media presents a very unrealistic idea of perfection but also there’s a movement for people to be more open about their skin problems, introducing the notion that it’s OK not to look perfect,’ says Dr Traube.
‘As a dermatologist I love that people are being more vocal about how their skin makes them feel. Various bloggers and celebrities with skin conditions such as Winnie Harlow [who has vitiligo] are great ambassadors. They’re saying: “This is my skin and I’m happy to put it out there,”’ agrees Dr Ahmed.
Indeed, acceptance seems to be a cornerstone to psychodermatology, especially for chronic conditions such as vitiligo where a cure may never be found. Both doctors confirm that for many of their patients, just feeling listened to and acknowledged can make a huge difference to their quality of life (and often as a direct consequence, their skin too).
‘There’s something called acceptance and commitment therapy, where you learn how to accept your condition and how to deal with negative thoughts about it,’ says Dr Ahmed. ‘Learning to live with your condition can be difficult but it’s also very possible to learn to love and accept that your skin is part of you.’
Perception also adds an interesting layer to psychodermatology, and both doctors allude to what is essentially a kind of skin dysmorphia where a patient may allow a couple of spots to dominate their thoughts, while others might refuse to accept their skin condition has improved. ‘There are lots of studies to show the chronicity of these skin conditions actually changes people’s personalities. If you’ve had eczema since you were a baby, you’re more likely to be more anxious and dependent on others,’ says Dr Ahmed. ‘People become conditioned to not feeling good about themselves and it can take a long time to break that, which is why we carry on working with our patients even after the skin condition itself is better.’
Other methods employed by the doctors include cognitive behavioural therapy, which is helpful for people with social anxiety surrounding their skin condition; habit reversal therapy – particularly useful for people who get into the habit of scratching; and even family therapy for when the family dynamic causes the patient stress which in turn triggers their skin condition. It’s all about treating each patient as an individual and getting to the root of how they’re feeling. ‘I do a lot of detective work and will employ a number of methods based on what I find out,’ says Dr Traube. ‘For scratching I might use a mindfulness technique. I had a patient with vitiligo who wouldn’t leave the house without being totally covered up and didn’t even like her boyfriend or family seeing her skin exposed. I used something called ERP or exposure and response prevention therapy, which is essentially gradually exposing someone to something that is challenging to them.’
‘The psychotherapy aspect of psychodermatology can really help by teaching different types of relaxation techniques such as guided imagery and mindfulness, working the nervous system to help calm it down. This in turn can help us calm down in general,’ says make-up artist and ‘human givens’ psychotherapist Lee Pycroft. ‘As well as tackling the stress people feel about their skin condition, it’s also about loosening the rigid beliefs they may have about their appearance from past conditioning.’
By now, most of us have heard about the #bodyposi movement, but how about employing a little skin positivity while we’re at? And if showing our epidermis some love and acceptance requires a little help to get there, maybe psychodermatology is the answer we’ve been looking for. ‘It breaks my heart when someone pays to see me privately when they could have seen me on the NHS, as I know how much they’ve been through to get here,’ says Dr Ahmed. ‘A lot of people still don’t realise the help that’s available to them and patients need to know that if they’ve seen their GP and they’re still not happy with their skin they can ask to see a dermatologist or psychodermatologist.’ Beauty is, after all, only skin deep.
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