FROM DISTRESS TO RADIANCE

Dr Pradnya Manwatkar elaborates on how inducing ‘happy hormones’ can help with patient outcomes.

We know for a fact that patients with various skin diseases, be it acne or bullous pemphigoid or psoriasis, experience high levels of stress.

Why are you asking me if I have“ stress?” asked my patient who had come for the first time to get a hyaluronic acid (HA) filler procedure. More often than not, patients find this line of questioning amusing, which is only until I mention to them that stress hormones activate certain enzymes that lead to the degradation of collagen and elastin, thus leading to early ageing and wrinkles.

Gone are the days when only changing physical lifestyle was needed to help patients with skin diseases or to ensure better aesthetic treatment outcomes.

We know for a fact that patients with various skin diseases, be it acne or bullous pemphigoid or psoriasis, experience high levels of stress. We try to pacify them by giving them medicines. And rightly so, for instantaneous relief, it is a must to shift the patient’s mindset from negative to positive. But we rarely try to ask tough questions to the patient and to ourselves on the onset of the disease. We had genes to blame – but then came along epigenetics. Then we blamed the patient for this play of epigenetics that was happening in the form of the disease. Change of lifestyle was recommended to reverse this play of epigenetics so that the skin disease would get treated faster and better. And yet, we find it hard to give patients sustainable treatment outcomes. Yes, we are able to accomplish relief. But why do we say that once a psoriasis patient always a psoriasis patient?

This is because we have ignored the most important reason to start with. Stress. Rather Distress. Stress can be good – the one that helps us evolve and become better at what we do, like exam stress. However, distress is a chronic and nagging form of stress that does not help one achieve their goals. It is persistent and has made the person an expert at ignoring it. Thereby, leading to statements like ‘stress is a part of life’, and ‘stress cannot be escaped’. It cannot be escaped but it need not make one helpless either. It can be dealt with. It is important to understand what sort of distress the patient has been going through.

The skin develops from a germ layer called the ectoderm. That in itself should tell us that the development of the skin and brain involves complex interactions between various signalling pathways and genetic programmes. Any disruptions to these processes can lead to a range of developmental disorders and diseases. The famous hypothalamic pituitary adrenal axis (HPA) is also known to us. If I look at the person that I love, my facial blood vessels would dilate and I would blush. Is there a possibility that I get acne every time I face a situation I do not like? Remember the exam period acne, or the innumerable patients that come to us with intermittent flares?

Maybe it is upon us to not ignore the correlation of the skin and the mind and to not consider these random flares as an occurrence of fate. Here, the concept of emodermatology works in tandem with medicinal therapy. Emodermatology is rational emotive behaviour therapy (REBT) applied to dermatology. It allows the practitioner to help the patient deal with their negative emotions better, in as little as 10 minutes. Hence, it is the basis of my line of questioning to all of my patients. The aim is to not only treat a skin disease, but it is also to improve the patient’s quality of life. And if you ask me about the aesthetic patient that comes in with no apparent skin disease, would not inducing some ‘happy hormones’ give a better glow? Every patient that walks into your clinic will have some underlying distress – big or small does not matter. Addressing it has become important if we are to provide additional value to the services we provide as dermatologists.

About the author:

Dr Pradnya Manwatkar has been practicing emodermatology since 2018 at her clinic Skin Matra, in Mumbai, and has authored two books on emodermatology. How To Tell Your Skin To Heal Itself, and From Skin Breakouts to Skin Breakthroughs Link: https://www.amazon.in/Dr-Pradnya-Manwatkar/e/B09HQNP2B-Z?ref=sr_ntt_srch_lnk_1&qid=1683304595&sr=1-1

References:

1 Chen, Y., Lyga, J. (2014). Brain-skin connection: stress, inflammation and skin aging. Inflammation; Allergy Drug Targets, 13(3), 177-190. doi: 10.2174/1871528113666140522104422