by Nicole Schnackenberg
The psychological/emotional underpinnings and ramifications of suffering from various skin conditions have only recently been given serious consideration in the scientific literature. This is despite the fact that emotional correlations with dermatological conditions such as eczema and psoriasis were made more than a 150 years ago when Erasmus Wilson, in 1850, attributed skin manifestations to “disorders of the nervous system, like emotions, especially of a depressive nature”. Closely behind him came Hillier who expressed his conviction that nervous excitement, shock and fear can cause changes in the condition of the skin.
Not only do emotions appear to affect the health of our skin but the health of our skin, also, can have a huge impact on our emotions. People may struggle with shame, distress and low self-esteem if their skin condition is of a visible nature, with hiding and camouflaging being two common responses. Pain and discomfort from the skin condition can also lead to depression and anxiety for some people.
Recently, the field of psychodermatology has entered the psychological and medical arena; it looks closely at the relationship between psychological distress and various dermatological conditions. Doctor Linda Papadopoulos is leading this field in many ways, with her extensive research suggesting an association between stressful life events and the onset of skin conditions, as well as the phenomenon of skin conditions igniting distress in significant numbers of sufferers. Doctor Papadopoulos felt moved to carry out research of this nature when she noted the huge change in the personality and the flailing self-esteem of a family member as a result of the onset of their vitiligo, a long-term condition which causes white patches to develop on the skin. In a recent magazine interview, Doctor Papadopoulos explained, “When the embryo is developing, both the skin and central nervous system develop from the epiderm. That’s why when we’re nervous we sweat and blush. In research we did in the Royal Free we found that your personality really affects the progression of these conditions. If you speak to anyone who’s had eczema they’ll tell you they can map out exacerbation with things going on at home. One of the things my research into vitiligo found was that stress can kick it off, like bereavement, and separation.”
In the recent piece of research linked here, scientists looked at the importance of mindfulness in psychosocial distress and quality of life in people with dermatological conditions. Mindfulness has been shown in multiple studies to have a positive impact on anxiety, depression and stress among a variety of other presentations. Mindfulness has been used in psychosocial interventions to reduce the distress associated with the avoidance and social anxiety sadly found in many skin conditions. Little is known, however, about the relationship between naturally occurring levels of mindfulness and distress in people with these conditions.
One-hundred-and-twenty adult dermatology patients completed items assessing the objective severity of their skin condition, shame, fear of negative evaluation by others, anxiety, depression, quality of life, and levels of mindfulness. Considering depression, 14% reported mild, 5% moderate and 2·5% severe symptoms. For anxiety, 22% reported mild, 23% moderate and 6% severe symptoms. In addition, 33·4% reported clinically significant social anxiety. After controlling for subjective severity, mindfulness explained an additional 19% of the variance in depression, 39% in anxiety, 41% in social anxiety, 13% in skin shame and 6% in dermatological quality of life. One specific facet of mindfulness, namely acting with awareness, was found to be the most consistent predictor of lowered distress. Researchers concluded that their findings suggest that higher levels of mindfulness are associated with lower levels of distress in people with dermatological conditions. This is certainly suggestive that offering mindfulness training for people with these struggles may be helpful in reducing their levels of distress. We are very happy to hear this and to be able to share these hopeful findings with you!
Further research is still needed into the usefulness of particular mindfulness techniques and their application for people with various kinds and levels of severity of skin conditions. Yet, a good start has been made. Perhaps the most important thing to remember is that the severity of the skin condition does not necessarily predict the level of distress; people can experience extreme distress as a result of even seemingly minor dermatological complaints, whilst those with more overtly severe skin condition may cope very well and experience little impact on their lives. Psychological support, including mindfulness training, therefore, should be made available to all people with dermatological conditions of whichever level of severity. If you or someone you know is struggling with emotional distress related to the condition of their skin, two good places to start are the British Skin Foundation (www.britishskinfoundation.org.uk) and Changing Faces (www.changing faces.org.uk). Namaste.