Several studies show that social stress is linked to skin disorders. The role of stress in skin disorders can be summarised within three medical groups: (i) disorders that cause the condition (ii) where the condition itself leads to stress and mental health issues (iii) where there is an interaction between the condition and stress at the onset of symptoms and during the course of the disease e.g. atopic dermatitis, psoriasis, urticaria, acne, effluvium, cancer. Sufferers often find it impossible to avoid trigger factors resulting in unpredictable flare ups of the skin symptoms. [1] 
Our skin pallor often reflects our reactions in daily life: pale with shock or fear, red with embarrassment or irritated with something or someone having ‘gotten under our skin’. Such idioms reflect the underlying physiological processes (neurological, hormonal, circulatory) involved in how we react in specific situations. To enable the body to cope with stressful situations, [measurable] stress mediators are released in the body that are reacted to by the immune system. These mediators will respond differently, depending on whether the stress is acute or chronic. As skin is a first line defence (i.e. and outer barrier) in our immune system, it follows that persistent stress can cause inflammation to occur at the skin surface and give rise to a range of disorders such as those mentioned above. In time, the brain may be affected with symptoms of malaise that are intended to conserve energy to allow repair and healing. This malaise may be indistinguisable from depression. [1] 
Dermatology is probably the leading medical specialty that advocates a ‘bio-psycho-social approach’ to the treatment of skin disorders. Irrespective of the cause or effect aspect of the skin disorder, dermatology acknowledges the talking therapies, as part of the treatment and indeed go as far as to say, that psychoanalysis is most effective. [1] The role ‘psychodermatologist’ exists in countries outside Ireland. A number of consultant dermatologists here in Ireland, have requested a psychotherapist to be part of their team. Sadly, the funding remains unavailable within the hospital system and patients must avail of psychotherapy privately. 
So how can the talking therapies help? Well, the term ‘stress’ in itself is an over arching term with many roots. In the medical world, stress is referred to as a cause while in the psychotherapeutic world, it remains a symptom, more favourably termed ‘distress’. If you ask ‘when did the skin condition start’ (as opposed to ‘how long have you had it), you may be told of an event (e.g. loss, separation etc) which combined with its manifest meaning, associations and memories, tells a story. The story is always specific to the individual. The alliance of the patient and therapist, provides a safe and dedicated space in which the patient’s story can emerge and the root cause(s) of the ‘distress’ can be arrived at gently, over time. 
If you have a skin disorder and would like to talk about it in a safe space, contact us here. 
[1] Peters, E.M.J. (2016) Stressed skin?-a molecular psychosomatic update on stress-causes and effects in dermatologic disease. Journal of the German Society of Dermatology 14(3): 233-252 
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