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Psychodermatology – how psyche and skin influence each other

The saying “The skin is the reflection of the soul” is common – and there seems to be more to it than meets the eye. In the field of psychodermatology, doctors are investigating how the well-being of the soul and the appearance of the skin are mutually dependent. Is this the key to healthier, more beautiful skin? Tikbow spoke with an expert.

What to expect in psychodermatology

Under the direction of Prof. Dr. Wolfgang Harth, the Clinic for Dermatology and Allergology at the Vivantes Clinic in Berlin has a proven focus on psychodermatology. What makes it special is that it treats not only the skin disease, but also the psychological causes and accompanying symptoms. Many patients who come to us have chronic inflammatory skin diseases such as psoriasis, neurodermatitis or acne,” explains Norma Mechow. The face or other visible parts of the body are often affected. Patients feel disfigured and perceive themselves as ugly. Because of their psoriasis, they no longer dare to leave the house and withdraw. Their self-image suffers enormously because of the skin changes;

One third of these patients with visible skin diseases develop psychological disorders such as depression or anxiety. We therefore not only treat the skin disease, but also provide psychological help," says the senior physician. "Often the psychological complaints lead again to new disease symptoms and a poor skin condition. It is important to break this cycle. Patients learn how to cope better with stress in talk and behavior therapy. Mechow is convinced: "If the psyche is not at peace with itself, the skin often is not either."

Skin lesions due to delusions

"There are skin diseases that have a psychiatric cause and are caused, for example, by delusions", Mechow explains. "Patients with so-called dermatozoa delusions believe that they have animals under their skin and try to remove them with vinegar balls or needles. In these cases, too, we not only treat the skin lesions, but also provide the appropriate psychiatric support;

Some skin diseases are of a psychological nature

Skin diseases can have many causes. In psychodermatology, one first checks whether it has physical causes. For this purpose, for example, the blood, urine and stool are examined. If deficiency symptoms, underlying internal diseases or an allergic reaction can be ruled out, there is often a psychological disorder that manifests itself in the skin condition,” explains the senior physician. This can be, for example, a depression.

In some cases, itching can also be caused by psychosomatic factors,"Many patients scratch their skin sore without realizing it," Mechow says. "Often it is a matter of Übersprungshandlungen to relieve stress. Here it is important to find alternatives to stress management that are not detrimental to the skin;

The fatal thing about itching is that scratching does not bring relief, but only makes everything worse. "Scratching triggers very specific stimuli in the body that trigger itching again", explains the Berlin senior physician. Patients with neurodermatitis know this very well. It is a vicious circle." Behavioral therapy can also be helpful here: patients learn, for example, to rub instead of scratch. "Rubbing at least keeps the skin barrier intact, otherwise scratching often causes cracks and leads to bacterial infections," says Mechow. "It can also help to keep an itch diary: When do I itch? How do I feel in these situations? We then look to see if there is a pattern and perhaps psychotherapeutic care is needed."

Psychodermatology is becoming increasingly important

Norma Mechow is üconvinced: "With skin illnesses the psychological component still comes too briefly. Every second to third patient who comes to us with a skin disease has a need for psychological care. We live in a society in which appearance is very important and we want to constantly optimize our appearance. The senior physician firmly believes that psychodermatology will continue to gain in importance.

Not every dermatologist is a psychodermatologist

Anyone who wants to place themselves in the hands of a psychodermatologist should look carefully, because a dermatologist is not automatically a psychodermatologist and therefore may not simply call himself one. A psychodermatologist is a specialist in dermatology with further training in psychotherapy. This psychotherapeutic training usually takes 36 months.