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Image courtesy @getyourskinout

Does your skin need therapy?

Psychodermatology could be the answer to the relationship between your skin and psyche

“The first time anyone had ever asked me about how it felt living with my psoriasis was aged 23 when I was in Cognitive Behavioural Therapy, which I initially started after a car accident,” Holly Dillon, founder of the #GetYourSkinOut campaign tells me. Having lived with psoriasis for 15 years, which at its worst, covers 98% of her body, it wasn’t until her therapist suggested psychodermatology that she was able to openly start dealing with and speaking about its effect on her mental health. “Retrospectively looking back, at 14, not only was I having psoriasis, but I was also getting quite frequent panic attacks and it's only now years on that I can look back and see that they're obviously related.”

Consultant Dermatologist and Psychodermatology specialist, Dr Alia Ahmed explained to me exactly what the treatment is. “Psychodermatology is a sub-speciality of dermatology that combines the principles of dermatology, psychology and psychiatry to provide a holistic approach to treating patients with skin disease. It acknowledges the effect of the skin on the psyche and vice versa. Patients can be people with primary dermatological disorders that experience poor psychological outcomes (e.g. anxiety and depression associated with eczema or psoriasis); or people with primary psychiatric disorders that present with skin symptoms (e.g. body dysmorphic disorder, skin picking and other obsessive-compulsive spectrum disorders).”

For Holly, her psychodermatolgy treatment took place in weekly, hour-long sessions over the course of a year and was life-changing. “It was a very exploratory phase of not wanting to do any drugs or westernised medication and look at my psoriasis with a 360-degree holistic approach. It gave me the clarity and the tools that I needed to live well with psoriasis.” Prior to her CBT sessions, psychodermatology was something that she had never been offered. Instead, doctors and specialists took an entirely clinical approach, prescribing creams, drugs and UVB phototherapy light treatment. “It's psychical, it's mental and I think the label of mental health often has connotations of having these huge issues like being bi-polar or being depressed, but for me it's smaller things like not being able to wear a dress because you've got psoriasis on your legs or not being able to eat some chocolate or have a glass of wine because I know those are triggers.” She admits that initially at that time, her skin condition wasn’t something that she would associate with her mental health either. While Holly doesn’t believe there is a cure for psoriasis within western medicine, she believes that having an awareness of how it can affect you both physically and mentally is imperative to managing the condition, and strongly recommends it to anyone struggling with a complex skin condition like her own.

 "CBT helped me acknowledge what my issues were and to find control because how do you manage control of a skin condition that’s uncontrollable” Holly Dillon

As Dr Ahmed explained, problems with the skin, despite being the largest organ in the body, have historically been seen as less important than other medical diagnoses. However, in a 2014 study that reviewed a dedicated psychology-based psychodermatology, it was discovered that 90% of patients who had psychodermatology therapy understood their skin condition better. 92% reported increased confidence and 94% reports reduced stress.

But it’s not just a treatment used via CBT Dr Ahmed tells me, “It also involves a wide range of psychological therapies such as mindfulness or acceptance and commitment therapy; or psychiatric medication for clinically significant symptoms of anxiety or depression. Treatment is tailored to the individual, their circumstances, and acknowledges the effect of skin disease on their quality of life.”

Holly explained that Psychodermatology and CBT gave her the tools to have clarity around what you need to live with psoriasis. “Part of finding those tools is being educated and knowing what you need. CBT helped me acknowledge what my issues were and to find control because how do you manage control of a skin condition that’s uncontrollable?”

While Holly had all her treatment with the NHS, getting referred can take anything from 16 weeks to a year. Just getting an appointment with a general dermatologist can take weeks as there’s a shortage on the NHS and currently the treatment is only available with the NHS at Newham University Hospital, The Royal London Hospital, Whipps Cross University Hospital and The Royal Free Hospital. Not only is proximity to London alienating to the many UK patients needing help, but the cost of having Psychodermatology through private healthcare is a costly process. Charlotte Ferguson-Quilter, Psychologist and founder of Disciple skincare revealed that an initial consultation at a Harley Street Clinic with a clinical psychologist who specialises in Psychodermatology will cost around £260 and £210 for each session after. A consultation with Dr Ahmed in her private clinic, Eudelo, will set you back £550.

"As far as psychological therapies are concerned, we have only just touched the surface" -  Dr Alia Ahmed

Traditional medical treatments for conditions like Holly’s are also limited in what they can offer. By the time Holly was 23, she was told by doctors that she’d failed every available option for treating her psoriasis. Talking, sharing and connecting with her therapist on a holistic way of managing the condition is what motivated Holly to start the #GetYourSkinOut campaign on Instagram. Using what she learnt in therapy, she created a platform to bring awareness to psoriasis, to educate and confront the many misconceptions around the condition. “Being able to share that visible, visual identity of people showing photos and being able to say 'That looks like me' or 'You're going through something similar', opens up something where you can feel quite alone and quite isolated. I found experiences and connections to people like me, people who I could relate to and understand what I was going through, and I could say ‘I'm in so much pain’ or ‘Has anybody tried this moisturiser?’ It opened up this endless connectivity to others experiencing the same thing.”

As for the future of Psychodermatology, Ferguson-Quilter believes that in the next decade we’ll see the emergence of Psychodermatology as a discipline in its own right. “The wider medical community are beginning to understand the importance of interdisciplinary practice and to develop an extensive medical education program with further research in this area. This will hopefully lead to better access to treatment for patients and more information available for the general public.”

Dr Ahmed also expects the demand for the service to increase as further studies are conducted into the relationship between the mind and the skin. “There already exists robust research to support the link between emotional stress and reactions in the skin but in-depth analysis will allow a more tailored approach to management of skin disease. As far as psychological therapies are concerned, we have only just touched the surface.”