Healing beyond skin

Dr Pradnya Manwatkar bridges skin health and emotional well-being with Emodermatology, addressing emotional triggers for holistic treatment.

Dermatology has come a long way in understanding the powerful connection between our emotions and the health of our skin. The term “Psychodermatology” explains how our thoughts and emotions affect our skin, while emodermatology takes it a step further by delving into deep emotional issues such as shame and self-worth. It sees the skin as a mirror of our emotional well-being and stresses the importance of integrating skin care with mental health care.

Simply put, emodermatology encourages dermatologists and mental health experts to work together to enhance treatment outcomes and put holistic patient care first. So, it is not just about our skin, it is about our overall well-being!

Merging emotions with dermatology

Over time, dermatology has evolved beyond treating just the physical symptoms of skin conditions. More and more dermatologists began noticing the profound emotional impact these conditions had on their patients. This shift marked the transition from psychodermatology, which acknowledged the link between the mind and skin, to a more holistic approach – emodermatology.

In earlier years, practitioners often found themselves struggling to explain why certain conditions, like lichen planus or resistant acne, persisted despite their best treatments. It soon became clear that emotional disturbances, such as stress, anxiety, or unresolved trauma, played a major role in the development and persistence of skin issues.

During consultations, it was not just the prescriptions that made a difference but empathetic conversations often provided patients with noticeable emotional relief. Dermatologists realised that something as simple as asking, “How is your family?” could open the door to meaningful dialogue, uncovering emotional stressors that influenced skin health.

This understanding led to a new approach – emodermatology, which bridges the gap between emotional well-being and skin health. By recognising and addressing the emotional roots of skin conditions, dermatologists began treating their patients more holistically, fostering not only clearer skin but a sense of emotional healing.

The mind-skin connection

In dermatology, one fascinating revelation has been the undeniable link between emotional stress and skin health. Think about it like how often do patients walk into a clinic, not just asking for acne treatment but visibly distressed by it? Their emotional turmoil often intensifies their skin conditions, highlighting a deeper connection that goes beyond the surface.

This mind-skin connection shows how psychological stress can manifest physically. Imagine being asked to close your eyes and think about your favourite food like the texture, the smell, the taste. Just that thought can make your mouth water. If a simple mental exercise can trigger salivation, why could stress not provoke skin conditions like hives or breakouts?

Stress hormones, particularly Corticotropin-Releasing Hormone (CRH), are key players here. They influence the immune system and steroid production, both of which are deeply tied to skin health. By understanding this link, dermatologists are realising the importance of addressing both the physical and emotional aspects of treatment, offering a more holistic approach to skincare.

Rational Emotive Behavior Therapy (REBT) and dermatology

In dermatology, treatments have traditionally focused on external triggers like pollution, UV exposure, or diet. But there is a key aspect that often gets overlooked which is the psychological stressors that silently influence skin health. Stress, anxiety, and emotional turmoil can worsen chronic skin conditions, yet these emotional factors are frequently ignored in standard dermatological care.

This is where the concept of merging Rational Emotive Behaviour Therapy (REBT) with dermatology comes in. It shifts the focus beyond creams and medications, recognising that emotional regulation is just as vital. Unlike psychodermatology, which deals with psychiatric disorders, this approach targets emotional dysregulation – helping patients to cope with the stress and frustration of living with persistent skin issues.

REBT is a form of cognitive-behavioural therapy that encourages patients to challenge irrational beliefs and adopt healthier emotional responses. By addressing both the emotional and physical sides of skin conditions, dermatologists can improve treatment outcomes, offering a more holistic path to clear skin and emotional well-being.

Principles of dermatology

In the world of dermatology, one fundamental truth stands out: chronic stress can wreak havoc on our skin. Many people do not realise that their skin issues, like acne or eczema, are often linked to emotional and psychological stressors. These can range from personal relationships to workplace pressures, contributing to a complex web of factors affecting skin health.

The sources of stress can vary widely, and even small annoyances like a pile of dirty laundry can feel overwhelming when someone is already feeling low. These everyday irritations can exacerbate long-term skin conditions, making it crucial for dermatologists to address the emotional landscape that influences skin health.

Part of a dermatologist’s role is to educate patients about the interplay between stress and skin. By promoting good skincare habits and encouraging patients to reflect on their emotional triggers, dermatologists can help foster a proactive approach to skin health. It is not just about applying products but it is about cultivating a mindset of responsible skincare, where patients think before they act. This awareness not only enhances skin health but also empowers individuals to take charge of their overall well-being.

The ABC Theory

The ABC Theory from REBT offers a fresh perspective on how dermatologists interact with their patients. At its core, this theory breaks down the relationship between events, beliefs, and consequences. It posits that for every Activating event (a), there is a Belief (b) that shapes how we respond, leading to a (c) Consequence.

Consider this: A patient may experience a flare-up of acne before an important presentation. Instead of merely linking their skin issue to the stress of the event, the real culprit often lies in their beliefs about how others perceive them.

By focusing on these internal beliefs rather than just external events, dermatologists can help patients gain valuable insights into their emotional distress. This approach encourages individuals to manage their skin conditions more effectively while also addressing their emotional responses to life’s challenges. Ultimately, understanding the ABC Theory empowers patients to reshape their perceptions, fostering a healthier relationship with both their skin and self-esteem.

For example, the belief that one must always perform perfectly and gain approval from others can create immense pressure, leading to increased stress and worsening skin conditions. Many patients set unrealistic standards for themselves, which can result in dissatisfaction with treatment outcomes. This relentless

Addressing emotional, physical, and behavioural consequences

Dermatologists often encounter patients whose skin conditions intertwine with complex mental, physical, and behavioural issues. While their primary focus is on dermatological concerns, they also recognise the importance of mental health. Conditions like obsessive-compulsive disorder (OCD) or trichotillomania (hair-pulling) may require referral to a psychiatrist, especially when they significantly affect the patient’s scalp or overall well-being.

Yet, dermatologists play a vital role in identifying emotional triggers and stressors that can exacerbate skin health problems. By honing in on the ‘A’ (activating event) of the ABC theory, dermatologists can collaborate with patients to manage stressors effectively, leading to fewer flare-ups and enhanced treatment outcomes. This holistic approach ensures that both skin health and emotional well-being are prioritised, paving the way for more comprehensive care.

The illogical beliefs

Understanding the patients’ illogical beliefs about themselves, others, and life is a crucial aspect of emotional health in dermatology. These beliefs typically fall into three categories: self-related, others-related, and life-related views. pursuit of validation often takes a toll on both emotional wellbeing and skin health.

Additionally, unrealistic expectations about life can complicate matters further. When individuals feel entitled to immediate gratification without effort, they may become frustrated when results are not instant. This mindset can impact progress in their skincare journey, as they may not fully appreciate the time and dedication required for effective treatment.

To provide comprehensive care, dermatologists need to identify and address these illogical beliefs. Statements reflecting deep-seated issues, like the idea that one should never experience acne, indicate a need for thoughtful discussion. By encouraging patients to challenge and reframe these beliefs, dermatologists can adopt a more holistic approach, ultimately enhancing both emotional resilience and skin health. This connection between mindset and skin can lead to improved treatment experiences and outcomes for patients.

The four belief systems affecting skin condition perception

Patients often categorise their emotional responses into four major belief systems, which dermatologists can actively dispute during consultations:

• Low frustration tolerance: For example; “I can’t stand this

acne anymore.”

• Overgeneralisation: For example; “This one acne makes me look unpresentable.”

• Depreciation: For example; “I hate these crow’s feet. I look so old.”

• Demandingness: For example; “This wrinkle must disappear forever.”

Each of these beliefs can negatively impact a patient’s emotional well-being. It is our responsibility, as dermatologists, to encourage our patients to question these ideas and educate them that they are not based on reality.

Applying disputation in practice

Dermatologists can play a transformative role in their patients’ journeys by encouraging them to rethink their assumptions about their skin conditions. By asking thoughtful questions, practitioners can help shift perspectives and foster a more positive mindset.

When patients express frustration about their appearance, thoughtful questions can prompt deeper reflection. By considering whether their skin condition impacts their success or recognising others who thrive despite similar issues, patients can understand their worth is not tied to their skin, fostering a more positive self-image.

Encouraging patients to focus on their abilities, achievements, and the qualities that define them beyond their appearance can lead to a more empowering outlook. This approach not only aids in emotional healing but also supports overall treatment success, allowing patients to navigate their skin conditions with renewed confidence.

Addressing stress: The root cause

Stress plays a significant role in exacerbating dermatological conditions, making it essential to understand its impact. Even when patients insist on not being stressed, probing deeper can reveal ongoing or episodic stressors that trigger flare-ups.

It is important to introduce various types of stress, including acute, chronic, episodic, eustress (positive stress), and distress (negative stress). This helps patients identify psychosocial concerns like the fear of judgment that can provoke biological stress responses, ultimately affecting their skin health.

Many patients feel defeated by their genetic predispositions to conditions like acne or psoriasis, believing their genes are unchangeable. However, by highlighting the concept of epigenetics, dermatologists can empower patients to see how lifestyle choices, such as diet, exercise, and stress management, can influence gene expression. This approach encourages individuals to take charge of their skin health and embrace positive lifestyle modifications.

Case studies

Consider the case of a patient with atopic dermatitis who wasn’t seeing improvement despite medical treatment. By shifting the focus from just physical symptoms to exploring her thoughts and family dynamics, significant changes occurred. This newfound perspective on her stressors ultimately led to remission.

Another notable example involves a man who had battled psoriasis for 20 years, with his condition flaring up after a traumatic event. Through counselling and cognitive restructuring, he learned to manage his flare-ups, even though the emotional scars lingered. This illustrates that the treatment is not about resolving everything in one session but it is about fostering insight and understanding that can lead to long-term improvement.

Mind-skin connection

When psychological awareness is added to dermatological care, it means that the patient as a whole is being treated. Dermatologists can provide better, longer-lasting treatment results if they understand the emotional causes of skin diseases and challenge people who hold false beliefs.

When patients learn more about the link between their mental health and skin health, they feel more in control of their skincare procedure. This makes their quality of life better and makes them happier with their treatment.

The above article has been extracted with excerpts from Dr Pradnya manwatkar’s presentation on ‘Understanding psychological aspects of dermatological disorders’ that was held at the Aesthetic Medicine India Conference 2024.

About Dr Pradnya Manwatkar:

Dr Pradnya Manwatkar, Consultant Aesthetic Dermatologist and Emodermatologist, Skin Matra, established her clinic to provide the latest skincare treatments and create awareness about proper skincare. She emphasises the importance of knowledge in achieving desired skin results and aims to change the common misconceptions about skin care. She is an aesthetic and emodermatology consultant practicing in Mumbai for the past 13 years. She is also the author of two books: “How To Tell Your Skin To Heal Itself” and “From Skin Breakouts to Skin Breakthroughs.”