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15]

Review Article

Interphase Between Skin, Psyche, and Society: A Narrative Review

Abstract Bagde Pranaya

Disorders of the skin affect the psyche of a person significantly. The interplay between internal Ashwanikumar,
and external world can be depicted through the various skin reactions in regard to psychological Soumitra Das1,
or physiological stimuli. Psychocutaneous illness could be exclusively psychological or stress
related or due to strong psychogenic factors. As per biopsychosocial model, it could be primary, Varghese P
multifactorial, or secondary to disfigurement. Whichever is the condition, invariably stress is a Punnoose2,
major contributing factor in prognosis and onset of disorders of the skin. Self‑explanation, myth, Udairaj Basavaraj3,
stigma, and diminished self‑confidence often lead to depression and suicidality followed by active Barikar Chandrappa
avoidance of the workplace, in turn, causing significant disability in the individual. The conflict Malathesh4,
between self‑image and perceived image frequently causes fear of rejection leading to social anxiety,
reduced self‑confidence, interpersonal communication, and impaired sexual intimacy with a partner. Sheikh Shoib4,
Maladaptive sets of coping strategies such as alexithymia, shame proneness, avoidance, concealment, Seshadri Sekhar
and escape are very common among the sufferers which impair the attachment with family and Chatterjee5
friends. Children are the extreme sufferers as they develop inferiority, low self‑esteem, loss of body Consultant Dermatologist,
image, and social withdrawal leading to rejection from parents and faulty development of attachment Department of
pattern. Hence, disorders of the skin can lead to impaired coping, impaired compliance, limitations Dermatology, DermaVue
in quality of life, negative body image, and stigmatization which invariably cause psychological Skin and Hair Clinic,
comorbidities such as depression, anxiety, phobia, and somatoform and adjustment disorders. Hence, Thiruvananthapuram, Kerala,
1
Department of Psychiatry,
there is a direct relationship between skin, mind, and society which we are going to explore in a
National Institute of Mental
detailed fashion to understand its impact on the psyche and the society. Health and Neuroscience,
3
ESI, Bengaluru, Karnataka,
Keywords: Depression, mind, self‑esteem, skin, society 2
Department of Psychiatry,
Government Medical College,
Kottayam, Kerala, 4Psychiatrist,
Introduction Moreover, how a person copes and adapts Health Sevice, Jammu and
to the skin conditions depend on various Kashmir, 5Department of
Skin is considered as the “organ of
factors such as the personality, family, and Psychiatry, Medical College,
expression” and it serves as the boundary Kolkata, West Bengal, India
social networks. Hence, knowing the psyche
between ourselves and outside world as
of a patient with dermatological diseases
the “first point of contact.” Being the
and also finding the impact of diseases on
largest organ of the body, the ways in
the psyche of the patient is essential.[3]
which skin can react both to physiological
and psychological stimuli highlights the Mind–Body Problem and Concept
relationship between skin and external of Psychosomatic Disorders
and internal factors. Disorders of skin
are often visible; hence, definitely, it has Human beings have two characteristics,
profound psychological impact on those physical and mental. Physical properties
who are affected. However, invisible such as size, weight, shape, color, Address for correspondence:
motion through space, and time are Dr. Soumitra Das,
skin disorders like those without having Department of Psychiatry,
proper clinical or histological features public, but mental properties such as National Institute of Mental
yet diagnosed by an expert dermatologist consciousness, perceptual experience, Health and Neuroscience,
can also change the mental well being of emotional experience, beliefs, and desires Bengaluru, Karnataka, India.
are possessed by self. It brings up various E‑mail: soumitra_nimhans@
patients.[1] It affects the social, occupational, yahoo.com, soumitratdmc@
and sexual interactions. As skin and mind ontological and casual questions regarding gmail.com
are interconnected, there is a need to “what is the relationship between mind and
understand the psyche of the person behind body? Are they same? Do they influence Access this article online
the skin conditions.[2] The unique nature of each other? Etc. Seemingly intractable
Website: www.indjsp.org
the skin disorders has the potential to make nature of these problems gave birth to
it both easy and difficult for the sufferer. many philosophical theories such as DOI: 10.4103/ijsp.ijsp_92_17

“dualism” (separation of mind and body), Quick Response Code:

Thisisanopenaccessjournal,andarticlesaredistributedundertheterms
of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0
License, which allows others to remix, tweak, and build upon the work
non‑commercially, as long as appropriate credit is given and the new
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For reprints contact: reprints@medknow.com
How to cite this article: Ashwanikumar BP,
Das S, Punnoose VP, Basavaraj U, Malathesh BC,
Shoib S, et al. Interphase between skin, psyche, and
society: A narrative review. Indian J Soc Psychiatry
2018;34:99-104.

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Ashwanikumar, et al.: Skin, Psyche, and Society

“monism” (both are single and holistic), and then, the symptoms. It includes psoriasis, atopic dermatitis, vitiligo,
behaviorism, functionalism, mind–brain identity theory, pigmentation disorders, acne, alopecia, vesiculobullous
and the computational theory were inclined to explain the disorders, lupus erythematosus, leprosy, and sexually
ability of the mind to modify behavior.[4,5] transmitted infections.[2,7,8]
The bond between skin and mind can explain the issue. Exposure to excessive stress and strain in skin patients
Skin-to-skin bond in mother–baby or blushing while shy can precipitate the skin diseases, for example, in acne,
can describe such relationship. Psychosomatic medicine eczema, neurodermatitis, etc. On the other hand, people
exploring the relationships among social, psychological, with psychological morbidity due to skin disease
and behavioral factors had evolved to overcome the (such as vitiligo, leprosy, and psoriasis) have inferiority
concept of dualism to integrate mind and body through feeling due to visible changes in the appearance of
scientific explanation. The immune system in the skin is skin which may develop toward suicidal ideation and
regulated by stress response system; likewise, many other depression.[9] The uncertain etiology and changing severity
experiments prove toward a mind–body relationship. can cause the patients to have their own reasoning for their
Psychodermatology as a specialty is established not to exacerbation, and they start avoiding places and events
replace the medicine but to augment the patient care in the which eventually affects their quality of life. Disorders
field of psychosomatic medicine.[6] of skin (such as leprosy, vitiligo, and sexually transmitted
diseases [STDs]) have been often associated with myths
Skin Disease and Psychology surrounding lack of hygiene and contagion along with the
idea that a person must deserve the disfigurement as a
Psychological factors are linked to disorders of skin in
punishment for previous guilt, sin, or transgressions. This
several and varied ways. Psychocutaneous diseases in the influences others to act negatively toward sufferer, and
past were categorized using personality‑specific conflict hence, it generates a feeling of profound stigma which, in
and cutaneous symptomatology. turn, makes the patient socially handicapped.[8,10,11]
Koblenzer, as well as a latest biopsychosocial model,
pointed three main categories of psychocutaneous illness as The Psychological Impact of Dermatological
in Table 1.[7] Disorders
It is been estimated that 30%–60% of patients Negative body image
with dermatological diseases experience significant Body image can be hypothesized as “the inside view.”
psychological or psychiatric problems. The common skin It pertains to our personalized experience about our own
diseases which have an impact on psyche are chronic looks. In dysmorphophobia and bulimia nervosa, the body
disfiguring and visible diseases with increased signs and image concept is distorted due to primary psychiatric
disease. While in psychosomatic and somatopsychic
Table 1: Classification of psychocutaneous illness diseases (alopecia, vitiligo, psoriasis, etc.,), the change in
Concept Classification Examples perception of body image is due to visible and disfiguring
Koblenzer Conditions exclusively Excess sweating skin conditions.[12] Change in surface and color of the
psychological in origin skin due to skin diseases creates feelings of negative
Conditions in which Urticaria body image. In some cases where skin lesions are present
strong psychogenic factors over genitalia, it leads to fear of rejection from partner
involved and loss of sexual intimacy. Emotional vulnerability and
Conditions in which course Eczema, vitiligo insecurity start developing which reduces self‑confidence,
of the disease is influenced interpersonal communication, and socialization. These
by stress patients may suffer from social phobia, anxiety, depression,
Biopsychosocial Dermatoses of primary Dermatitis and suicidal attempts.[8,13]
model psychiatric genesis artefacta,
trichotillomania, Coping and adjustment problems
delusion of
parasitosis, etc.
Coping means strategies (cognitive, behavioral, and
Dermatoses of Psoriasis, vitiligo,
emotional) used to manage specific stressors. People
multifactorial basis of acne, atopic living with dermatological conditions (vitiligo, leprosy,
which the course is subject dermatitis, chronic alopecia, and eczema) have to adjust with personal,
to psychiatric influences urticaria, etc. social, psychological, and physical distress. Alexithymia
(psychosomatic diseases) (difficulty in emotional expression and experiencing with
Secondary psychiatric Anxiety, phobia, high sensitivity to anxiety), shame proneness, avoidance,
disorders due to serious depression, concealment, and escape are seen when there are an
or disfiguring dermatoses adjustment adjustment and coping issues specifically in visible,
(somatopsychic diseases) disorders noticeably disfiguring dermatoses. The attachment with

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Ashwanikumar, et al.: Skin, Psyche, and Society

family members, spouse, and children get affected. If they Child and parents
are not getting emotional support from spouse and family,
When a child is affected with visible and severe
it causes increased self-disgust and it facilitates the sense
dermatological conditions either congenital or
of being insecure and unaccepted among all. Negative
acquired (ichthyosis, epidermolysis, and autoimmune skin
comments from others, feeling of shame causes increased
diseases), their parents face psychological issues first. It
avoidance and leads to loneliness and communication
is difficult for the parents and family members to accept
difficulties. When patients hold negative implicit attitudes
and adjust with child’s disease and behave empathically
toward self and disease, coping becomes difficult.[8,14]
with them. About 36%–42% of parents suffer from
Studies described that patients suffering from psoriasis
anxiety disorders and 26%–36% suffer from depression.[17]
use escape avoidance and self‑controlling as chief coping
Furthermore, rejection of the kid and blaming is a common
strategies as these help them avoiding the conflicting
response from parents. These children are prone to develop
situations and control their emotions. As patients are
inferiority, low self‑esteem, loss of body image, and
hypervigilant and anxious, they are always in a mood to
social withdrawal very early in their life. Parents have
escape the situations where they have to face emotional
to understand that the child needs special care and love
turmoil. They also use distancing which reinforces the
besides proper treatment.[7,8,13]
behavior of social isolation.[15]
Partners
Social withdrawal
How one look and how one wants to look in the eyes
Chronic skin disorders, oscillating severity, exacerbations
of others make powerful contribution in sustaining an
of disease, visible disfigurement or pigmentation, social
intimate relationship, especially between partners. Ideally,
stigma, inability to cope up with the disease, lack of care,
partners should support and motivate each other in
and support are some of the factors that make the sufferer
sickness and health. When one of the spouses is having
depressed and as a result social withdrawal is seen as
a skin condition and if the partner’s support is lacking,
avoidance defense mechanism. Patients start keeping
then the disease‑related stress expands which leads to
secrecy and avoiding activities involving exposure of skin
interpersonal conflicts and decay in a relationship. Marital
and concealing affected areas by different means. Socially
harmony, sexual intimacy, and emotional attachment
withdrawn patients may have phobia, panic attacks,
get hampered.[8,13] It causes fear of proximity, negative
anxiety, and depression. It may lead to functional and
perception toward spouse, and sexual criticism. Persistent
emotional insecurity with deterioration of performance and
depressed mood (dysthymia) is the likely result when the
productivity at personal, occupational, and social level.
sense of belonging is lost. Unaffected partner’s acceptance
Thus, the patient is at risk of committing suicide.[16] Due to
to disease and coping with the complexities of disease and
all of the above-mentioned psychological problems, there is
sustaining the unconditional love and support for the patient
poor compliance of patients for the treatment and follow‑up.
is needed. Otherwise, it deepens the psychological distress.
Certain other factors such as episodic, recurrent, chronic
Empathic coping is a challenge for the partners of diseased
skin diseases, delay in response, and long duration therapy
patients because it involves understanding the impact of
also reduce the compliance. They avoid the interaction
skin disease on their loved one and also on the functioning
with doctors about their disease, and due to depression and
of their relationships.[18]
withdrawn attitude, there is a loss of hope to continue the
medication and get cured. It again causes worsening of skin Change in social behavior among family members
disease and psychological deprivation too.[13] Social withdrawal is the response to the damaging effects
of social stigma. Denial is very commonly seen in
Psychological Impact of Skin Disease on
family members of skin patients. They prefer to hide the
Patient’s Family
talk and discussion about the skin disease and diseased
It is well acknowledged that diagnosis of disorders of person. Avoidance of family functions by patients is
skin brings a lot of negative impact on the psychological considered as a protective way by family. Hence, patients
well‑being of the patient and family members. It undeniably develop embracement and anxiety when meeting people.
affects the quality of relationships. Depending on the onset They become a victim of rude negative comments in the
of skin disorder, the reaction pattern of patient and family face of public ignorance. It changes functioning of the
changes and it poses a challenge for emotional and social relationship of a patient with parents, siblings, partner,
well‑being.[13] Family members often feel the high‑level and children which indirectly affects the social network
stigma, appear overwhelmed with fear of future, poor quality of the patient and family too. Acceptance of disease
of life with chronic insomnia, job loss, constricted relationship by family members without changing the emotional
with society, etc., The caregiver often shows maladaptive attachment with the patient is important in coping with
coping with various behavioral disturbances such as chronic relationships in skin patients. The counterbalancing
frustration, low mood, burnt out, depression, and anxiety.[17] support from friends and family is essential to keep the

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Ashwanikumar, et al.: Skin, Psyche, and Society
patient’s mental and physical stamina to face his disease
in a better way.[13,18]
Psychological Impact of Skin Disease on Society
Stigmatization
Stigma can be defined as a mark or sign that not only
sets a person apart from others but also leads to their
devaluation. It occurs because of some threat to orderly
social interaction. Strong geographical and cultural taboos
are also responsible for stigma. Stigmatization is common
in visible and disfiguring skin diseases. It is considered
that skin diseases are due to curse of God or previous
transgressions. People in society have concept that all
skin illness is contagious and coming in proximity with
skin patient can increase their chance of acquiring the
disease.[10,11] People with dermatological diseases often
complain that their main difficulties arise from others’
negative reactions to their disease, rather than the disease
itself. There are certain beliefs about stigmatization
in skin patients such as anticipation of rejection, the
feeling of being flawed, sensitivity to opinions of others,
secretiveness, and negative attitude. One of the important
predictors of such beliefs is previous experience of
rejection.[13] When a person is explicitly rejected on the
basis of their disease, it gives a direct negative experience
which is called as an enacted stigma. While when a
person sees someone else getting the negative experience
of rejection and expects to be treated in similar ways, it
is called as vicarious stigmatization. Patients suffering
from psoriasis, vitiligo, leprosy, HIV, and STDs face
such type of stigmatization commonly.[13,19,20] Staring look
and intrusive questioning made by by others, avoidance
of physical contact such shake hands, avoidance of
used materials of patient often cause embarrassment
and sense of rejection. A kind of rejection sensitivity
develops in patients who are stigmatized in society.
The patient becomes vigilant for the presence of further
stigmatization, interprets neutral events as stigmatizing
because of the feeling of shame, and attempts to conceal
their appearance from others.[13]
Psychological Comorbidities Secondary to Skin
Diseases
The high prevalence of psychiatric disorders (>30%) is
present among patients with skin disorders such as acne,
pruritus, urticaria, alopecia, and herpes virus infections.
In a clinic bases study in India, with predominant sample
of acne vulgaris (24.13%), psoriasis (22.14%), lichen
planus (10.70%), vitiligo (13.18%), and urticaria (19.4%),
the maximum number of patients was suffering from
depression 36.32% followed by anxiety disorder 18.41%
and somatoform disorder 7.96%. Obsessive‑compulsive
disorder was diagnosed in 6.47% followed by adjustment
disorder 4.98% and alcohol dependence syndrome
4.98%.[21] An another study from western literature depicted
102
about 74% of lifetime prevalence of various psychiatric
disorders with a predominance of depression, anxiety, and
substance abuse in alopecia. Hence, the prevalence varies
according to location and type of skin disorders.[22] Here, in
Table 2, epidemiology of psychiatric comorbidities in some
common skin disorders is depicted but these vary widely
depending on the setting, geographical location, age group,
gender, specific disease, etc.
Depressive disorders
Depression is a therapeutic problem in dermatological
disorders. About 18% and 24% of patients with alopecia
areata and psoriasis are estimated to be suffering from
depression as per Indian clinic‑based study.[29] These
patients usually have chronic itching, neurotic excoriations,
reduced self‑esteem, suicidal thoughts, and hypochondriacal
concept about disorders of the skin. Low mood, loss of
interest, reduced energy, increased tiredness, and limitation
of daily activities are the foreground for diagnosis of
depression.[30] Dysthymia (long‑lasting persistent depressive
mood) is seen in many patients with chronic, recurrent, and
exacerbating skin diseases. Common skin disorders with
depression are psoriasis, atopic dermatitis, acne, prurigo,
etc.[8,31,32]
Anxiety disorders
Persistent fear (generalized anxiety) and acute fear (panic)
are two variants in anxiety disorders with a lifetime
prevalence of 37.4%.[33] About 4% and 12% had anxiety
disorders in groups of alopecia areata and psoriasis in
Indian clinic‑based sample.[29] Social phobia is common in
skin diseases because of visual exposure to skin disease
and resultant stigmatization. The patient feels centered
Table 2: Psychiatric comorbidities in skin disorders
Dermatologic Psychosocial and psychiatric associations
disorders
Psoriasis Significant stress (39%), depression (24%),
suicidal ideation (2.5%), alcohol abuse (18%)[23]
Acne Depression (8.8%), suicidal ideation (5.6%)[23,24]
Atopic Stressful life events (70%), anxiety (26%),
dermatitis depression (17%)[23,25]
Urticaria Mental tension and fatigue (77%),
depressions, anxieties, and mixed
anxiety and depressive disorders
(all patients as per a study), personality
disorders (18%), somatoform (6.5%)[26]
Vitiligo Depressive disorder (37%), depressive
disorder (18%), and generalized anxiety
disorder (7%)[27]
Leprosy Major depressive disorder (30.8%), panic
disorder (11.7%), obsessive‑compulsive
disorder (15%), BDD (11.7%), generalized
anxiety disorder (9.2%), social phobia (9.2%),
somatoform pain disorder (5.8%), high risk of
suicide (7.5%)[28]
BDD: Body dysmorphic disorder
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Ashwanikumar, et al.: Skin, Psyche, and Society
around the fear of being closely observed by others. They
face the fear of social criticism. It is characteristically
associated with avoidant behavior and social withdrawal.
Common disorders of skin with anxiety and phobia are
eczemas, acne, rosacea, recurrent herpes, acne, seborrhea,
ichthyosis, etc.[34]
Compulsive disorders
Compulsive acts are repeated behaviors (handwashing)
or ideate acts (praying, counting) to which a person
feels compelled as a reaction to a compulsive thought.
Common disorders of the skin with compulsive behavior
are hand‑foot eczema where the patient washes hands and
feet repeatedly and another example is body a dysmorphic
disorder where the patient looks at the mirror to control or
influence their outward appearance.[8]
Stress and adjustment disorders
Serious stress and life events can elicit skin condition
such as urticaria or may lead to attacks or deterioration
of chronic dermatoses such as in psoriasis and seborrheic
and atopic dermatitis.[2] On the other hand, disorders of
skin themselves are stressful and may elicit emotional
and adjustment disorders. Stress reaction may be seen
in the form of numbness, disorientation, limitation in
consciousness, inability to process stimuli, depression,
fear, withdrawal, and hyperactivity in alternating degrees.
Adjustment disorders present as brief to longer depressive
episodes, anxiety symptoms, apathy, avoidance, acute
eruptions of aggression, rage, fear, or panic.[8,13,35,36]
Dissociative disorders
This is characterized by partial or complete loss
of normal integration among memories of the past,
awareness of identity, immediate sensations, and control
of bodily functions. There is decoupling of physical
and emotional functioning of a person. Dermatoses in
which dissociative disorders are commonly seen include
dermatitis artefacta, urticaria, pruritus, anesthetic skin
areas, and pseudoallergic reactions.[37]
Personality disorders
Skin diseases may give rise to change in personality of
a person as a whole. Emotionally unstable personality,
mainly borderline personality disorders are common in
association with disorders of the skin. Women are affected
more with high chance of suicidal attempts. There is deep
instability in interpersonal relationships and self‑image and
effect often with intense impulsiveness.[2,38]
Culture and skin
Cultural influences are evident in most of the disorders in
India. Psychosomatic skin diseases are very often influenced
by cultural factors such as religious and spiritual beliefs,
diet, and style of clothing, sun exposure, and socioeconomic
status. In India, light‑skinned people are given higher rank
Indian Journal of Social Psychiatry | Volume 34 | Issue 2 | April-June 2018
in marriage and considered to be a beauty. Hence, people
with dark skin often suffer from emotional turmoil in the
society. Visiting temples, performing offerings and puja,
taking a dip in “holy rivers,” application of urine, and cow
dung are common rituals to alleviate skin disorders which
often exaggerate the disease. Even various toxic chemicals
are used as a part of the ritual in different festivals might
exaggerate the illness. Brinjals, black gram, eggs, and
chicken such foods are commonly used in an Indian
household. These often act as allergens. On the other hand,
psoriasis and leprosy impose a great stigma on family and
person leading to ostracized in the society which, in turn,
cause more disability.[39]
Conclusion
The psychological impact of dermatological diseases leads
to impaired coping, impaired compliance, limitations in
quality of life, negative body image, and stigmatization
which invariably cause psychological comorbidities
such as depression, anxiety, phobia, and somatoform and
adjustment disorders. The common skin diseases include
psoriasis, vitiligo, alopecia, acne, prurigo, chronic urticaria,
eczema, atopic dermatitis, seborrheic dermatitis, rosacea,
recurrent infections, sexually transmitted infections, and
vesiculobullous diseases. In patients with skin illness, the
thought process and concerns about diseases are often
displaced onto self as a whole. When the sense of “normal”
self‑falls down, the feeling of shame, fear of criticism, and
social anxiety starts setting in the mind. Hence, it is very
important to understand the evolution of cognition of skin
patients and the ways in which the skin diseases and their
sense of being are interconnected.[8,13,38,40]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Mysore V. Invisible dermatoses. Indian J Dermatol Venereol
Leprol 2010;76:239‑48.
2. The link between skin and psychology [Internet]. Available
from: http://www.apa.org/monitor/2015/02/cover‑skin.aspx. [Last
accessed on 2017 Jul 19].
3. Harth W, Gieler U, Tausk FA. Clinical Management of
Psychodermatology. Springer-Verlag Berlin Heidelberg: Springer;
2008.
4. Stanford University. Center for the Study of Language and
Information (U.S.). Stanford Encyclopedia of Philosophy
[Internet]. Stanford University; 1997. Available from: https://
www.plato.stanford.edu/entries/dualism/. [Last accessed on 2017
Nov 19].
5. Leitan ND, Murray G. The mind‑body relationship in
psychotherapy: Grounded cognition as an explanatory
framework. Front Psychol 2014;5:472.
6. Recognizing the Mind-skin Connection – Harvard Health
103
[Downloaded free from http://www.indjsp.org on Wednesday, January 20, 2021, IP: 122.174.255.15]
Ashwanikumar, et al.: Skin, Psyche, and Society
[Internet]. Available from: https://www.health.harvard.edu/
newsletter_article/Recognizing_the_mind-skin_connection. [Last
accessed on 2017 Nov 19].
7. Papadopoulos L, Walker C. Psychodermatology. United
Kingdom: Cambridge University Press; 2005. p. 158.
8. Jafferany M. Psychodermatology: A guide to understanding
common psychocutaneous disorders. Prim Care Companion J
Clin Psychiatry 2007;9:203‑13.
9. Gupta MA, Gupta AK. Depression and suicidal ideation in
dermatology patients with acne, alopecia areata, atopic dermatitis
and psoriasis. Br J Dermatol 1998;139:846‑50.
10. Eram U. Myths And Stigma Associated With Skin Diseases:A
Review Article; 2017. Available from: https://www.zenodo.org/
record/253878#.WW-ZDIiGPIU. [Last accessed on 2017 Jul 19].
11. Chaturvedi SK, Singh G, Gupta N. Stigma experience in skin
disorders: An indian perspective. Dermatol Clin 2005;23:635‑42.
12. Shuster S, Fisher GH, Harris E, Binnell D. The effect of
skin disease on self image [proceedings]. Br J Dermatol
1978;99:18‑9.
13. The Psychological and Social Impact of Skin Diseases on
People’s Lives; 2013. Available from: https://www.appgs.co.uk/
publication/view/the-psychological-and-social-impact-of-skin-
diseases-on-peoples-lives-final-report-2013/. [Last accessed on
2017 Jul 19].
14. Korabel H, Grabski B, Dudek D, Jaworek A, Gierowski JK,
Kiejna A, et al. Stress coping mechanisms in patients with
chronic dermatoses. Archives of Psychiatry and Psychotherapy
2013;3:33-40.
15. Silva JD, Muller MC, Bonamigo RR. Coping strategies and
stress levels in patients with psoriasis. Anais Brasileiros de
Dermatologia 2006;81:143-9.
16. Harth W, Gieler U, Kusnir, D, Tausk F.A. et al. Suicide
in Dermatology [Internet]. In: Clinical Management in
Psychodermatology. Berlin, Heidelberg: Springer Berlin
Heidelberg; page 187–8. Available from: http://link.springer.
com/10.1007/978-3-540-34719-4_12. [Last accessed on 2017 Jul
19].
17. Manzoni AP, Weber MB, Nagatomi AR, Pereira RL,
Townsend RZ, Cestari TF, et al. Assessing depression and
anxiety in the caregivers of pediatric patients with chronic skin
disorders. An Bras Dermatol 2013;88:894‑9.
18. Kay Thoman-Touet S. A qualitative study of the effect of chronic
illness on marital quality ; Available from: http://lib.dr.iastate.
edu/rtd. [Last accessed on 2017 Jul 19]
19. Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR,
Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: A review of
the literature and recommendations for the way forward. AIDS
2008;22 Suppl 2:S67‑79.
20. Jacob JT, Franco‑Paredes C. The stigmatization of leprosy in
India and its impact on future approaches to elimination and
control. PLoS Negl Trop Dis 2008;2:e113.
21. Raikhy S, Gautam S, Kanodia S. Pattern and prevalence of
psychiatric disorders among patients attending dermatology
OPD. Asian J Psychiatr 2017;29:85‑8.
22. Colón EA, Popkin MK, Callies AL, Dessert NJ, Hordinsky MK.
Lifetime prevalence of psychiatric disorders in patients with
alopecia areata. Compr Psychiatry 1991;32:245‑51.
23. Gupta MA, Gupta AK. Psychiatric and psychological
104 Indian Journal of Social Psychiatry | Volume 34 | Issue 2 | April-June 2018
co‑morbidity in patients with dermatologic disorders:
Epidemiology and management. Am J Clin Dermatol
2003;4:833‑42.
24. Uhlenhake E, Yentzer BA, Feldman SR. Acne vulgaris and
depression: A retrospective examination. J Cosmet Dermatol
2010;9:59‑63.
25. Slattery MJ, Essex MJ, Paletz EM, Vanness ER, Infante M,
Rogers GM, et al. Depression, anxiety, and dermatologic quality
of life in adolescents with atopic dermatitis. J Allergy Clin
Immunol 2011;128:668‑71.
26. Tey HL, Wallengren J, Yosipovitch G. Psychosomatic factors in
pruritus. Clin Dermatol 2013;31:31‑40.
27. D.Vernwal. A study of anxiety and depression in Vitiligo
patients: New challenges to treat. European Psychiatry. Vol. 41.
Abstract of the 25th European Congress of Psychiatry. Florence,
Italy: Elsevier Masson; 2017. p. S321.
28. Rocha‑Leite CI, Borges‑Oliveira R, Araújo‑de‑Freitas L,
Machado PR, Quarantini LC. Mental disorders in leprosy: An
underdiagnosed and untreated population. J Psychosom Res
2014;76:422‑5.
29. Karia SB, De Sousa A, Shah N, Sonavane S, Bharati A.
Psychiatric morbidity and quality of life in skin diseases:
A comparison of alopecia areata and psoriasis. Ind Psychiatry J
2015;24:125‑8.
30. Evers AW, Lu Y, Duller P, van der Valk PG, Kraaimaat FW,
van de Kerkhof PC, et al. Common burden of chronic skin
diseases? Contributors to psychological distress in adults with
psoriasis and atopic dermatitis. Br J Dermatol 2005;152:1275‑81.
31. Fried RG, Gupta MA, Gupta AK. Depression and skin disease.
Dermatol Clin 2005;23:657‑64.
32. Wolfgang H, Uwe G, Daniel K, Tausk FA. Prevalence of
somatic and emotional disorders. Clinical Management in
Psychodermatology. Berlin, Heidelberg: Springer Berlin
Heidelberg; 2008. p. 7‑8.
33. Abebe G, Ayano G, Andargie G, Getachew M, Tesfaw G.
Prevalence and factors associated with anxiety among patients
with common skin disease on follow up at alert referral hospital,
Addis Ababa, Ethiopia. J Psychiatr 2016;20;19.
34. Garrie SA, Garrie EV. Anxiety and skin diseases. Cutis
1978;22:205‑8.
35. Zinzow HM, Britt TW, McFadden AC, Burnette CM, Gillispie S.
Connecting active duty and returning veterans to mental health
treatment: Interventions and treatment adaptations that may
reduce barriers to care. Clin Psychol Rev 2012;32:741‑53.
36. Basavaraj KH, Navya MA, Rashmi R. Relevance of psychiatry
in dermatology: Present concepts. Indian J Psychiatry
2010;52:270‑5.
37. Gupta MA. Somatization disorders in dermatology. Int Rev
Psychiatry 2006;18:41‑7.
38. Nakamura  M, Koo  J. Personality disorders and the “difficult”
dermatology patient: Maximizing patient satisfaction. Clin
Dermatol 2017;35:312‑8.
39. Shenoi SD, Prabhu S. Role of cultural factors in the
biopsychosocial model of psychosomatic skin diseases: An
indian perspective. Clin Dermatol 2013;31:62‑5.
40. Jasch K, Hermes B, Seikowski K, Harth W. Emotionally unstable
Personality disorder (borderline disorder) in dermatology.
Hautarzt 2008;59:304‑7.