Dressing the skin

Sabrina was nine when the first signs appeared: red patches, persistent itching and, sometimes, swelling of the face. The diagnosis came quickly: chronic urticaria, an inflammatory skin condition that causes severe itching and unpredictable flare-ups.

“Over the years, I saw several dermatologists. They all prescribed antihistamines and told me the condition would eventually go away, and that there was nothing I could do but wait.” Sabrina waited for 13 years. Then, at 22, she decided to try a different approach. She began working on herself, seeing a kinesiologist twice before enrolling later that year in a personal development programme combining a rational approach with a more emotional one.

“It wasn’t like seeing a psychologist, but it helped me reconnect with myself.” A few weeks later, something unexpected happened: her symptoms disappeared completely for several months. “My urticaria stopped completely. That had never happened before.”

When the Skin Reflects the Mind

Dermatologist Mathieu Leuenberger says the connection between the mind and the skin is not a new idea. Even so, the psychological aspect of skin disease has often been neglected. Skin problems were either treated as cosmetic and therefore “not serious”, or left entirely to psychology. “There are indeed connections between the nervous system, the immune system, the skin and the endocrine system. Together, they make up what we call the NICE system.” NICE stands for neuro-immuno-cutaneous-endocrine. It is a way of looking at the body as an interconnected network.

“The skin has a particular role because it is closely linked to the nervous system. Signals pass both ways between the skin and the brain, carried by biological messengers such as hormones, neurotransmitters and inflammatory mediators, which are present in both. These mechanisms can trigger or worsen some skin diseases and can also contribute to them becoming chronic.”

A psychosomatic component is thought to be present in 30 to 40% of dermatology cases. Yet many dermatologists do not raise the subject during consultations.

The Divide Between Body and Mind

These links are better understood today, but bringing them into routine care remains difficult. “In medicine, we still tend to separate the physical from the psychological,” the dermatologist says. Psychological issues are still usually seen as the territory of psychologists or psychiatrists, which makes genuinely comprehensive care harder.

Practical limits play a part too. “Healthcare professionals receive little training on these connections, and consultations typically last just 15 to 20 minutes. We have to focus on the essentials. Raising the possibility of psychological factors without knowing how to support the patient afterwards can complicate care.”

Recognising Emotions for Better Care

“I wish someone had discussed the psychological side of it. I didn’t want to be told it was ‘all in my head’, but to have someone explain that skin problems can also be linked to deeper issues such as stress, trauma and emotions.”

Rethinking Dermatology Consultations

Taking emotions into account could change the consultation itself. “Above all, we need more time than in a standard appointment. Each consultation would need to last around 30 to 45 minutes,” the dermatologist explains. “That gives patients time to express themselves and allows us to hear how they see their illness, what they think about it, what has happened recently in their lives and the emotions linked to those events.”

In some cases, screening questionnaires can help identify psychological disorders. “They provide a less direct way of raising the subject and can help open up the discussion.” Ideally, care would go further. “There should be more joint consultations with a psychologist or psychiatrist.” This can be particularly useful when dermatologists face strong emotional reactions that they do not always feel equipped to manage.

This does not mean explaining every case in psychological terms. Rather, psychological factors can offer another line of enquiry once other explanations have been exhausted. Leuenberger says the question often comes up when standard treatments do not have the expected effect. Patients generally welcome the approach. “They are often relieved that we take the time to talk about how they feel.”