Management of Psychodermatologic Disorders

Philip D. Shenefelt, MD, MS


Dermatology Nursing 

In This Article

Psychosomatic Aspects of Skin Disorders

Roles of Stress and Emotion

Inflammatory and sensory skin disorders are significantly affected by stress and emotion. Griesemer (1978), who was both a dermatologist and a psychiatrist, developed an index of the effect of emotions on various skin disorders (see Table 2). The interactions of stress and emotion on the skin and skin disorders are mediated by the nervous system including autonomic nervous system, immune system, and hormonal system (Urpe, Buggiani, & Lotti, 2005). Stress can also induce or worsen anxiety disorders or depression in susceptible individuals. Drugs which reduce anxiety or depression such as benzodiazepines or selective serotonin reuptake inhibitors (SSRIs) can be helpful in those individuals. Nonpharmacologic methods such as heart rate variability biofeedback, cognitive-behavioral methods, hypnosis, meditation, and relaxation can counteract the effects of stress and emotion (Shenefelt, 2008).

Reducing Stress and Emotions in Specific Skin Disorders

Psychosomatic components play a significant role in a number of inflammatory, immune mediated, and behavioral skin disorders (Panconesi, 2005). In one study, 10% of patients at a dermatology clinic had psychosomatic disorders and another 15% had adjustment disorders (Seyhan, Aki, Karincaoglu, & Ozcan, 2006). Reducing stress and emotions and behavioral habits that damage skin, hair, or nails can enhance response to treatment when used in conjunction with other appropriate treatments for the specific skin disorders. Stress may be measured with subjective units of distress on a 0–10 scale and may be reduced with heart rate variability biofeedback, cognitive-behavioral methods, hypnosis and self-hypnosis, meditation, relaxation training, or yoga (Ehlers, Stangler, & Gieler, 2005; Hughes, Brown, Lawlis, & Fulton, 1983). Specific skin disorders that can benefit from these measures include acne, alopecia areata, atopic dermatitis, dermatitis artifacta (factitial), dyshidrosis, herpes simplex, hyperhidrosis, lichen planus, lichen simplex chronicus, neurotic or psychogenic excoriations, nummular dermatitis, perioral dermatitis, pruritus, psoriasis, rosacea, seborrheic dermatitis, telogen effluvium, trichotillomania, and urticaria (Shenefelt, 2008). If necessary, interrelated anxiety or depression can be treated with anxiolytic drugs or antidepressants (Lee & Koo, 2003) (see Table 3).


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