In a telephone interview with HealthCentral, Dr. Peter Lio, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, said that the main function of the skin is to keep water and key nutrients in and keep allergens, irritants, and infectious agents out. Additionally, our skin is our sensory organ, the engine for vitamin D production, and it protects us from the elements, to name just a few of its major functions.
Because there’s a whole group of jobs the skin does, if the skin can’t do its job, lots of different kinds of problems can arise. According to Dr. Lio, there are two key areas for skin issues: the barrier function and the immune system connection.
When the skin’s barrier doesn’t work correctly – for example, the skin can’t hold moisture or nutrients in or the bad things get in, like irritants, allergens, or infectious agents – those barrier breaks wreak havoc on the body. Once this happens, even a little bit, you can get stuck in a vicious cycle.
According to Dr. Lio, “If the immune system is comprised - either inappropriately overactive in the case of autoimmune and inflammatory diseases, or impeded as in the case of immune suppression - things can go awry very quickly,” and, again, you can get stuck into a vicious cycle.
As embryos develop, the ectoderm, the outermost layer of cells or tissue of an embryo in early development, gives rise to both our skin and our nervous system. Meaning that forever our skin and nervous systems are intertwined.
Skin problems impact mood in many ways. Chronic itch could drive anyone crazy. Vitiligo, or the loss of skin color, can affect mood and self-esteem. Acne and acne scars have a huge emotional impact, as does hair loss for women. Dr. Lio said it best: “Skin affects our psyche more than anything thing else. Our skin is our face to the world.”
In a telephone interview with HealthCentral, J. Raymond DePaulo, Jr., M.D., Co-Director of the Johns Hopkins Mood Disorders Center, said that some medications for skin disorders can create or exacerbate psychiatric issues. For example, in 1998, the U.S. Food and Drug Administration (FDA) issued a warning to physicians regarding a possible association with the use of Acutane (isotretinoin) and depression, psychosis, suicidal ideation, and suicide.
Additionally, some psychiatric medications’ side effects can create or exacerbate skin issues. For example, medications for ADHD are stimulants and can make users “ticky and picky.” Lithium can make existing acne much worse, causing further emotional distress.
Often, it’s very difficult to tell which came first: the skin disorder or the mood disorder. It’s best to partner with a medical professional who is trained to help you pull together all of the clues into a cohesive story. Dermatologists, allergists, and psychiatrists can help you sort out these chicken and egg skin/mood complexities.
Keep a journal of possible triggers of your skin condition flare-ups, like: What did you eat? What did you put on your body? Were you exposed to something different in your environment? Be sure to give your doctor a detailed history about what’s happened. Bring your journal to your appointment. Above all, have hope. Dermatologists, allergists, and psychiatrists have a large arsenal of tools to work with you.