Denda, Denda and Takei published a paper this month (February, 2013) that presents a hypothesis connecting our emotional states with epidermal pathology, i.e. emotional distress is linked to bad skin health.

The mechanisms they propose for this problematic relationship include the release of a range of neurotransmitters and pro-inflammatory mediators from the keratinocytes in the epidermis. These skin cells influence the skin’s ability to maintain an effective barrier in the stratum corneum and skin conditions such as atopic dermatitis and psoriasis may arise as a result.

Conversely, damage to the skin that leads to this barrier being impaired also triggers the release of cytokines associated with depression in cancer patients. What’s more, skin injuries are associated with increased glucocorticoid release and glucocorticoids are in turn correlated with depression.

Why Depression May Help Skin Heal

There are some who believe that depressive symptoms are actually of benefit in that they inhibit a person’s desire to socialise and venture out into the world. As a reaction to physical trauma this makes a great deal of sense initially as it reduces the likelihood of infection and further injury in the weakened state and allows for conservation of energy with which to recover faster.

The problem arises when the condition becomes chronic and the depressive state also becomes permanent. In such cases the psychological symptoms may begin to actually impair healing and reduce quality of life overall.

Psoriasis and Psychiatric Help

A literature review by Russo, et al (2004), noted that some 1-2% of the population suffers from psoriasis and that this common skin disorder is associated with a range of psychological problems, including poor self esteem, sexual dysfunction, anxiety, depression and suicidal ideation.

Interventions to treat the skin disease may, therefore, help patients with mental health issues, whilst adjunct therapy that aids patients’ emotional health may in turn help their skin.

Skin Emotion Specialists – What Next?

Back in 2002, Fried suggested that dermatologists begin referring patients with psychocutaneous disorders or skin conditions with a psychological component to ‘skin emotion specialists’ in order to destigmatise the psychiatric nature of the disease. Such specialists could be psychiatrists, counsellors, biofeedback specialists or even social workers with an understanding of the impact of a skin condition on mental health.

The lack of skin emotion specialists suggests that the idea never really caught the attention of dermatologists. However, with increasing evidence of a significant link between psychological health and skin health the concept of a skin psychiatrist may make a comeback.