Skin and Psyche : Diversionary Symbiosis

A significant proportion of patients with skin diseases have associated psychosocial factors. Not only does psychopathology manifest on the skin in absence of any real skin disease, primary skin disorders can also be exacerbated by emotional stress adversely influencing the homeostasis of immunological and inflammatory processes in deeper layers of the skin. Furthermore, many patients develop emotional problems as a result of having disfiguring skin diseases. In addition, some patients having solely sensory disturbances in absence of primary dermatoses or identifiable medical or neurological conditions, as well as some purely dermatologic conditions such as post-herpetic neuralgia may preferentially need psychotherapeutic modalities to address their underlying psychopathology irrespective of the presenting dermatologic manifestation arising out of 'somatisation' of a psychopathology into physical problems. The most obvious course of action of referral to a psychiatrist or another mental health professional may unfortunately not be readily tenable either due to the perceived stigma associated with psychiatric illness or lack of insight on the part of patients. In the interregnum, effective management of the psychologic or/and psychiatric problems can only be done by the dermatologist provided he has an adequate knowledge base and experience to undertake psychotherapeutic modalities.