We all know that there is a clear connection between the skin and the mind. I have long argued that dermatology may best be described as a specialty that deals with the skin, hair, nails, mucus membranes, and psyche. As noted in the pages ahead, atopic dermatitis is a condition in which the mind-skin connection is commonly evident. Yet, whether due to clinical time pressures or perhaps our own discomfort with addressing psychological issues in our patients, dermatologists may not always address the psychological components of skin disease.
I firmly believe that it is essential to incorporate an assessment of the patient's psychological well-being into the dermatology clinical visit, and I have proposed a straight-forward approach for doing so: the SAD Evaluation. SAD stands for Stress, Anxiety, and Depression.
As described in a previous edition of Practical Dermatology® (November 2011, available online at PracticalDermatology.com), the SAD Evaluation requires no lengthy questioning and no score tabulation. Simply ask each patient to rate his/her level of Stress, Anxiety, and Depression on a scale from 1, minimum, to 10, maximum.
Close to one-third of dermatologic disorders involve psychiatric and psychological factors, according to estimates (Am J Clin Dermatol. 2003; 4(12): 833-42). These include acne, atopic dermatitis, psoriasis, and rosacea. When dermatologists fail to acknowledge this reality, we potentially make patients feel even more vulnerable, depressed, or anxious. By simply acknowledging their psychological status, we can help patients feel less anxious and less stressed.
Often, simple reassurance goes a long way. Perhaps we can even share some strategies for stress reduction. Efficient treatment and improvement of the dermatitis can break the cycle of psychological distress. Importantly, in some cases, we may need to make a referral to a medical professional who can help the patient far more than our therapies can.
Stress, anxiety, and depression are, sadly, prevalent in our society, and they contribute to certain dermatologic diseases, including eczema. When we care for the whole patient and address these factors, we increase the likelihood of therapeutic success and build lasting relationships with patients based on empathy and trust.
—Joseph Bikowski, MD, FAAD Chief Medical Editor