June 2019

People living with skin conditions can suffer mental health distress and in many areas of the country they lack access to adequate support.

People living with skin conditions such as psoriasis and vitiligo can experience distress and be subject to rude or unwelcome comments from others.  As such skin conditions can affect mental health.

Dr Thompson is a Clinical Psychologist specialising in psychological wellbeing in skin conditions, and he acknowledges that there is a gap in services available for people experiencing distress.  In one of his recent studies, a person living with rosacea (a condition often confused with acne) was reported as saying:

I got called a clown a couple of times … you hear a lot of negative comments when you're younger and it sort of sticks with you.

Indeed, says Dr Thompson, a recent survey in our local dermatology service found as many as 48% of patients were experiencing some degree of distress, and the research studies suggest that just over 10% of people in Europe with a skin condition suffer moderate to severe levels of depression that should be being treated. The lack of services to address the mental health needs of people with skin conditions, feeds into a lack of recognition of the problem.  This is problematic as untreated mental health issues can lead to ruined lives, and in some cases untreated cases of depression related to skin disease have been related to suicide.

A report in 2013 by the All Party Parliamentary group on Skin (APPGS) agreed that people did not have good access to psychological services. Despite this report there has been little research into the development of psychological support over the last five years, and a recent BBC survey of dermatologists suggests that the majority of patients do not have easy access to psychological support.   

Dr Thompson who was a psychological advisor to the APPGS report in 2013, has worked with colleagues to develop services and resources for people.  The British Association of Dermatologists recognising the need of patients has been working to develop a patient facing website that contains advice and self-help resources tested by Dr Thompson and his colleagues.  The self-help resources available draw on cognitive behavioural techniques and some also make use of mindfulness, as this has been shown to be related to increased ability to cope with social concerns associated with skin related distress.

On a positive note some NHS services do now exist.  For example, Sheffield Health and Social Care NHS Foundation Trust has started to provide a dedicated psychological service for people with skin conditions, where people can self-refer.

Charities also provide an invaluable support service, and there is emerging evidence as to how peer support can help to grow people’s confidence.  For example, in a study about to be published in the British Journal of Dermatology, one participant in a Facebook forum run by Alopecia UK stated:

In the beginning I couldn’t go out, wouldn’t look in the mirror, became withdrawn and probably very depressed.  Since joining the group I have realised that it’s okay to be different and that the sky won’t fall in just because I’ve lost my hair. 

Nevertheless, there remains a need for mental health services to reach out to address the psychological issues that can be associated with living with a skin condition, and this summer the All Party Parliamentary Group on Skin is planning to redouble its efforts to lobby for further services.

Here are some linked/supporting studies:

https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.15780

https://journals.sagepub.com/doi/full/10.1177/2059513118822954

https://onlinelibrary.wiley.com/doi/10.1111/bjd.17998

https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.12990

https://www.ncbi.nlm.nih.gov/pubmed/27169607

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