In the last 10–15 years, large-scale research involving psychiatrists has begun in the field of dermatology. And it turned out: not everything that occurs on the skin is caused by dermatological diseases. Before that, some patients went to doctors for years, treating rashes by all means – from the latest drugs to kerosene – without much success. The disease returned again and again. And all because the main reason has not been eradicated. And only when these people came to the psychiatrist did some kind of clearance emerge. I will give you an example. A woman had a pimple on the eyelid, itching appeared. She went to the ophthalmologist, she was prescribed an ointment that did not help.
The patient was referred to a dermatologist with a suspicion of demodicosis, a disease caused by a microscopic tick. The causative agent was not found. Than only a woman treated her disease: alcohol, calendula, various eye ointments. Itching, rashes and inflammation began to spread to another eyelid. By the time this patient came to see me, she had been struggling with her problem for five years. And her appearance and condition were not very good. We began to understand how her illness began. It turned out that when a woman died her husband, she was seriously worried about the loss. And the problem that has arisen in the eyelid has exacerbated the situation.
As a result, the patient developed depression. We treated this woman mainly with antidepressants. Of course, anti-inflammatory ointments were also used, because her face was acne. But if previously no local drugs helped, now that the treatment has concentrated on improving her psychological state, success has been rapidly emerging. Two years ago, I saw this woman: she feels great, looks wonderful, her eyes, face skin are clean.
What is primary and what is secondary in such situations? Did depression cause skin disease? Or acne scratching led to depression?
In this case, of course, the woman’s depressed state after the death of her husband manifested itself in the form of a skin disease. But it happens differently. Imagine: a beautiful, well-groomed woman. And suddenly she has eczema in open areas of the body: on her face or hands. Naturally, she is desperate. It seems to the woman that people shy away from her, that they look askance at work. She imagines that now her husband will leave, no one else will love her. In this case, of course, a skin disease caused depression. But it is still necessary to treat the skin and the mental state. It happens that dermatological and mental problems occur in parallel. Take atopic dermatitis, for example. Suppose, in the fall, the patient’s mood decreases, drowsiness appears, or, conversely, insomnia, pessimistic thoughts arise. But at the same time of the year, his chronic illness worsens – atopic dermatitis. Of course, both must be treated. But what is interesting: if we psychiatrists give the patient supportive therapy at this time, then not only depression may not occur, but atopic dermatitis will not worsen. Or will manifest itself to a small extent.
If I understand correctly, there are skin diseases that are caused by some of their causes: errors in the diet, for example. And there are dermatological problems that are triggered by psychological causes. Can they be distinguished?
Sure. First, we ask the patient in detail. If a psychological problem started the process on the skin, then the person usually tells after what events the rash appeared: quarrels, divorce, death of a loved one. I even had a case when preparing for the wedding caused the patient a skin problem. Secondly, we look at where the rashes occurred. If the reason is psychological, then they concentrate on accessible parts of the body – where a person can reach and comb – arms, legs, face, upper back. In addition, “our” patients often complain that under their skin “someone is crawling, moving.” But analyzes show: there is nothing there.
When a person begins to have heart problems after stress, this seems to be understandable: everything inside is interconnected. But why, for example, after a quarrel with her husband, rashes appear on her hands?
This is precisely the connection between the psyche and the skin – the most direct. Even during the prenatal period, the skin and nervous system develop from the same germ layer. This connection has interested researchers since the 18th century. But despite the fact that today there are many scientific works on this topic, scientists cannot yet finally answer exactly how the state of the psyche affects the skin. But this connection, of course, is.
We experience stress. But why is it your skin that suffers from your patients?
Perhaps someone has this genetically determined. The skin of such a person is the place of least resistance. And, as you know, where it is thin, it breaks there. Maybe his parents or one of them suffered from a dermatological disease and inherited it. But it also happens that mother and father have completely healthy skin. But their genes have formed together so that in a child it was this organ that turned out to be the most vulnerable. And under stress just the skin suffers.
Of great importance is the character of the patient. If a person is anxious, taking everything to heart, then a reaction to stress, he may well have a rash on the skin. There is another interesting group of patients that often falls into our field of vision. Such people have a certain ideal image of themselves in their heads – what it should look like. They constantly examine themselves: whether the pimple has jumped up where, the hair on the right eyebrow is growing evenly, if there is redness or blanching where. And as soon as they find a “flaw”, then they immediately begin to correct it: squeeze it out, pick it up, cut it out. As a result, the skin becomes inflamed, and this is a real problem. It is very difficult to interact with such patients. They do not agree to be treated by a psychiatrist. Or quickly quit taking drugs. And antidepressants, for example, begin to give their effect only after 10-14 days. The character, of course, is not treated. But we are able to help such people. Small doses of drugs would save them from close attention to their appearance, and they would avoid many problems.
But does the character of a person change under the influence of skin problems?
Generally yes. Especially if rashes appear in visible areas of the body. A person becomes closed, non-contact, anxious. Some generally stop leaving the house, quit work. Such people, of course, need the help of a psychotherapist or psychiatrist. It is necessary to rid them of depression, anxiety and return to an active life. The percentage of dermatological patients who need to be consulted by a psychiatrist is quite high. But there are people who are completely calm about their problem. They say: “I don’t care about either the rash on my face, or how others relate to this.” Well, then we do not impose our participation.
And how do patients get to you? After all, the idea of going to a psychiatrist with acne, I think, will appear in a person’s last resort …
Sure. Modern dermatologists, who read a lot, are interested in novelties in the field of medicine, carefully advise such patients to consult a psychotherapist. But only after the truly dermatological causes of the disease are excluded. However, even in these cases, people are reluctant to come to us. Therefore, now in some dermatological clinics there are psychiatrist rooms. A person doesn’t need to specially go somewhere to a neuropsychiatric dispensary or a psychiatric hospital. After all, one consciousness that he needs a psychiatrist leads a person into a state of shock. In fact, we should not be afraid. Life is becoming more complicated, and an increasing burden falls on the psyche. Therefore, if you have passed all the examinations, the doctors have not found any problem in their part and advise you to consult a psychiatrist, do not be alarmed: you are not crazy. It’s just that your nervous system has failed in something.