Why Adding a Psychodermatologist to Your Care Team Can Help With Eczema

Whether you’ve just been diagnosed with eczema or you’ve been living with the condition for some time, paying attention to your emotional and mental health is a crucial part of managing it.

“Eczema is usually with you for life. If the disease is making you miserable, [increasing] your stress and anxiety, or leading to depression and poor social relationships, finding somebody who can help you manage those parts of it can be a huge help,” Dr. Piliang says. This is where a psychodermatologist can help.

Psychodermatology focuses on the interaction between the mind, skin, and body, says Mohammad Jafferany, MD, the president of the Association for Psychoneurocutaneous Medicine of North America and a psychodermatologist in Saginaw, Michigan.

Professionals in this specialty are trained in dealing with the psychological and psychiatric aspects of skin disease, Dr. Jafferany says. “This is usually a dermatologist who has special training or interest in psychiatry, and who can combine and utilize their knowledge in both fields to treat psychodermatology disorders,” he says.

All skin diseases can be difficult to deal with, but that’s especially true for people with eczema, says Piliang. “Eczema can impact school performance and work performance, as well as relationships with your family and friends — it can have a big impact on quality of life,” says Piliang.

“People with eczema report a worse quality of life than people with other kinds of chronic diseases, such as heart disease or hypertension, and they report a worse quality of life than people with other types of skin diseases, such as acne or alopecia. This is especially true if they have moderate to severe eczema,” she says.

In addition, living with eczema can be isolating for many people, in part due to the physical appearance of the rash, says Piliang.

“People with eczema can feel embarrassed or uncomfortable to go outside,” she says.

This is compounded by the fact that any physical activity can make eczema worse in some people, she says. “When they go out into the heat and they start sweating it can make the itching go crazy,” she says.

Worse, the itching caused by eczema is also very disruptive to sleep, according to Piliang. “People with eczema tend to be itchier at night, and it can keep them up or wake them. Poor sleep can lead to irritability, inattention, drowsiness — you just feel awful,” she says.

While psychologists are very good at dealing with mental health, bringing in a psychodermatologist who also understands the skin aspect of the condition can be really beneficial, Piliang says.

“They can help you get to a point of acceptance about your disease and the routines you have to go through to manage your disease; that can help with stress, anxiety, and depression,” she says. “Knowing you have someone you can turn to and trust when you have a flare or you’re experiencing mental health issues related to your disease is incredibly important.”

In a typical dermatological visit, your doctor focuses on the skin disease — they examine and treat. A consultation with a psychodermatologist complements the standard dermatology exam, focusing on the mental and emotional side of the condition, in addition to the physical side, Jafferany says.

A psychodermatology visit includes a detailed interview that focuses on the patient’s psychosocial history plus a full examination of the skin, says Jafferany. “That includes what is going on in their work life, family life, and social life. I ask about any marital or relationship problems and work-related stress because all these things can directly or indirectly affect skin disease,” he says.

Any kind of stress can lead to an inflammatory response, which can cause eczema to get worse, he says.

Ideally, regular consultation with a psychodermatologist should address these areas:

• Identify symptoms and provide strategies around managing them. If you have certain behaviors you want to stop, such as picking at your skin or scratching, a psychodermatologist can create a plan to help reduce or eliminate them, says Jafferany.
• Improve sleep hygiene. A psychodermatologist can work with you to identify and fix the issues that may cause poor sleep. Improving sleep may help reduce stress, depression, and anxiety, says Piliang.
• Complement cognitive behavioral therapy (CBT). CBT can be useful in some people who have a distorted thought process that exacerbates anxieties, says Jafferany. “We work to change those negative thought patterns so that the person doesn’t act on them. CBT can be used to manage stress as well,” he says.
• Break the cycle of stress that can make eczema more severe. There can be a cycle of stress that occurs in people with eczema, according to Jafferany. “Eczema causes stress, not only because it is visible but because it can cause itching and disruptions in sleep. That stress can lead to increased inflammation, which further worsens the disease, which can go and on,” he says. A psychodermatologist can work with you to help get flares under control through medication and by giving you coping skills to manage day-to-day stressors, he says.
• Prescribe medications to treat anxiety or depression. In some cases, a psychodermatologist may prescribe medications such as an antianxiety medication or antidepressant to treat skin-related psychological issues, says Jafferany.

• All forms of eczema are linked to depression and anxiety, so having a psychodermatologist — a dermatologist who’s also qualified to treat mental health conditions — on your team can make your medical care more effective and save you the trouble of seeing two practitioners.
• A psychodermatologist will examine you physically and also talk with you about any emotional concerns related to your health.
• They can prescribe medication for both dermatological and mental health symptoms.