The psychiatric aspects of skin disorders

The skin and the psyche are linked from embryologic, biological, psychological and cultural perspectives. Both the skin and the brain are developed from the same ectodermic germ layer. New evidence in psychoneuroimmunology suggest that both the skin and the psyche are affected by immunologic vulnerabilities and endocrine reactions. Emotional stress may exacerbate many chronic dermatoses and can initiate a vicious cycle referred to as the 'itch-scratch cycle'; therefore, treatment of such cases may be difficult without addressing stress. The dynamic interaction between the skin and the psyche is also manifest in cosmetic behavior, whereby the psychological state of the individual is altered through the widely utilized cosmetics and cosmetic procedures. The motives for seeking cosmetic procedures may include a desire to enhance self-confidence, body image and self-empowerment. Individuals of both genders are becoming concerned about their physical appearance and are increasingly seeking cosmetic procedures. The secondary effect of reducing the internal experience of negative emotions may make patients feel less angry, sad or fearful. However, some associated psychological factors and comorbid psychiatric conditions are linked with less favorable results. Therefore, the enhancement of the dermatologist's knowledge about psychiatric and psychological-related issues are paramount to improving outcomes. Finally, the rapid development of telecommunication technologies has made it both possible and affordable to enhance clinical care, medical education and training through the use of telemedicine.