Does your skin need a shrink? Feb 12, 2007

Feb 12, 2007
Does your
skin need a
Emerging field of
psychodermatology aims
to soothe the soul, too
When you feel good, you look good. But when you're stressed out,
your skin is often the first place to show it.
By Diane Mapes
MSNBC contributor
The hives started as soon as Lorelei Russ moved in with her boyfriend.
“At first, I thought it was the latex paint or the cats or something environmental,” says Russ, 32,
of Brooklyn, N.Y. “So I went to a doctor who told me to take antihistamines.”
The drugs didn’t help, but after nine months of breakouts, Russ discovered something that did: a
“I slowly figured out that my hives only happened when I was with my boyfriend,” says Russ. “It
became my stress reaction. As soon as I left the relationship, my skin stopped freaking out.”
While Russ didn’t realize it, she’d stumbled onto the powerful mind-body connection that is at
the heart of an emerging field known as psychodermatology. Focusing on the boundary between
psychiatry and dermatology, psychodermatologists (or “skin shrinks”) care for the skin and the
soul, dovetailing traditional treatments like antibiotics or topical medications with alternative
methods such as relaxation, biofeedback, self-hypnosis or psychotherapy.
“An estimated 30 to 60 percent of people who come to a doctor for help with skin problems also
have emotional issues that are churning as well,” says Dr. Ted Grossbart, an assistant clinical
professor of psychology at Harvard Medical School and author of "Skin Deep: A New
Mind/Body Program for Healthy Skin."
“These emotional stressors can keep the best skin medicine in the world from working," he says.
"You’ve got to address what’s going on in the heart as well as on the skin.”
A perfect storm for skin trouble
Stephanie Gasper, 32, of Kirkland, Wash., would agree. Since childhood, she’s suffered from
psoriasis, a scaly skin condition exacerbated by stress. Two years ago, Gasper found herself amid
a perfect storm of stress when she had to organize a move from England to the United States, plan
her wedding and have her wisdom teeth out — all at the same time.
“My psoriasis just got worse and worse,” she says. “I remember trying on wedding dresses and
being so embarrassed because you could see all of this red, scaly skin. But as soon as everything
was settled and I was on the plane for the States, it completely disappeared.”
Now that Gasper has given birth to a new — and colicky — baby, though, her psoriasis is back,
and she’s shopping for a psychodermatologist. “My doctors would always tell me to take a bath
with candlelight or try to listen to music to calm down, but they’d never actually prescribe any
alternative treatments,” says Gasper. “I’m definitely ready to go for that now.”
One of the first names on her list is Dr. Bernard Goffe, founder of Dermatology Associates of
“Whenever my old patients come in with a flare-up of eczema or acne or psoriasis, the first thing
we do is ask, ‘What’s going on with your life?’” says Goffe. “And often they’ll be in the middle
of a fight with their boss or going through a divorce. I had one patient where you could almost
draw a curve correlating his hair loss with the ups and downs of the lumber market. I find a very
frequent relationship with these things.”
Goffe — who says he’s recommended psychiatrists, antidepressants and biofeedback to his
patients, with good results — is not the only one who’s spotted this mind-skin connection.
In August 2006, the Journal of the American Academy of Dermatology published a study that
found 57 percent of patients suffering from alopecia (or hair loss) had total or partial hair
regrowth after undergoing hypnosis. And a series of small studies conducted at Carleton
University in Canada found half of patients lost their warts after undergoing hypnosis.
Relaxation tapes, meanwhile, have been shown to help those suffering from psoriasis; researchers
at the University of Massachusetts Medical School discovered that patients who listened to
meditation tapes while receiving UV light treatments saw their skin clear up nearly four times
faster than those who got the light treatment alone. And in a case report published in the journal
Applied Psychophysiology and Biofeedback, a 56-year-old woman who suffered from severe
psoriasis lesions on her arms for seven years despite trying all the standard medical treatments
was cured after 13 weeks of biofeedback therapy.
None of this surprises Kristen Salvestrini of Beverly, Mass., one bit.
The 27-year-old spent a year in and out of doctor’s offices, trying everything from steroid creams
to a strawberry-free diet to rid herself of a pervasive eczemalike rash; she finally turned to
Grossbart, who used guided imagery and psychotherapy.
“It came out that I’d been through a pretty devastating breakup which corresponded to the time
when my skin started having problems,” says Salvestrini, who is rash-free these days. “One of my
big things is not expressing my emotions, especially anger. But those emotions have of way of
coming up one way or another.”
Hypnosis for hives
Psychodermatology can cover everything from a “ring finger” rash suffered by a someone in an
unhappy marriage to psychiatric disorders that result in self-inflicted skin damage to the isolation
felt by those living with highly visible skin disorders such as psoriasis, alopecia or vitiligo
(patches of de-pigmented skin).
“We have groups that provide education, but they also provide psychological support, like group
therapy,” says Dr. Bernard Cohen, a pediatric dermatologist at John Hopkins School of Medicine
in Baltimore. “They’ve absolutely helped.”
And while some might raise an eyebrow at treating hives with hypnosis, or eczema with
antidepressants, Salvestrini says the bottom line for her is that psychodermatology offers people
an alternative.
“A lot of times when I was going from allergist to dermatologist to nurse practitioner, I’d start to
feel really hopeless because it wasn’t getting better,” she says. “It’s just great to know there’s
something else out there that may work.”
Diane Mapes is a Seattle freelance writer and author of the recently released "How to Date in a
Post-Dating World."
© 2007 MSNBC Interactive