DermWire’s Practical Guide to Assessing Quality of Life and Mood in Patients With Chronic Skin Diseases

Top dermatologists share tips on how to identify at-risk patients during a panel discussion on the psychosocial impact of chronic skin diseases sponsored by Abbvie.

Psoriasis, atopic dermatitis (AD), hidradenitis suppurativa (HS), and other dermatological conditions often go more than skin deep and can have profound effects on a patient's quality of life, mood, and mental health.

This is the main takeaway from a panel discussion on the psychosocial impact of chronic skin diseases sponsored by AbbVie. “The Science of Skin” took place in New York City and was hosted by interior designer and TV personality Nate Berkus, who discussed his psoriasis diagnosis for the first time.

“Psoriasis breakouts or episodes occur at the most important times and do undermine your confidence when walking out into the world,” Berkus told the crowd. “Psoriasis can affect physical wellness but also emotional and mental well-being.”

Oftentimes, the onus falls on dermatologists to recognize and address these co-occurring psychosocial issues.

“Dermatologists have come a long way in terms of how we approach patients, and we take a much more holistic approach now,” says Mona Gohara, MD. She is an associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut, and a dermatologist in private practice in Hamden, Connecticut.   

“It’s really important to go beyond the physical exam to really talk about how the disease is impacting their lives,” she says. “If we are not assessing the full impact of the skin condition, we are not going to be able to give them the best outcome.”

There are practical and easy ways to do this. Dr. Gohara calls it "gateway gab." She will start a conversation by asking patients about their summer plans or kids. “Nine out of 10 times this works,” she says. “If you establish a rapport, you don’t have to ask about depression and anxiety per se.” Patients often provide enough information in these casual conversations to reveal if they are struggling emotionally.

New York City dermatologist Evan Rieder, MD, is one of a handful of doctors who is double board-certified in dermatology and psychiatry. As such, he is uniquely suited to identify and address mental health challenges in his dermatology patients. “I always ask about quality-of-life issues, and then, if they are affected, I start asking about mood,” he says. 

“The reality is that we are limited in time and not many dermatologists are asking these questions,” he says.

Dr. Reider suggests that dermatologists add mental health professionals to their referral network to help better treat patients who are struggling with mood.

“There is a treatment armamentarium that we can [provide] at dermatology practice, or I can change the dynamic of the relationship and try to introduce a mental health care professional,” he says.

Dr. Reider recommends that his patients practice “MESS” to boost their mood and improve their quality of life:

Mindfulness such as deep abdominal breathing and progressive muscle relaxation can be practiced regularly.

Exercise can increase endorphins and improve mood and energy.

Sleep hygiene includes using the bedroom for sleep and sex and nothing else.

Social engagement or spending quality time with family and friends can also improve health and outlook.

Heightened Mental Health Concerns in Darker-Skinned Patients

Patients with darker skin tones may be disproportionately affected by the psychosocial effects of inflammatory skin conditions, Dr. Gohara adds. “These skin diseases are often misdiagnosed on brown or black skin, and access to mental health is limited for these patients, too.”

Patients tend to connect more with doctors whip look like them, and there is a dear of dermatologists with skin of color, she says.

 “We need to train more black and brown dermatologists and encourage students to go into STEM,” she says.