The Link Between Skin Health & Mental Health

Dr. Shannon Humphrey – Vancouver, BC

Can you talk to us about the link between acne, specifically, and mental health?

There is definitive scientific evidence that acne has an impact on mental health, on overall well-being, and on psychosocial function. One of the really interesting pieces that we can extract from the scientific literature is that the severity of acne doesn’t correlate with the severity of psychological symptoms, so sometimes even the mildest acne can cause the greatest psychological suffering for patients. In the acne consultation, it’s critically important to unpack the impact that the acne is having beyond just skin deep.

Do you find that the mental health impact on different age groups differs?

So adult women have been highlighted as a group that have the most significant psychological impact from acne, and I think there are many socio-cultural reasons why, but acne is not normalized in this group of people, and they may not have suffered from acne in the past, or at least not recently, and so we need to take it very seriously. Even if mild acne is presenting in a woman who may be having a midlife hormone shift, the potential for that having a huge impact on her psychological health is significant, and we really try and tailor treatment, not only to the severity of acne, but to the severity of impact on the patient.

Teenagers are a unique group because developmentally, this is a time of massive flux, a time of brain development, a time of establishment of self-identity. So in some ways, teenagers are very vulnerable to the psychological impacts of acne because they are developing their self-esteem and their self-identity. It’s also a group where acne has been normalized, and in some patients, this is helpful. “Oh, it’s just my time of life”, but in others, it can really increase the suffering, because their acne and their concerns are not taken seriously by their families or friends or even healthcare professionals when this is written off as normal in that time of life. And so I think it’s important to explore issues of self-esteem, psychological well-being and even self-identity with teenagers who are struggling with acne.

What advice do you give, then, specifically to patients who are having mental health challenges related to their skin?

So if patients are struggling from a psychological perspective, and they relate to any skin symptom or concern, I encourage them to talk to their physician, whether it’s a primary care physician or their dermatologist. There are solutions that can alleviate not only skin disease but also the associated psychological burden, and I’d encourage them to communicate that really clearly. This may not look like much, but it is weighing on me. It’s keeping me from doing things I want to do in my day-to-day life, which will really help your physician to tailor care, not only to what they see in your skin, but to the impact they know it’s having on you.

Can dermatologists make those direct referrals to the mental healthcare providers, or do you always defer back to the primary care physician or family doctor?

So in Canada, the primary care physician, the family doctor, is the person who would have the longitudinal relationship with the patient, and depending on the symptoms and concerns of that patient, they would be the one to facilitate referrals to a medical dermatologist, to a psychologist or to a psychiatrist.

Now, of course, there’s a complex web of working together for the best patient care, and at times, a dermatologist may flag this for the family doctor and indicate that we need to go beyond just dermatologic therapeutics here. Sometimes, treating the skin condition gives enough relief from the mental health burden associated with it that there may not be additional psychological support needed, but it needs to be customized to the patient, and the family doctor is always part of that circle of care.