Casey Jordi

Addie Degenhardt
IDEAS Project Block
October 21, 2016
The physical manifestation of mental ailments in the bodys largest organ, the skin, is a
connection that has been slow to be accepted in academic and medical settings in the United
States. This relatively new field, known as psychodermatology, investigates the link between
skin disorders and mental disorders, and how one can directly impact the other in varying
degrees of severity. The medical field of psychodermatology is a recent phenomena, although the
notion of a mind/body connection is not; one of the first documented instances of professional
acknowledgement of the mental impact of acne was in their 1948 paper, Psychogenic Factors in
Dermatologic

Disorders, where Sulzberger and Zaidens wrote, There is no single disease which
causes more psychic trauma and more maladjustment between parents and children, more
general insecurity and feelings of inferiority, and greater sums of psychic assessment than does
acne vulgaris.
However, the term psychodermatology was not coined until much later, the first use

having been recorded in 1974, when Herman Musaph used the word in his study Mechanisms in
Symptom Formation. Musaph, now considered the father of modern psychodermatology, was a
renowned practitioner in general medicine, having moved on after World War II to study the
fields of psychiatry and psychoanalysis. Musaphs specializations were endless, and in addition
to psychoanalysis, he became interested in dermatology. From 1953, he was the consulting
psychiatrist in the Department of Dermatology at the University of Amsterdam, where he delved

deeper into the psychosomatic responses associated with having skin disorders. In Europe at that
time, the limited knowledge regarding skin/emotion connections drove many scholars to interest
in the blooming field of psychodermatology, which was later established by the creation of the
Department of Psychodermatology, with Musaph acting as the head. He described the field as
the study of psychological variables related to the onset, course and treatment of skin diseases.
(The European Society for Dermatology and Psychiatry)
Recognizing the significance of the minds effect on how the body presents itself is
imperative to accepting the validity of problems, commonly social problems, faced by
adolescents who suffer from skin conditions and mental illnesses. From many perspectives,
understanding how skin and mentality are linked is conducive to creating an environment that
feels safe for peers and students by acknowledging that, beyond stress from school and personal
life, withdrawal from social settings is the result of countless factors; among these factors, and
perhaps in some cases largely, the presence of a noticeable skin disorder will negatively impact
the individuals self image, confidence, and emotional responses. (Barankin & DeKoven 713)
The constant barrage of beauty standards on adolescents plays no small part in this issue.
The stigmatization of skin disorders, particularly acne, as a result of poor hygienic practices can
lead to isolation from sufferers, whose peers perpetuate the idea that visible skin disorders are
contagious and gross. The fact that skin diseases can often be progressive and episodic means
that sufferers can sometimes feel that they constantly have to adapt to the changes in their
physical appearance. (Papadopoulos & Walker 3) Skin conditions are generally seen as purely
cosmetic occurrences, something that only dermatologists should be concerned about in order to
fix it and make the patient aesthetically pleasing again. The fact that skin conditions are almost

always visible compared to other internal diseases makes it difficult to feel as though one has
control over their own body, less like a private matter to deal with personally and more like a
public display.
The purpose of the research in this annotated bibliography is to gain a better
understanding of the field of psychodermatology, and how widespread its effects are in both
academia and the personal lives of millions of people, especially adolescents. In addition, I hope
to encourage awareness of the psychological effects of having skin disorders, and introduce
another dimension to common skin diseases that will expand on more than just the physical
aspects.

Barankin, Benjamin, MD, and Joel DeKoven, MD. "Psychosocial Effect of Common Skin
Disorders." US National Library of Medicine. N.p., 28 Apr. 2002. Web. 3 Oct. 2016.
Benjamin Barankin is a dermatologist and founder of Toronto Dermatology Center, and
Joel Dekoven is a consultant dermatologist at Sunnybrook Hospital, in addition to being
an associate professor at the Department of Medicine at the University of Toronto. The
objective of this essay is to increase awareness of the psychosocial effects of having
common skin disorders, specifically psoriasis, acne, and atopic dermatitis. The authors of
this paper emphasize that skin conditions are more than just a 'cosmetic nuisance', and
can have profound effects on the mental wellbeing of a patient, especially when exposed
to the stigma spread by both the general public and also many doctors who disavow their
experiences. Acne, in particular, is a condition frequently paid no heed to outside of
concern involving cosmetic beauty, and is, in fact, downplayed in comparison to other
health conditions that affect internal parts of the body. However, the effect of acne is
'comparable to that of arthritis, back pain, diabetes, epilepsy, and disabling asthma.'
Barankin and Dekoven link this with the fact that acne is, generally, located on the face,
an area of the body which is almost always exposed. This idea of location + condition =
more drastic effects is something that should be considered in this project.
Clay, Rebecca A. "The Link Between Skin and Psychology." American Psychological
Association. N.p., Feb. 2015. Web. 22 Sept. 2016. Rebecca A. Clay is a professor at the
American Psychological Association, whose interests and specialties range from
psychology to dermatology. In this article, she discusses the link between psychology and

dermatology and strives to legitimize the field of psychodermatology. Clay makes it a

point to bring up the wealth of success in the field overseas in Europe, and how countless
research colleges have experienced an influx of interested students. As the article
continues, she discusses how the services that psychologists are trained in can be
specifically applied to the field of dermatology, with three root psychodermatology
disorders: skin problems affected by stress, psychological issues caused by [disfiguring]
skin conditions, and psychiatric disorders that manifest via the skin, such as delusional
parasitosis (the delusion that one has parasites, which can lead to excessive picking of the
skin and self harm) and trichotillomania (the urge to pick one's body hair, usually
associated with compulsive disorders and anxiety). It can be inferred that, by recognizing
the issue and working to publicize it, the next step would be to organize preventative
measures to either minimize the risk of having a dermatological condition because of a
psychological disorder, or vice versa.
Edgar, Julie. "Me and My Psoriasis: A Personal Story of Treatment and Acceptance." WebMD.
WebMD, n.d. Web. 12 Oct. 2016. In this article, Julie Edgar, who has had psoriasis her
entire life, describes her feelings and experiences with the condition, and how it has
interacted with her day to day life. She highlights the anxiety faced while trying to decide
what to wear, what would have the most coverage, and how the weather would lessen or
worsen her symptoms; this leads into her discussion of treatment - having smooth skin,
"one that wouldn't mark [her] as damaged", or choosing to save money. She describes
how, when she sought treatment, dermatologists regarded her with curiosity rather than
concern, referring to the illness as 'medieval' and thus not having much knowledge.

Because of the lack of treatment, she found herself hiding her skin from society, even
actively building her life around the covering of her psoriasis. Her story is personal
experience, and her end goal is to make the point that even after seeking treatment for
20+ years that never worked, she still ended up with a life she was a proud of.
Horne, Juliette. "Psychosocial Factors in Dermatology." DermNet New Zealand. N.p., Apr. 2015.
Web. 03 Oct. 2016. Juliette Horne is a health psychologist at Middlemore Hospital,
located in New Zealand. This article looks in depth into the multiple psychosocial effects
of having a skin disorder. Many of these effects are kindred to depression and generalized
anxiety, with symptoms such as loss of interest, suicidal thoughts, and lack of social
engagement. The audience of this article appears to be people who are suffering from
both skin conditions and psychological conditions, as it is written in simple terms and
with a list format. However, it is also a call to action for other medical professionals,
stating that downplaying the psychological effects that a patient is experiencing is worse
than doing nothing at all, and can have an even more profound impact on the patient's
mental health. Horne also describes the prevalence of mental illness in dermatology
compared to outside of dermatology, such as how obsessive compulsive disorders are
about 22% more common in a dermatological setting than the 3.5% in the general. This
source can be used to link mental illness and dermatological disorders, and as a means of
comparing and contrasting them.
Ranieri, Bianca. "Skin Conditions in Adolescence." Personal interview. 20 Oct. 2016. In this
interview, Bianca Ranieri answered questions based on their personal experiences with
skin conditions. Ranieri deals with rosacea and acne (brought on by rosacea) on a daily

basis, and has faced a lot of inward disgust at themselves. They describe how, for a good
portion of their adolescence, they thought they only experienced acne, as most teenagers
do. However, after doing some research, they discovered the disorder called 'rosacea',
characterized by redness and flaky skin on the face, especially the skin located on the
forehead, nose, cheeks, and chin. It turned out their acne was a result of, and not the
cause of, the redness on their face. Ranieri then goes on to explain that, along with having
a skin condition, they also have to deal with bouts of depression; the interactions between
their rosacea and mental illness were severe, with major depressive episodes as a result of
the discomfort they experienced because of their own face. In addition to this, their
family also insisted on buying face cleansing products that only worsened their rosacea,
and many times, during those instances with depression, they couldn't even bring
themselves to use, which only contributed to the idea that they have their skin condition
as a direct result of their own shortcomings. It's imperative that, in the field of academia,
personal experiences are listened to and respected in order to gain a better insight into
what trials people actually face.
Walker, Carl, and Linda Papadopoulos. Psychodermatology: The Psychological Impact of Skin
Disorders. Cambridge: Cambridge UP, 2005. Print. In this book, multidisciplinary
specialists Papadopoulos and Walker describe the interaction of the mind and body
before, during, and after the onset of certain skin disorders. They also discuss the various
outside factors faced by people with skin conditions, especially the stigmatization of
dermatological disorders and how that stigma negatively impacts sufferers. They
maintain a clear stance throughout the entire work, capitalizing on how it's necessary for

dermatologists and psychiatrists to take their patients seriously when they complain of a
mental/physical side effect in accompaniment to their physical or mental illness.
Papadopoulos and Walker provide solutions beyond superficial action, suggesting
psychological treatments in sessions to elevate the patient's security levels and help them
work through the stigmatization aspect of their skin disorders. It is helpful to have a
professional and scholarly perspective on the topic of mental/physical relationships
corresponding to skin conditions, because many times, the specialists will have a solution
to suggest.

The very idea of psychodermatology as a field is that it relays the experiences of people
with skin disorders in a multidimensional way, combining the fields of psychology and
dermatology to benefit patients and the development of science. Psychodermatology focuses on
the boundary between psychiatry and dermatology. Understanding the psychosocial and
occupational context of skin diseases is critical[...]. (American Family Physician) To fully
manage an environment of peers that is respectful and understanding toward different peoples
health, specifically people with skin disorders, it is necessary to bridge the gap between mental
and physical ailments and provide a safe space so that patients can handle their problems.
To bridge the research and art form, we will be creating a fashion show with clothing
representative of multiple skin disorders. Our models will primarily be adolescents with skin
conditions, and if they are comfortable with it, the areas affected will not be covered as a
statement to the ideal skin type being smooth and blemish free.