Skin diseases such as acne vulgaris, alopecia areata, eczema, and psoriasis are leading non-fatal contributors to the global disease burden.

Seth D, Cheldize K, Brown D, et al. Global burden of skin disease: Inequities and innovations. Curr Dermatol Rep. 2017;6(3):204–210.

 

While the clinical impact of most skin diseases is undeniable, the negative impacts of these conditions on mental and emotional health cannot be understated, particularly given the potentially deleterious effects of psychiatric comorbidities when left underrecognized and/or inadequately treated.

Achtman J, Kling MA, Feng R, et al. A cross-sectional study of untreated depression and anxiety in cutaneous lupus erythematosus and dermatomyositis. J Am Acad Dermatol. 2016;74(2):377–379.

 

In exclusive interviews with MDLinx, a prominent US-based dermatologist discussed the mental health effects associated with skin disorders and the importance of prompt identification to ensure optimal outcomes for affected patients.

 

Real-world impact of skin diseases

Skin diseases exert a significant negative psychological burden on patients with these conditions, with certain chronic skin conditions negatively impacting patients’ daily activities, sleep, and overall quality of life.

Guo F, Yu Q, Liu Z, et al. Evaluation of life quality, anxiety, and depression in patients with skin diseases. Medicine (Baltimore). 2020;99(44):e22983.

 

Research published in the Journal of the American Academy of Dermatology shows that one in five patients with atopic dermatitis (AD)—one of the multiple categories of eczema—have at least mild depression. Most patients with this disorder experience fluctuating levels of depressive symptoms over the course of their disease.

Chatrath S, Lei D, Yousaf M, et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitisJ Am Acad Dermatol. 2022;S0190-9622(22)00792–00797.

 

Perhaps partially related to the persistent pain, pruritus, and sleep disturbances associated with AD, many patients reported concentration difficulties, slow movement, and thoughts of self-harm.

The study authors suggested that improving control of AD symptoms could “secondarily improve mental health” in patients with the skin disease.

 

Effects on young people

Longitudinal research suggests that AD is also associated with depression and internalizing behaviors in children and adolescents, particularly if the disease is severe.

Kern C, Wan J, LeWinn KZ, et al. Association of atopic dermatitis and mental health outcomes across childhood: A longitudinal cohort study. JAMA Dermatol. 2021;157(10):1200–1208.

 

In an MDLinx interview, Shawn Kwatra, MD, explained that skin disorders are a unique set of conditions in which “the whole world can see your pathology.”

Patients with diseases such as prurigo nodularis or vitiligo suffer even more because of psychosocial distress.

“There is embarrassment, and many patients withdraw socially,” he added.

Kwatra, who serves as the director for the Johns Hopkins Itch Center, sees the mental health effects of skin disorder symptoms in everyday practice.

He suggested that dermatologists and other clinicians are at the forefront of identifying mood disorders in patients with skin conditions to ensure prompt management of psychiatric comorbidities and improved patient outcomes.

“Oftentimes, patients with intractable itch have impaired sleep, which can lead to the development of anxiety, depression, and other psychological conditions,” he added.

Patients can be screened for sleep disturbances and depressive symptoms during clinic visits.

As a result, Kwatra noted that some patients find that psychotropic adjunctive therapy can help improve their overall quality of life and mental well-being.

 

Individualized treatment

Aside from the symptoms of the disease, the burden of ongoing treatment for chronic diseases may also be associated with impairments in mental health.

Heckman BW, Mathew AR, Carpenter MJ. Treatment burden and treatment fatigue as barriers to health. Curr Opin Psychol. 2015;5:31–36.

 

Clinicians should seek to develop individualized treatment strategies for patients with skin diseases, emphasizing approaches that both reduce side effects and ensuring overall efficacy.

Skroza N, Tolino E, Balduzzi V, et al. Advantages of tailored Isotretinoin treatment in moderate to severe acne: Real-life data. Front Pharmacol. 2021;12:733526.

 

Some research suggests that optimizing therapy and managing adverse effects of treatment may also help improve treatment adherence, leading to better outcomes for patients and potentially beneficial effects on mental health.

Choi JW, Kim BR, Youn SW. Adherence to topical therapies for the treatment of psoriasis: Surveys of physicians and patients. Ann Dermatol. 2017;29(5):559–564.