07/05/2021

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Tatler’s Education Editor investigates the emerging medical discipline of psychodermatology

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One of the great joys of boarding school is being with your friends 24 hours a day, seven days a week. But if you’re a teenager with a highly visible skin disorder such as acne, constantly living under the gaze of your peers can be stressful. A recent study in an international journal specialising in dermatology showed that almost 90 per cent of 15-year-olds felt embarrassed and self-conscious about their acne, causing a quarter of them to avoid sport, swimming, and even social interactions – and this could be exacerbated in a boarding environment.

‘The impact [for teenagers with skin disorders] can be devastating, leading to low mood, depression and social avoidance as well as the inevitable lack of self-esteem and self-belief,’ says Marina Gardiner Legge, headmistress of Heathfield School in Ascot.

The resilience and mental wellbeing of our teenagers is a growing concern. Mental health network, Emerging Minds: Action for Child Mental Health, recently reported that one in 10 children and young people have a diagnosable mental health problem, such as depression, anxiety or self-harm. Stress levels during the teenage years are compounded by the desire to fit in – something that neuroscientist Professor Sarah-Jayne Blakemore explains in her book about the teenage brain, Inventing Ourselves, is a genuine physiological need at this stage of life.

While a highly visible skin condition can affect mental health, the emerging medical discipline of psychodermatology is revealing that, in turn, mental wellbeing also has an impact on our skin.

‘There are well-established, biochemical links between the experience of psychological stress and your skin,’ explains eminent psychodermatologist Dr Alia Ahmed of the Royal London Hospital and private Eudelo Clinics on Harley Street and in Vauxhall. ‘When you feel stressed, your brain releases a number of chemicals and they kick off inflammation in your body and your skin. That inflammation is the driver for most skin diseases like eczema, psoriasis and acne. This then goes around in a vicious circle.’

However, Dr Stefanie Williams, medical director at the Eudelo Clinic, cautions that we should not see stress as the sole cause of skin conditions. ‘If you have a general tendency towards acne and other skin conditions, then stress such as exams can make it worse. But if you don’t have any genetic acne predisposition at all, then stress won’t cause you to breakout.’ In short, stress – and other lifestyle factors – can aggravate pre-existing acne, but does not cause it.

Psychodermatology treats skin conditions by combining traditional medicine with effective psychological techniques such as psychotherapy, mindfulness and cognitive behavioural therapy (CBT). Research shows that this combined treatment has physical and psychological benefits, with a 2014 British Association of Der- matologists’ study revealing that, among patients who completed psychodermatology therapies, nine out of 10 reported reduced stress, increased confidence and a better understanding of their condition.

It is a seminal theory but, in practice, teenagers are unlikely to link their skin condition to their mental health and, even if they do, may feel too self-conscious to visit a psychologist. The award-winning Teenage and Young Adult Dermatology Clinic at Oxford University Hospitals is looking to overcome these barriers, and reduce any stigma or embarrassment, by employing an on-site psychiatrist who is both accessible and low key.

‘I try to get all new patients to meet our in-house psychologist, so they can have a quick catch-up and explore if there is anything we can help them with,’ explains Dr Tess McPherson, a consultant dermatologist who leads the paediatric and adolescent service at the centre. ‘Some will benefit from formal CBT, others will be referred to psychiatric care for antidepressants; some people just need a chat and a little bit of support, while others will be offered a course of mindful yoga.’

One patient who has benefited from the holistic approach offered by this groundbreaking clinic is 18-year-old Miriam.

‘I’ve always had eczema, and then it started getting really bad during secondary school, when I was in Year 7 or 8,’ she said. ‘It was really lovely to find the centre – I felt like I’d finally got somewhere. Talking to Tess gave me so much more confidence than the GP ever had. She said, ‘We’ll sort this out’, and she had a whole plan – I came out of there feeling better than I had in quite a while.’

Like all the young patients at the clinic, Miriam met the resident psychologist shortly after her dermatology consultation. ‘It was weird, because I’ve had eczema since I was so little, I’d never really thought about it as more than a skin problem or even an addiction – all the scratching and touching my face, and all these little tics,’ she explains. ‘I never considered it may be beneficial to think about it in a different way.’

Delmaine Donson / Getty Images

CBT offered through psychodermatology clinics is one of the best ways to stop the itch-scratch-pick cycle that can lead to infection and scarring. In Miriam’s case, however, it was recommended that she listened to a specially prepared mindfulness CD every night. ‘Through that concentration, the itch became less important and less on my mind and that helped,’ she says.

Psychodermatology has been transformational for Miriam. ‘Yes, my eczema is still here,’ she explains. ‘I have A-levels coming up and there are flare-ups, so I’ve got to be careful, but I’m in such a good routine now, thanks to Tess, that I can control it a lot better than I used to and so it affects me far less.’

The impact of skin conditions on mental health can be serious, but psychodermatology is helping teenagers accept their skin and empowering them not to be held back by it. Though currently only available in a few specialist dermatology clinics, those patients who’ve been helped testify that the physical and mental benefits of psychodermatology are truly life changing.

For further information, visit:

British Association of Dermatologists (bad.org.uk)

Eudelo Clinics (eudelo.com)

Oxford University Hospitals Dermatology Service (ouh.nhs. uk/services/departments/specialist- medicine/dermatology)

Dr Linda Papadopoulos (drlinda.co.uk)

Mind over matter

Leading psychodermatologist, psychologist and broadcaster Dr Linda Papadopoulos offers five ways to help teens overcome skin conditions

1. Be aware of the vicious cycle With some dermatological conditions, there is the potential for a vicious cycle to be set up whereby the worse our skin looks, the more stressed we get, and the more stressed we get, the worse our skin looks. Being aware of this and intervening, not just externally (with topical treatments), but also internally, through stress management and self-care, is vital.

2. Listen to your skin Get a diary and draw a line down the middle of the page. On one side, write down every time your skin flares up; down the other side, note what is going on in your life, how you are feeling, how busy, stressed or anxious you are. Compare to see if you can spot any patterns in your emotional state and skin health.

3. Don’t put your life on hold Don’t let your skin limit your world. Don’t wait for it to clear up before you book the holiday, ask out the girl or go for that job interview. Instead, minimise the impact that it has on you by getting on with your life regardless.

4. Develop strategies to deal with uncertainty One of the hardest things is that you are constantly having to adapt to a change in appearance and, consequently, your body image. Engage in both short-term strategies like concealing or treatment but also in deeper, long-term strategies like pursuing activities you enjoy and finding support to talk about your feelings.

5. Don’t be defined by the condition Skin conditions are often visible to others and, as a consequence, we may feel our condition begins to define us. It doesn’t. Don’t feel obliged to answer questions about it. Instead, when you engage with people, talk about your interests and the things that matter to you. If you are asked about it, have a stock answer that assures them that you are fine with it.

In a spot of bother?

Here are a range of cosmetic solutions to help calm and control

LA ROCHE-POSAY

Effaclar Duo[+]

This anti-blemish moisturiser uses a natural prebiotic to balance skin bacteria and helps to prevent hormonal breakouts. £16. laroche-posay.co.uk

NATALIYA ROBINSON

Teen Skin Treatment

This facial to address early skin complaints is best for calming and controlling sensitive or acne-prone skin – aimed at 12- to 19-year-olds. £130. nataliyarobinson.co.uk

DR ARIEL HAUS

HydraFacial

A prescriptive cleansing and skin nourishing treatment including a

deep pore cleanse, exfoliation, hydration and key ingredients to control sebum production in the skin. £220. drhausdermatology.com

YOUNG LDN

Bespoke Acne Facial

A customised treatment plan will ensure your concerns are taken care of both inside and out. From £78. youngldn.com

SKINADE

Targeted Solutions Clear

Designed to target specific concerns and support normal skin function. It is naturally flavoured with pineapple and available in 30-, 60- and 90-day courses. £90 for a 30-day course. skinade.com

This article first appeared in the Tatler’s 2020 Schools Guide

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