Managing mood disorders associated with skin diseases

By Brandon May | Medically reviewed by Amanda Zeglis, DO, MBA
Published June 8, 2022

Key Takeaways

  • Skin diseases are leading non-fatal contributors to the global disease burden.

  • Such diseases exert a significant negative psychological burden on patients, with some chronic conditions negatively impacting their daily activities, sleep, and overall quality of life.

  • Dermatologists and other clinicians are at the forefront of identifying mood disorders in patients with skin conditions to ensure prompt management of psychiatric comorbidities and improved patient outcomes.

Skin diseases such as acne vulgaris, alopecia areata, eczema, and psoriasis are leading non-fatal contributors to the global disease burden.[]

While the clinical impact of most skin diseases is undeniable, the negative impacts of these conditions on mental and emotional health cannot be understated, particularly given the potentially deleterious effects of psychiatric comorbidities when left underrecognized and/or inadequately treated.[]

In exclusive interviews with MDLinx, a prominent US-based dermatologist discussed the mental health effects associated with skin disorders and the importance of prompt identification to ensure optimal outcomes for affected patients.

Real-world impact of skin diseases

Skin diseases exert a significant negative psychological burden on patients with these conditions, with certain chronic skin conditions negatively impacting patients’ daily activities, sleep, and overall quality of life.[]

Diseases that considerably affect physical appearance tend to further increase the risk for mood disorders and acute anxiety conditions, which may impact the course of the condition and treatment outcomes.

Research published in the Journal of the American Academy of Dermatology shows that one in five patients with atopic dermatitis (AD)—one of the multiple categories of eczema—have at least mild depression. Most patients with this disorder experience fluctuating levels of depressive symptoms over the course of their disease.[]

Perhaps partially related to the persistent pain, pruritus, and sleep disturbances associated with AD, many patients reported concentration difficulties, slow movement, and thoughts of self-harm.

The study authors suggested that improving control of AD symptoms could “secondarily improve mental health” in patients with the skin disease.

Effects on young people

Longitudinal research suggests that AD is also associated with depression and internalizing behaviors in children and adolescents, particularly if the disease is severe.[]

In an MDLinx interview, Shawn Kwatra, MD, explained that skin disorders are a unique set of conditions in which “the whole world can see your pathology.”

"Patients with diseases such as prurigo nodularis or vitiligo suffer even more because of psychosocial distress. "

Shawn Kwatra, MD

“There is embarrassment, and many patients withdraw socially,” he added.

Kwatra, who serves as the director for the Johns Hopkins Itch Center, sees the mental health effects of skin disorder symptoms in everyday practice.

He suggested that dermatologists and other clinicians are at the forefront of identifying mood disorders in patients with skin conditions to ensure prompt management of psychiatric comorbidities and improved patient outcomes.

“Oftentimes, patients with intractable itch have impaired sleep, which can lead to the development of anxiety, depression, and other psychological conditions,” he added.

"Patients can be screened for sleep disturbances and depressive symptoms during clinic visits."

Shawn Kwatra, MD

As a result, Kwatra noted that some patients find that psychotropic adjunctive therapy can help improve their overall quality of life and mental well-being.

Individualized treatment

Aside from the symptoms of the disease, the burden of ongoing treatment for chronic diseases may also be associated with impairments in mental health.[]

The chronicity of skin disease is no exception.

Clinicians should seek to develop individualized treatment strategies for patients with skin diseases, emphasizing approaches that both reduce side effects and ensuring overall efficacy.[]

Some research suggests that optimizing therapy and managing adverse effects of treatment may also help improve treatment adherence, leading to better outcomes for patients and potentially beneficial effects on mental health.[]

What this means for you

Mood disorders such as anxiety and depression are highly prevalent in patients with skin diseases. Clinicians should be alert to comorbid mental health issues in this population. Understand the mental health burden associated with skin diseases and increase your awareness of the symptoms of mood disorders occurring in patients to ensure early detection and care. Consider using screening tools for anxiety and depression in such patients.

Related: Expert advice: Addressing men’s resistance to skin protection

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