Credit for this CME is expired
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Original release date 12/06. Approved for CME credit through November 2007.
After reading this article, you will be familiar with:
- The recent findings in the basic science and clinical aspects of the skin-brain connection.
- The association between dermatologic disorders and psychiatric symptoms.
- The dermatologic disorders seen in psychiatric patients.
Who will benefit from reading this article?
Psychiatrists, primary care physicians, dermatologists, neurologists, nurse practitioners, psychiatric nurses, and other mental health care professionals. Continuing medical education credit is available for most specialties. To determine whether this article meets the CE requirements for your specialty, please contact your state licensing board.
Dr Gupta is professor in the department of psychiatry at the Schulich School of Medicine and Dentistry, University of Western Ontario in London, Ontario. She reports that she has no conflicts of interest concerning the subject matter of this article.
The skin is the largest organ of the body and functions as a social, psychological, and metabolically active biologic interface between the individual and the environment. Recent studies have demonstrated that as the biologic interface, the skin plays an important role in the multidirectional communication between the endocrine, immune, and central nervous systems; in addition to acting as an effector organ, the skin is also a producer of humoral and neural signals that act both locally and centrally.1,2
Biologically, the skin is an active barrier that separates the organism's internal homeostatic milieu from the stresses and "insults" of the external environment. The skin is therefore equipped to respond to continuous stresses and insults, eg, from solar radiation, mechanical trauma, changes in humidity, and infectious agents, and it has the capability to "fine-tune" itself so that it can differentiate between "environmental noise" and biologically relevant stimuli and stresses. It is possible that this important and somewhat unique role of the skin is also the basis for its sensitivity to psychological stressors; from an evolutionary perspective, physical stressors such as mechanical trauma and infections often have an important psychological component. This article reviews some of the recent findings in the basic science and clinical aspects of the skin-brain connection. The article also reviews some of the major dermatologic associations of psychiatric disorders and the psychiatric disorders encountered in patients with dermatologic disorders.3
Recent research indicates that the skin and its appendages are both a target of key stress mediators (such as corticotropin releasing hormone [CRH], cortisol, catecholamines, prolactin, substance P, and nerve growth factor) and a source of these classic immunomodulatory mediators of the response to psychologic stress.1,2
The skin-brain connection may be the basis for the observation that a wide range of inflammatory skin conditions such as atopic dermatitis and psoriasis are exacerbated by psychological stress. Clinically, the importance of psychosomatic factors in dermatologic disorders is well recognized; psychosomatic factors are important in at least one third of all dermatology patients. Furthermore, the placebo response in certain dermatologic disorders is greater than 30%, which further emphasizes the importance of psychosomatic mechanisms in dermatology.
1. Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-1704.
2. Slominski A, Wortsman J. Neuroendocrinology of the skin. Endocr Rev. 2000;21:457-487.
3. Gupta MA, Gupta AK. Psychodermatology: an update. J Am Acad Dermatol. 1996;34:1030-1046.
4. Gupta MA, Gupta AK, Kirkby S, et al. A psychocutaneous profile of psoriasis patients who are stress reactors: a study of 127 patients. Gen Hosp Psychiatry. 1989;11:166-173.
5. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139:846-850.
6. Hull PR, D'Arcy C. Acne, depression, and suicide. Dermatol Clin. 2005; 23:665-674.
7. Pistiner M, Pitlik S, Rosenfeld J. Psychogenic urticaria. Lancet. 1979;ii:1383.