Skin & Mental Health - IOSH · ©EnviroDerm Services 2018 Conclusions •The skin is an organ of communication •Many links between skin and mental health •Psychiatric disorders

Skin & Mental HealthDr Helen Taylor

EnviroDerm Services

©EnviroDerm Services 2018

Overview of presentation

•The origins of the skin

•The skin in health and disease

•The importance of our skin

•Psychological influences on skin disease

•Skin disease influencing psychology

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Our Remarkable Skin

•Our largest, oldest and most sensitive organ

•16% of our total body weight

•Average individual has 2m2

• It protects us 24/7 and is under constant attack

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Origins

•One of the earliest organs to develop in the embryo

•Sense of touch is highly sensitive as early as when an embryo is six weeks old

•Most immediately exposed to the environment

•At birth it goes through extreme changes

•Throughout our lives it is a primary interface between our body and the complex world in which we live

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A Simple Membrane?

•Varies on different skin sites

•Changes over the course of our life

•Sleep impacts skin

•The skin can repair itself

•Significant damage can lead to different skin formation

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Skin Site Matters

•Thickness

•Structure

•Functionality

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©EnviroDerm Services 2018 7

The Life of Skin


Sleep and the Skin

• Sleep affects the appearance of the skin

• The skin changes with our circadian rhythm

During Day Light During the Night

Highest skin protection Highest DNA repair

Highest skin thickness Highest cell proliferation

Highest sebum production Highest skin temperature

Highest pH Highest barrier permeability

Lowest cell proliferation Highest itching

Highest moisture loss

Highest skin blood flow

Lowest barrier recovery

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Skin Repair

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Scarring

Images courtesy of Scar Academy


The skin

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Epidermis

Dermis

Subcutis


The skin as a barrier

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Skin Diseases

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Skin Disease

Dermatitis Other

Exogenous Endogenous Non-occupational Possibly Occupational

Contact dermatitisIrritantAllergic

Photodermatitis

AtopicSeborrhoeic

DiscoidPhotodermatitis

Etc.(many different types)

PsoriasisPsoriatic arthritis

Dystrophic epidermolysisBullosaTineaEtc.

UrticariaVitiligoCancersOil acne

Chrome UlcerCement burn

Etc.

Non-dermatitic


The Importance of the Skin

• Important physiological functions

•Social significance

• Links between skin and other health issues

• Links between psychology and skin• Psychological influences on skin• Skin influence on mental wellbeing

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Functions of the skin

• Your skin is the outer covering of your body

• It acts as a barrier to contain body fluids etc. from escaping

• It acts as a barrier to prevent harmful substances, bacteria etc. from entering

• It has to be flexible and elastic


Skin and the Environment

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Skin

Body

. . . . . . . . .. . . . . . . . . . . . . . . . . .

Vitamin D3

Sense organs


Social Significance

•First thing people see• First impression• Influences behaviour

• Society places great importance on beautiful looking skin

•Our skin can influence how we feel about ourselves

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Making a Good First Impression

•Can affect appearance

•Myths surrounding lack of personal hygiene

•Stigmatism

•26% of psoriasis patients had experienced an episode where someone had avoided touching them

•Rumsey et al. stigmatism study found that this was a real affect and not just perceived

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Skin Influencing Society

•Continual strive to look good•Estimated market share for cosmetics & toiletries in 2017 was £9.77

bn•Skin research -> new developments

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A range of products and treatments


Skin and Self-Esteem

•Feeling unattractive

•Feeling outcast

• Impact on self-esteem not necessarily linked to the severity of the skin condition

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Skin Disease in Relationships

•Appearance, attractions & shame

•Difficulties in communication

• Impact on social networks

•Body image and sexual intimacy

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Skin in other disease

•Nutritional deficiencies

•Diabetes

•Carpal Tunnel

•Cardiology

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Psychological influences on skin

• Long established that there are links between emotions and skin disease

•Strong links between the nervous system and the skin

•Degree of reaction to a stimulus is governed by our perception of the stimulus

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Stress & Skin

•Physiological changes• Increased TEWL• Increased sebum• Changes in colour

•Acute stress

•Chronic stress• Increased susceptibility

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Stress with Inflammatory Skin diseases

• Itching

•Sleep disturbance

•Withdraw touching

•Diet modification

•Disfigurement reactions

•Underachievement

• Lifestyle stress

•Emotional stress

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Stress & Recovery

•Patients with marital problems recovered slower than those without marital problems• Impacts the immune system

• Influence from external stressors can impact on understanding skin disease

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Skin Problems Influenced by Stress

•Atopic eczema/dermatitis

•Occupational dermatitis

•Seborrheic dermatitis

•Psoriasis

•Urticaria

•Alopecia

•Vitiligo

•Wound healing

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Psychological Causes of Skin Disease

•Psychosomatic skin disorders

•Undifferentiated somatoform idiopathic anaphylaxis•Cause is not due to exposure to a substance•Psychological factors are underlying cause

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Treatment for Psychological Conditions

• Links between some pharmaceutical therapies for psychological conditions and some skin diseases• Acne• Psoriasis• Dermatitis

• Lithium

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Comorbidity

•Depression

•Obsessive-compulsive disorder

•Social anxiety disorder

•Post-traumatic stress disorder

•Body image disorders

•Delusional disorders

•Side effects of treatments

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Depression

• Chronic recurrent skin disorders are known risk factors for more persistent episodes of depression

• “We conclude that the patients with atopic dermatitis were more depressive and psychosomatic symptom-prone than normal controls and suggest that some patients with atopic dermatitis should be treated both dermatologically and psychiatrically.”

• “onset of psoriasis prior to age 40 years has been associated with greater difficulties in expressing anger”

• Increased severity of psoriasis leads to increase in suicidal ideation

• “Severity of acne does not necessarily correlate with severity of depression”

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Depression linked with a wide range of dermatological disorders

•Pain

• Irritation

• Impact on sleep

•Treatments can be unpleasant

• Impact on social interaction

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Obsessive-compulsive Disorder

•Can be caused by, be a cause of skin disease or both

•Hand washing

•Hair plucking

•Picking of a lesion on the skin

•Repetitive bathing

• scratching

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Social Anxiety Disorder

•Fear of social situations

•Can interfere significantly with life

•Encountered in cosmetically disfiguring skin diseases

•Particularly prevalent when occurs during developmentally critical periods of life

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Post-traumatic Stress Disorder

•Trichotillomania

•Dermatitis artifacta

•Body image problems associated with lack of touch during early years

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Body Image Problems

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•Camouflage or hide perceived problem

•Patients with eating disorders • often have concerns with skin

image• Dietary intake problems can

affect appearance of skin

Complaints include:

• Thinning hair

• Acne

• Wrinkles

• Scars

• Vascular marks

• Pigmentation of the complexion

• Swelling

• Asymmetry

• Excessive facial hair


Delusional Disorders

•Parasitosis

•Crawling sensation on skin

•Emitting foul odour

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Side effects of treatment

• Isotretinoin• Depression

•Dapsone• Manic depression

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Conclusions

• The skin is an organ of communication

• Many links between skin and mental health

• Psychiatric disorders often assumed to occur as a result of skin problem but may be the cause or a causative factor in the skin problem

• Treatment of a range of skin disorders may involve therapies to deal with psychological components

• Skin disorders can significantly impact overall mental health and wellbeing

• Changes in the skin may indicate other underlying health issues

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Thank you for your attention!Questions?

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Documents

Skin & Mental Health - IOSH · ©EnviroDerm Services 2018 Conclusions •The skin is an organ of communication •Many links between skin and mental health •Psychiatric disorders