Here's Why You Might Need to See a Psychodermatologist

August 24th 2017

Almost everyone experiences a minor skin issue at some point in their lives, and it can be tied to stress. For instance, maybe you've noticed that you tend to get breakouts or a temporary rash during periods of high anxiety, like when preparing for a test or getting ready to start a new job. 

However, while these manifestations are minor annoyances for most, some people's skin issues are so persistent that that they need a medical professional who explores the connection between the mind and the skin. 

As The Cut's Melissa Dahl explained, researchers around the world are studying the "brain-skin axis" and how emotional issues and skin problems are linked, in field called psychodermatology. 

"So far, it’s safe to say that, for some people, emotional problems do seem to worsen skin problems, and vice versa," Dahl wrote. "But what’s happening in the brain and body to cause this? And is psychotherapy really powerful enough to make it stop?" 

ATTN: talked to Matt Traube, a psychotherapist who specializes in psychodermatology and sees patients with a range of skin issues. 

ATTN:  I don't think most people have heard this term before. So first of all, what is psychodermatology? 

Traube: Psychodermatology is essentially the relationship between psychology and dermatology and [the] underlying emotions that can underline a skin condition. We ask, "what are the triggers? how do we learn and better understand those connections?" 

ATTN: Would a person specializing in psychodermatology be a type of dermatologist or someone trained in psychiatry? 

Traube: I think it could be a dermatologist. It could also be a psychologist or a psychiatrist. Dermatologists tend to treat the physical symptoms. They're really working on the the body. In psychiatry, we tend to treat the mental, but [I] don't want to say only psychiatrists are doing it. When I see people, it's often because they've seen a couple dermatologists and [the dermatologists have] said, "I think there is psychological issue here. You should see someone." 

ATTN: Would a new patient typically see multiple doctors or dermatologists before they see you? 

Traube: More often than not, but not all patients. Patients that I see will usually see a dermatologist or two or in some cases, will see a handful of dermatologists before they see me. They might say, "You know I've got this issue and it's not going away and conventional treatments aren't working. I notice things get worse when I'm stressed or things get worse around an emotional event." There [are] studies that clearly correlate that when we're stressed out, the body shows more acne. Not for everyone, but a percentage. I think commonly people know this. They notice, "When I'm stressed out, my skin looks worse." A variety of conditions get worse when there's stress. If you can get something that's kind of quick and easy from a dermatologist, absolutely do that. Who can argue that? For dermatologists, there are a lot of interventions that they can use that do wonders, but there is a percentage of people where the skin condition is a little more stubborn. 

ATTN: What kind of skin conditions do you see in your office?

Traube: I see a lot of people who have a tough time with acne. There [are] two issues at play: one is the actual skin condition and the other is the stress the skin condition causes. I may just see [a] scar but to them it's a huge deal. It makes them feel uncomfortable in social situations or on date, or it's an obstacle for them to thrive occupationally. Let me give you a rundown of what else is in my practice.  Like I said, I see people with acne. I also see people with body dysmorphic disorder; that's when people convinced some part of their body is disfigured or flawed. I see people with eczema and psoriasis. Certain types can be very itchy.

They'll say, "I've got this rash here. It's really itchy," and I'll try to help them work with the itch component. Sometimes the itch is really unbearable. I see people with skin picking issues. They've got really compulsive skin picking issues and it's really affecting their life.  Also, hair pulling. I see a portion of people who pull their hair, and can't stop pulling it. I also see people with rosacea, and sometimes I'll see people with hives. I would say those are the main ones. A lot of these skin conditions [are] really stubborn and they're not responding to the normal treatments. 

ATTN: What is the most important thing for people to know about psychodermatology? 

Traube: It's generally the intersection between dermatology and psychology. I think maybe something that would be helpful for people to understand is that it's about working with psychological aspects of the skin condition and it's this idea that emotions like stress, anger, and anxiety can trigger skin conditions. We can also help people manage the emotional impact of the skin conditions. A lot of my clients will say they feel that skin in general is very trivialized. When you have a skin condition and it's bad, it's very serious and people's lives are really ruined by it. Having a skin condition is very subjective. You can have three people with the same condition and some people will be very limiting and some people are not bothered by it. For people who struggle, it's a big deal and we're working to try to make it less of a big deal.

RELATED: This Common Nervous Tic Could Be a Serious Mental Illness

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