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When our patients come to us for an aesthetic consultation, we focus on assessing their physical features, proportions and balance in animation and repose. We consider their expectations and manage this against anticipated outcomes and explain risk and options. This results in a treatment plan with strategies for natural rejuvenation and maintenance which takes time and considerable expertise. However, the time management of the consultation must be balanced against the economic needs of the business.
These time constraints may cause us to miss some underlying causes of sub-optimal skin health. The link between mental health along with gut health is an important aspect of skin assessment and management of skin disorders that may present in our clinic.
As aesthetic practitioners, we are familiar with the functions of the skin. One vital function is to act as a powerful communicator to the outside world; through facial expression, colour and even smell, our skin can communicate a range of emotions. The condition of the skin sends out strong messages, and its appearance affects our self-image, self-esteem, identity and how we socialise and interact with others.
As a result, the appearance of the skin has a significant influence on both our mental and physical health. The impact of our psychological well-being on the skin's health is also important to understand when treating skin conditions.
Numerous studies have concluded that patients with visible skin conditions experience a poorer quality of life and have an increased risk of depression, anxiety, and suicidal tendencies.
As practitioners, we must consider both aspects of this two-way relationship - how a psychological condition can exacerbate skin problems and how a skin concern can affect one's mental health and well-being.
Psychodermatology is a well-established field in Europe and is offered as an outpatient service in some NHS hospitals. This specialism gets its name from psychiatry which is focused on the "internal" nonvisible disease, and dermatology, which is focused on the "external" visible disease.
This field of medicine recognises the relationship between mental health issues like stress, emotional upset, depression and other psychological problems and how they exacerbate skin problems.
Our skin can alert our brain to stress, and it can also be a target of stress responses. This two-way communication system between brain/skin is due to the complex interaction between our nerves, hormones and immune system. This disturbance raises cortisol levels, also known as our stress hormone. High cortisol levels over long periods can cause mental and physical health symptoms.
Psoriasis, cold sores and atopic eczema are influenced by stress mediators, which set off this chain of events leading to skin inflammation and hormonal disruption. This impairs the skin barrier function leading to dry, sensitised skin susceptible to acne breakouts. The resulting appearance of the skin can cause even greater stress and anxiety, leading to more serious mental health problems.
Continued chronic stress can promote premature ageing. Raised levels of inflammation over long periods, along with a compromised immune system, leads to a phenomenon known as inflammaging. The skin is under stress from both internal and external causes. This is why it is so important to consider the potential causes and treat both from the inside out with lifestyle changes and outside in with skin health strategies.
Acne is another good example of how stress can contribute to a skin condition and how the skin condition can cause increased anxiety. Stress hormones trigger the sebaceous glands to produce more oil. The increased oil production causes a build-up of bacteria and inflammation. The resulting blocked skin and spots can cause extreme anxiety and severely impact the sufferer's mental health and confidence, which can profoundly affect every aspect of their lives.
Scars, including self-harm scars and acne scarring, can be a constant reminder of difficult times in one's life and are often embedded in the psyche of the affected. Pigmentation and birthmarks often cause embarrassment and lead to those afflicted becoming introverted or hiding behind a mask of makeup.
As practitioners, it's essential to understand and consider psychological factors that may influence skin health. Strong emotional responses, both positive and negative, can be associated with the condition of our skin.
The skin consultation should sensitively explore a psychological history that might impact the skin’s health and a skin condition affecting the patient's mental well-being.
The practitioner’s language and phrasing need to be considered as throw-away phrases such as "you will grow out of it" or “it’s not that bad” are not helpful in professional skin consultations. Managing patients’ expectations with honesty and empathy is paramount. Gaining a patient's confidence and trust is required to communicate and inform them that total resolution may not be achievable or that reoccurrence of some symptoms is probable. This helps to develop an acceptance whereby the patient can manage their skin concerns and concurrently live meaningful lives not dictated by their skin.
Advise that can be given to our skin health patients to support their mental well-being.
About The Author
Karen Sargeant, Founder of Charlie Oscar Training, Karen has worked in the beauty and medical aesthetics industry for over 30 years. Her work as a clinic owner, practitioner and educator has reinforced the importance of how the work environment should positively impact good health and longevity.
Karen’s many years of experience and expertise in medical aesthetics, combined with her background in education, lends itself perfectly to delivering First Aid for mental health and wellness training to the sector.
Karen continues to work as a practitioner, regularly contributing to professional journals and frequently invited to share her knowledge at aesthetic conferences.