Bad nerves, bad skin go together
By John Quinlan, Journal staff writer | Posted: Friday, December 29, 2006
Psychodermatology.
The word conjures images of deranged medicine men, killer warts and a scalpel-wielding Corbin Bernsen. No, wait, that was the psycho dentist movie, you might say while blushing. And by blushing, you have a clue to the true meaning of this study of medicine that involves the interaction between the mind and the skin.
That emotional trouble might show up as skin trouble was the basis for an article in the recent issue of Harvard Women's Health Watch. Although cause and effect can be difficult to pin down, considerable data suggest that in some people, psychological factors can activate or worsen certain skin conditions.
Recognizing and treating these psychological issues might help the skin, too, the study reports. And this has led to a field called psychodermatology, its aim being to recognize emotional issues that may affect the way skin problems respond to medical treatment.
The mind/skin connection isn't news to the nation's dermatologists, the front-line doctors who see it on a daily basis, said Dr. Michelle Daffer, dermatologist with the Midlands Clinic in Dakota Dunes.
Seeing 40 or 50 patients a day as one of the metro area's three dermatologists, Daffer says she finds the problem once or twice each week. It affects about 1 percent of her patients.
There are several factors related to having nervous conditions associated with skin problems, Daffer said. The result is that a number of people see skin lesions on themselves without actually having rashes.
"We see people come in who complain of non-healing areas on their arms, and it's usually because it's all self-induced," she noted.
One of the outlets for some anxious or depressed people is to scratch their skin enough that they get lesions, Daffer said. Due to the constant scratching, the lesions never heal and, in fact, become so thick that they are raised. It is a condition doctors call neurodermatitis, which refers to the joining of the nerves and the skin.
"That's actually been an interesting condition because a lot of times people will come in and say they don't understand why their skin keeps breaking out," she said. "It itches, and the more you scratch at something, the more it itches. So if you actually start scratching that area, it will continue to itch and it will continue to break open -- and they'll never heal."
And the itching brings more problems, with people coming in because they think something seriously wrong is happening under their skin.
"Typically, when you look at these people and you have them take off their shirts, they'll have a line of it across their back, but it'll end because places where they can't reach actually won't have any spots," she said.
Some people, she noted, will break an arm and suddenly one side of their body will clear up because they are unable to reach -- and scratch -- it.
"All of that is kind of self-induced lesions," Daffer said.
In such cases, treatment can involve the use of medications to help control the itch and to help calm down their nerve endings.
Depression and anxiety
"Usually, these people have problems with depression and anxiety. And they have these sensations that their skin is itching and a lot of it is kind of a physical sensation of their emotional state," she said.
Consequently, when horrible things happen in their lives -- deaths in the family, divorces or children going off to college -- suddenly their skin will get worse, the result of scratching; and they'll say they're breaking out with a new rash.
Even such common skin problems as acne can be made worse by constant scratching and picking. It is a condition called acne excoria in which mild acne is made worse by constant scratching -- one or two pimples magnified a hundredfold through scratching. In many cases, facial scars so inflicted will never heal.
"Some people will have something that sets them off, that starts that picking and scratching, like chicken pox. But because of their underlying nervous state of either anxiety or depression, instead of just letting it heal and go away, they pick at them until it never heals," Daffer said.
This forces dermatologists to look at the issues more intensely and ask the patients about their state of mind. And some patients must be started on antidepressants or antipsychotic-type medications, she said.
Unfortunately, at first glance, it is difficult to distinguish the people suffering from emotional problems from those with true skin conditions. Even a biopsy can't always show if the problem is self-induced or caused by underlying inflammatory problems. So first-time visitors are given the benefit of the doubt.
"It often takes several visits to get a feel for their emotional state, too -- and when it gets bad and when it gets better," Daffer said.
"Then when I realize that no medicine gets them better and that when they come in and oftentimes as they get to know you, they're able to tell you more about their emotional state. And usually these people are a little more emotional, too."
Old-time doctors used to tell nervous patients just to go home. After all, it's only nerves. "But nobody wants to be told that there's nothing you can do," Daffer said. "There are ways that you can make it better."
Delusions of parasitosis
Dermatologists also find some patients with a related condition called "delusions of parasitosis," which involves people who actually believe that they have bugs in their skin.
"Usually these people do have some uderlying type of psychotic state," Daffer said. "They are very difficult because they truly feel that things are crawling inside of them. They think their skin is infected with some type of bugs. And they will pick and dig their skin open and try to find things that are in there."
These patients will bring in pieces of hair, fuzz or maybe sock lint that they are convinced is some type of bug that they cut out of their skin. In mosts cases, the evidence is nothing more than scabs.
People suffering from delusions of parasitosis often have to be followed more closely by a psychiatrist and put on higher doses of psychiatric medicines, anti-psychotics, to help them with their delusions.
These people are particularly tough to treat because they don't realize they have any type of depression or anxiety problem, she said, "and if they don't recognize that, then oftentimes treatments aren't very helpful."
Emotionally activated skin problems can affect all age groups and both sexes, Daffer said, but women are more likely to seek help than men. Women come in because their skin breaks out, she said, while men come in for different reasons, a skin cancer, appendicitis or something, and then are asked about their rash by the physician. She said she also tends to see fewer men in their 30s and 40s because, in general, they tend to avoid physicians as long as they can.
John Quinlan can be reached at (712) 293-4225 or johnquinlan@siouxcityjournal.com
The word conjures images of deranged medicine men, killer warts and a scalpel-wielding Corbin Bernsen. No, wait, that was the psycho dentist movie, you might say while blushing. And by blushing, you have a clue to the true meaning of this study of medicine that involves the interaction between the mind and the skin.
That emotional trouble might show up as skin trouble was the basis for an article in the recent issue of Harvard Women's Health Watch. Although cause and effect can be difficult to pin down, considerable data suggest that in some people, psychological factors can activate or worsen certain skin conditions.
Recognizing and treating these psychological issues might help the skin, too, the study reports. And this has led to a field called psychodermatology, its aim being to recognize emotional issues that may affect the way skin problems respond to medical treatment.
The mind/skin connection isn't news to the nation's dermatologists, the front-line doctors who see it on a daily basis, said Dr. Michelle Daffer, dermatologist with the Midlands Clinic in Dakota Dunes.
Seeing 40 or 50 patients a day as one of the metro area's three dermatologists, Daffer says she finds the problem once or twice each week. It affects about 1 percent of her patients.
There are several factors related to having nervous conditions associated with skin problems, Daffer said. The result is that a number of people see skin lesions on themselves without actually having rashes.
"We see people come in who complain of non-healing areas on their arms, and it's usually because it's all self-induced," she noted.
One of the outlets for some anxious or depressed people is to scratch their skin enough that they get lesions, Daffer said. Due to the constant scratching, the lesions never heal and, in fact, become so thick that they are raised. It is a condition doctors call neurodermatitis, which refers to the joining of the nerves and the skin.
"That's actually been an interesting condition because a lot of times people will come in and say they don't understand why their skin keeps breaking out," she said. "It itches, and the more you scratch at something, the more it itches. So if you actually start scratching that area, it will continue to itch and it will continue to break open -- and they'll never heal."
And the itching brings more problems, with people coming in because they think something seriously wrong is happening under their skin.
"Typically, when you look at these people and you have them take off their shirts, they'll have a line of it across their back, but it'll end because places where they can't reach actually won't have any spots," she said.
Some people, she noted, will break an arm and suddenly one side of their body will clear up because they are unable to reach -- and scratch -- it.
"All of that is kind of self-induced lesions," Daffer said.
In such cases, treatment can involve the use of medications to help control the itch and to help calm down their nerve endings.
Depression and anxiety
"Usually, these people have problems with depression and anxiety. And they have these sensations that their skin is itching and a lot of it is kind of a physical sensation of their emotional state," she said.
Consequently, when horrible things happen in their lives -- deaths in the family, divorces or children going off to college -- suddenly their skin will get worse, the result of scratching; and they'll say they're breaking out with a new rash.
Even such common skin problems as acne can be made worse by constant scratching and picking. It is a condition called acne excoria in which mild acne is made worse by constant scratching -- one or two pimples magnified a hundredfold through scratching. In many cases, facial scars so inflicted will never heal.
"Some people will have something that sets them off, that starts that picking and scratching, like chicken pox. But because of their underlying nervous state of either anxiety or depression, instead of just letting it heal and go away, they pick at them until it never heals," Daffer said.
This forces dermatologists to look at the issues more intensely and ask the patients about their state of mind. And some patients must be started on antidepressants or antipsychotic-type medications, she said.
Unfortunately, at first glance, it is difficult to distinguish the people suffering from emotional problems from those with true skin conditions. Even a biopsy can't always show if the problem is self-induced or caused by underlying inflammatory problems. So first-time visitors are given the benefit of the doubt.
"It often takes several visits to get a feel for their emotional state, too -- and when it gets bad and when it gets better," Daffer said.
"Then when I realize that no medicine gets them better and that when they come in and oftentimes as they get to know you, they're able to tell you more about their emotional state. And usually these people are a little more emotional, too."
Old-time doctors used to tell nervous patients just to go home. After all, it's only nerves. "But nobody wants to be told that there's nothing you can do," Daffer said. "There are ways that you can make it better."
Delusions of parasitosis
Dermatologists also find some patients with a related condition called "delusions of parasitosis," which involves people who actually believe that they have bugs in their skin.
"Usually these people do have some uderlying type of psychotic state," Daffer said. "They are very difficult because they truly feel that things are crawling inside of them. They think their skin is infected with some type of bugs. And they will pick and dig their skin open and try to find things that are in there."
These patients will bring in pieces of hair, fuzz or maybe sock lint that they are convinced is some type of bug that they cut out of their skin. In mosts cases, the evidence is nothing more than scabs.
People suffering from delusions of parasitosis often have to be followed more closely by a psychiatrist and put on higher doses of psychiatric medicines, anti-psychotics, to help them with their delusions.
These people are particularly tough to treat because they don't realize they have any type of depression or anxiety problem, she said, "and if they don't recognize that, then oftentimes treatments aren't very helpful."
Emotionally activated skin problems can affect all age groups and both sexes, Daffer said, but women are more likely to seek help than men. Women come in because their skin breaks out, she said, while men come in for different reasons, a skin cancer, appendicitis or something, and then are asked about their rash by the physician. She said she also tends to see fewer men in their 30s and 40s because, in general, they tend to avoid physicians as long as they can.
John Quinlan can be reached at (712) 293-4225 or johnquinlan@siouxcityjournal.com
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Linda wrote on Nov 20, 2007 12:58 PM:
Danise wrote on Dec 29, 2006 3:01 PM: