Q2A

Got an enquiry ........

I've had eczema in some form for most of my life, ranging from small, mild patches to being hospitalized. The problem is, I can't stop picking or scratching at my skin, to the point where I make myself bleed every day. I've been to the G.P, who prescribe creams, ointments, antihistimines, whatever, and I've tried fingind someone to approach about the fact that at this stage it may be a mental issue rather than a physiological problem. Problem is, no one ever takes eczema seriously. Most people thinks its something nearly every kid or baby in the world gets at some point on the inside of their elbows or something. I read about a practice online called Psychodermatology; dermatologists who specialise in the psychological impacts and causes of skin problems. But I can't actually find one, or anyone who would treat this as a real thing and not a form of OCD or just a regular skin issue. Do you know of any practices that might be able to help?

This is our reply.......

We understand that you have been having problems with picking and scratching at your skin, and that you would like some help to find some support with this as you believe it may be a mental issue, rather than a physical one. You have also said you would like some help to find more info about psychodermatology, or any other practices that might be able to help.

Psychodermatology focuses on the boundary between psychiatry and dermatology and seeks to pay attention to the needs of the person's emotional health as well as the health of their skin. Many skin conditions have been linked to stress and it has been said that between 30-60 per cent of people who visit a doctor with skin problems also have emotional issues which may be having an impact on their health. For example, study in the American Journal of Pathology. Researchers found that the immune cells in skin can over-react when levels of stress rise, resulting in inflammatory skin diseases. With this in mind we would agree that you are right to investigate this link in yourself and your own condition, and it is important to look into what can be done that could help you with.

Firstly we would like to give you a contact who may be able to offer advice in accessing a psychodermatologist, and then we would like to suggest a few ways in which you might be able to help yourself to get more support with these issues too.

Unfortunately it is a considerable distance from where you live, but there is a psychodermatology department at the Royal Free Hospital in London. The service is contactable during office hours on 020 7472 6197 which is a direct line to the psychodermatology administrator and secretary.They also have an email contact -
alexandra.mizara@royalfree.nhs.uk.

Their address is:

Department of Dermatology
Royal Free Hospital
Pond Street
London
NW3 2QG

They believe that "psychological factors such as stress have an effect on many skin disorders. Having a skin disorder can also affect your mood and behaviour. Psychological treatment can be helpful in both coping with and treating many skin disorders, either alone or in combination with conventional medications." They use a CBT (Cognitive Behavioural Therapy) approach. This focuses on helping a person to learn new ways of thinking and behaving in order to try to reduce psychological symptoms such as stress, anxiety and depression which could be making a skin problem worse.

We would recommend that you could try contacting them to ask them for more info about what psychodermatology clinics are available across the UK, and to offer advice as to what other help you could receive.

Ordinarily you would see a psychodermatologist through your GP making a referral, but of course this depends on whether this service is available in your area. Another thing you could try is speaking directly to your GP about what options you might have for referral. Another option might be for you to ask your GP if you can be referred to a dermatologist if you don't have one already, as they may have access to more info about psychodermatology clinics and treatment that's available. If nothing else is available, if you feel very strongly about fixing this issue your options could include seeking a referral to see them down in London although you would have to check this was possible, with regards to you being able to travel to attend appoinments which we understand might be expensive and inconvenient.

Another thing to consider might be talking to your GP to see if they might be able to continue to support the physical side of the problem with medication, ointments etc and to refer you to get CBT seperately? While it may be less specialised you might just be be able to find a Cognitive Behavioural Therapist who might understand and be able to apply the CBT to your issues with your skin. Also, if you are not happy with your GP's response and don't feel they are being helpful please remember that you have the right to change GPs until you have one who is able to support you with this. The issue that you are experiencing is a medical one and they should be able to provide help, advice and support.

As well as getting in touch with health professionals it might help to look at your life and emotional health in general to see if there are any areas that are causing you stress, that could be triggering or making your picking and scratching worse. Things such as meditation, exercise and yoga can help with stress reduction as well as relaxation, pampering yourself and trying to free up space to yourself in your life, and avoiding or trying to find ways to deal with negative relationships.

We know you do not believe that the idea that this could be linked to OCD applies to you and of course it may not, but in some cases skin picking is what is known as an Obsessive-Compulsive Spectrum Disorders. Also, for some people continually picking skin is a form of self harm, that could be a reflection of deeper emotional issues, or it could just be a bad habit that may have developed over time as a response to your physical issues with eczema . Again, there are therapies that can help with these types of issues. For example The "habit-reversal technique" is a strategy used to inhibit scratching and it has been reported to have some success with skin disorders, such as eczema and psoriasis. This involves people monitoring themselves for early signs and looking out for situations where they might end up scratching and them practising alternative responses, such as clenching the fists.

You have said that no one ever takes eczema seriously but we would suggest that this is not acceptable and that you are doing the right thing in looking into this and looking for help and support in an area that is just beginning to be better understood in more recent times. If you have skin problems you should be able to see a dermatologist and access all the emotional and physical support that you need to deal with this condition, and if you don't get the support you are looking for straight away keep trying and if necessary, you could perhaps look into accessing some books on psychodermatology, CBT and mind-body medicine either through your local library, bookshop or online to help you build your knowledge and understanding of these issues.

Perhaps if you would be willing to try contacting the Royal Free Hospital psychodermatology department and discussing the possibility of accessing a dermatologist and CBT from your GP, then if you don't feel that has been helpful you could get back in touch with us and we could try and see what other help we can find for you?

We hope this reply has been useful, feel free to contact us again

All the best

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