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Can Psychodermatology Help Your Eczema?

Thursday, 21 February 2008

For many people with eczema, conventional dermatology is dramatically helpful. But if your frustration is building because you are not getting the help you’re hoping for, it may be time to add some new tools.

Eczema is as clearly medical as heart disease or stomach trouble, yet mind and body always do an intricate dance together. You probably know that many medical problems respond well to stress reduction and life changes, but perhaps did not realize that eczema is also very responsive to psychological techniques.

Rather than dividing illness into "emotional" or "psychosomatic" and "physical," I see emotions as one factor in all skin diseases. Some skin problems are like the common experience of blushing: an emotional event produces a direct and dramatic change in the skin.

Emotional stress may be the sole cause of a few symptoms, but is more typically a trigger of the flare-ups of an ongoing medical condition. In one study, seventy percent of atopic eczema sufferers were able to identify their specific emotional triggers.

Recent studies tell us that between thirty and sixty percent of all people who seek medical attention for a skin problem experience significant underlying psychological turmoil. This is critically important because emotional problems can keep even the most sophisticated medical treatment from working.

The Itch-Scratch Cycle that is responsible for so much misery is also very fertile ground for psychodermatology. Emotional factors can cause, and frequently heighten itching and scratching. Psychological techniques can be vital tools for breaking the cycle.


How do you determine if you are a likely candidate for these techniques? How important is emotional stress in your illness? The more of these questions you answer “yes,” the more seriously you should consider psychodermatology.

Ask yourself:
1. Do your symptoms get worse (or better) with emotional turmoil?
2. Is your condition more stubborn, severe, or recurrent than your doctor expects?
3. Are usually effective treatments not working for you?
4. Do most treatments work, but not for long?
5. Is each disappearing symptom quickly replaced with another?
6. Do your symptoms get better or worse in a very erratic, seemingly nonsensical way?
7. Do you see striking ups and downs in your symptoms with changes in your social environment: vacations, hospitalizations, business trips, or the comings of family members or bosses?
8. Do people find you strikingly stoic, unruffled, or computer-like in the face of stressful life events?
9. Is your level of distress and concern about your problem strikingly high or conspicuously absent?
10. Is your skin worse in the morning, suggesting that you rub or scratch unintentionally at night?
11. Do you have trouble following your health care provider's instructions?
12. Do you do things you know will hurt your skin, such as picking or scratching, overexposing yourself to sunlight, or not following your doctor’s directions?
13. Do you feel excessively dependent on your dermatologist or excessively angry with him or her? (Even if the faults are real, are you overreacting?)
14. Does it seem that others notice improvements in your skin before you do? Is it hard for you to acknowledge when your skin has improved?

The more of these questions you answered positively, the more likely a candidate you are for getting help from psychological techniques. This approach can provide:
1. Help finding the hidden role of your emotions in your eczema. Are they causing,
triggering, or heightening outbreaks? You'll learn to know yourself and use this knowledge to make your skin better.
2. Techniques to reduce itching and scratching. (
3. A systematic method to reduce the emotional impact of your illness so you can cope better and suffer less while your skin improves.


Beyond the usual physical and environmental changes what seems to switch your eczema into high gear?

*Fred’s father was a tyrannical dictator. His skin flared whenever people pressured or demeaned him in father-like ways.

*Lisa had always been a very “good girl.” When her jerk of a husband stirred up ‘not good‘ feelings like anger, she experienced an angry rash rather than feeling the forbidden emotions.

*Sara had been taught that “Big girls don’t cry.” When confronted by the heartbreak of her severely retarded students, she experienced eczema around her eyes rather than tears.

*Karen’s anxious, overprotective mother left her feeling that the universe was a perilous place. For her, fear equaled flare.

Each of these people were able to see substantial skin improvements as they learned to “Feel it in their heart, not in their skin.”


In 30 years of working as a skin psychologist, I have been most impressed with the effectiveness of three treatment tools:


With literally hundreds of different approaches, it is hard to be an educated consumer. Look for good personal chemistry: someone you feel ‘gets’ you. Look for a depth of experience working with eczema and scratching. Someone can be a great therapist for people with other problems, yet ignorant and ineffective in this area. Ideally a therapist should be competent to address behavior change, cognitive (thinking) issues, and also the emotional side of the problem and relevant personal history. A therapist who is too strictly committed to one approach or technique may have major blind spots.


Antidepressants, anti-anxiety agents, and mood stabilizers have been very helpful for some of my patients, and a disappointment for others. If you want to go this route it is important to be persistent and expect to experiment with different drugs and dosages.


These techniques, which also usually include relaxation and imaging, are best taught by a qualified psychotherapist. You can learn to actually change your skin from within. Do you go into a spacey trance state when you scratch? This “inadvertent negative hypnosis” can be transformed into an effective scratch reduction technique. Emotional stress can keep the most effective medical treatment from working. Yet this same mind-body link, when it is working FOR you, can produce dramatic improvements.

Reference: | donate

About the writer: Ted A. Grossbart, Ph.D. is a licensed clinical psychologist in private practice in Boston. He is a Senior Associate and Clinical Supervisor for Beth Israel-Deaconess Hospital's Department of Psychiatry, and an Assistant Clinical Professor of Psychology at Harvard Medical School.


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