Psychodermatology – What is it?

Anyone with excoriation disorder likely has gone to a dermatologist at some point. There are physical as well as psychological reasons for the development of skin picking disorder, yet for a long time, dermatology focused on the skin condition. With advances in science and technology, the field of psychodermatology is gaining more recognition.

Dermatologists now understand the role of the “skin-brain connection” in psychosomatic skin conditions. As the largest organ in the body, the skin contains a dense network of nerve cells sensitive to stress and sympathetic nervous system activation. The sympathetic nervous system is the part of the central nervous system that activates during the fight or flight response. It’s that feeling of butterflies, nausea, tingling, and edginess that people who live with anxiety or panic or any of the related disorders feel. In people who experience chronic stress, the sympathetic nervous system remains on red alert all the time. Imagine what the skin experiences in a constant state of red alert. In addition to nerves, the skin is also a significant part of the endocrine system, meaning it responds to hormones such as cortisol, estrogen, testosterone and many others.

Psychodermatology considers the role of stress activation in skin disorders. In some cases, too much stress can cause an outbreak of a skin condition but similarly, a skin condition can cause increased stress activation. In extreme cases, excessive stress causes such severe skin diseases that a patient cannot function. Regarding body-focused repetitive behaviors such as compulsive skin picking, many people do not want to go to a dermatologist due to the stigma and embarrassment involved with telling a doctor the reason for skin wounds. However, effective treatment of excoriation disorder may involve a complete evaluation to determine if an underlying skin, hormone, or nervous system condition contributes to the compulsive picking.

While most people with compulsive skin picking seek out therapists to help them with the compulsions and behaviors related to picking, consulting with a dermatologist can also help. On the surface, a dermatologist can help you care for your skin before, during, and after picking episodes. However, a psychodermatologist will also investigate and evaluate further to determine the connection between your physical skin as well as your endocrine and nervous systems within your skin.

Effective treatment comes from determining the appropriate contributors to a condition. The relationship between the skin and the mind goes both ways, so treatment may involve fixing the mind but it may also need to fix the skin or its related systems. 

Information for this article came from

Gupta, M. A. (2018). Psychiatrick dermatology: Management. Clinics in Dermatology, 36, 687-690. https://doi.org/10.1016/j.clindermatol.2018.09.013