Psychodermatology always gets a spell-check dotted red line under it on my laptop! The term has been around quite a while in various guises, including psychocutaneous (another dotted red line!) medicine and psychosomatic dermatology (that’s OK!). Part of psychological medicine and liaison psychiatry, psychodermatology is of interest to clinical practitioners in both mental health and dermatology, as well as in primary care and family practice.
Unfortunately those of us who practise in this neck of the woods sometimes get called skin shrinks, which makes us out to be a bit weird perhaps. But the close link between skin and brain goes back to embryology: it’s important to remember that the nervous system and the skin share their origins in one of the early tissues of the foetus, the ectoderm.
The Traffic Light Phenomenon, part of everyday behaviour, shows us one of the links between mind and skin. We rub and scratch our skin when we are frustrated, anxious, bored, worried, depressed, preoccupied, upset or stressed. Mental rumination, restless thinking, or worry is often accompanied by skin scratching that may or may not involve any itch, but in each of us may be characteristic behaviour pattern that friends and family immediately recognise as indicating our frame of mind.
So far this need not involve clinical practice, but what is important is that when skin is diseased, these common behaviours can complicate matters.
With atopic eczema the rubbing and scratching can lead to a thickening of the skin called lichenification. This chronic or longstanding type of eczema is relatively resistant to standard topical treatment. Fortunately however a combination of simple behaviour therapy called habit reversal and optimal topical medication is effective, either as a self-help treatment programme, or through referral to those of us working in psychodermatology (there’s that dotted line again!).