In other cases, people have truly psychiatric diseases that present as dermatological ones, including cutting, nail biting, hair pulling, some tic behaviors, and delusional parasitosis, a mistaken belief that one is being infested by parasites such as mites, lice, fleas, spiders, worms, bacteria, or other organisms.
Bruce Katz, MD, director of the Juva Skin and Laser Center and the director of the cosmetic surgery and laser clinic at Mount Sinai Medical School, both in New York, explains it this way: "It's the target organ theory, and certain people have different target organs that channel stress," he tells WebMD. "Some people get ulcers, some people get migraines, and other people get rashes as the skin is their target organ," he says.
That's why when "we have patients who come in with stress-induced or neurotic conditions related to psychological issues, we refer them to a psychologist or psychiatrist or even acupuncture," Katz says.
The good news is that by consulting with other specialties and using new treatments for skin disorders including lasers, doctors are better able to treat both the skin and the emotional issues than ever before, he says.
New Field, New Treatment Possibilities
"If appearance is impacted due to a skin condition, you can end up having to deal with self-esteem issues and social stigma, which, if unaddressed, can lead to depression," Mallin says.
"If they truly have depression or a diagnosed anxiety or psychological disorders, medication can be helpful and so can a brief course of cognitive behavioral therapy that works at changing reactions and behaviors," Mallin says.
Relaxation training can help as well.
One study at the Touch Research Institute at the University of Miami showed that children's mood and activity levels improved, as did all measures of their skin condition including redness and itching, after massage therapy. Parents' anxiety also decreased.
Another potential solution is habit-reversal training.
"Say you pick at your acne or eczema and you get scarring and are actually making it worse, you need to be aware where your hands are," she says. "Being more self-aware of what your hands are doing and having alternative behaviors that take the place can help."