Should you see a psychodermatologist?

June 17, 2021

Get ready for a new term in your skin-care lexicon: psychodermatology, Allure reports.

A relatively new medical specialization, psychodermatology primarily addresses skin concerns that could be linked stress and anxiety. Some of the doctors practicing it even have dual degrees in dermatology and psychiatry.

Overall, however, patients consult psychodermatologists to treat four kinds of psychopathologies: Depression, anxiety, obsessive behaviors, and delusions.

Obsessive behaviors can be seen in repetitive disorders such as  trichotillomania (the so-called “hair-pulling disorder”); while delusions would include parasitosis, which leads people to incorrectly believe that their skin is infested by parasites or insects.

But it’s the first two type —depression and anxiety—that may have more universal implications. While psychodermatology can be used to help address psoriasis, eczema, hyperhidrosis, and alopecia, the benefits can go beyond that to even more common worries like acne and age-related concerns, Allure reports.

That last one may come as a surprise, but according to Amy Wechsler, a dermatologist and psychiatrist in private practice in New York City, a reduction of stress boosts collagen production which can plump lines and wrinkles and help to icnrease cell turnover. “[You remember] what it feels like to go on vacation and people at work are like, ‘Wow, you look great?'” It’s proof, she insists, that in just seven days of tackling stress, she says, “you can see it on your skin.”

Currently, psychodermatology is considered a niche practice in the United States with established clinics devoted to it only found in seven U.S. cities (Rochester, New York; New York City; Tampa, Florida; Saginaw, Michigan; Madison, Wisconsin; Kansas City, KS; and San Francisco)according to the Association for Psychocutaneous Medicine of North America.

But lately, it’s also been popping up in newspaper articles and even inspiring new skin-care lines—like Loum, based on the ingredient neurophroline derived from wild indigo, which the brand claims reduces cortisol levels in the skin.

The practice includes the same familiar topicals and treatments that you’ll see at a traditional dermatology practice, but with the addition of other strategies as needed—among them:

  • Interpersonal therapy,
  • Cognitive behavior therapy (meant to address distorted thoughts that could be adding anxiety),
  • Hypnosis (which has some evidence that it could be beneficialfor certain skin conditions, including warts); and
  • Recommendations for sleep hygiene and mind-body practices like meditation and yoga.

If it’s appropriate, there may also be a psychological medication prescribed, such as serotonin reuptake inhibitors, if the patient exhibits symptoms of depression that could be a contributing factor to the state of their skin.

The effects can have far-reaching impacts on quality of life. “The mind is very tightly linked to the skin, particularly through the sensory nerves that reach the very superficial surface of the skin,” explains Francisco Tausk, dermatologist, past president of the APMA, and head of the Center for Integrated Dermatology.

“These nerves release into the skin small neuropeptides that have a very strong influence on cutaneous physiology and how the skin behaves in health and disease.” Some of these neuropeptides: cortisol, adrenaline, and substance P.

Wechsler takes the example of cortisol, which when chronically raised, can cause a host of problems including inflammation and collagen breakdown. What that can lead to: “Premature aging, acne, eczema, psoriasis—you name it. The skin barrier doesn’t work well, so you get more sensitive to allergens.” In other words, she says, “All sorts of bad stuff happens.”

According to Allure, psychodermatology appointments, just like separate appointments in either field, are highly individualized—depending greatly on the doctor’s practices and the patient’s needs. For example, Wechsler prefers to send her patients to outside specialists when psychological medications are needed, and instead focuses her own practice largely on active listening therapies. Other practices offer additional psychology-based strategies within the practice itself.

Regardless, you’ll still walk away with a regimen. It just may be a little longer and touch on more disciplines than you might be used to discussing with your derm. And that may include more in-office work and even homework, like doing yoga a couple of times a week.

Finally, dealing with elevated cortisol levels on your skin may get easier as interest increases and experts and brands find ways to address it. Loum founder Kat Bryce sees potential for us all to benefit as the United States wakes up to the link between mental health and our complexions. After developing her line, she and her partners are believers. “Now we see the fundamental impact of stress on skin, we hope more developments will come in this space as the need is enormous and the opportunity for effective solutions vast,” she says.

Research contact: @Allure_magazine

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