Speaking today at the American Academy of Dermatology's skin academy(Academy), dermatologist and clinical psychologist Richard G. Fried, MD, PhD,FAAD, of Yardley, Pa., discussed the reciprocal relationship between feelingsand appearance, and how failing to address these concerns can affect how welook, feel and function.

"When patients are going through a rough period in their lives, negativeemotions can wreak havoc on their appearance," said Dr. Fried. "So, as aresult, patients might start to notice that their hair is thinning, their skinis inflamed or their nails are brittle -- which can be physical manifestationsof their mental state. These unwanted physical changes can have a profoundlynegative impact on how they feel. The negative emotions can trigger a viciouscycle of worsening skin, hair and nails leading to worsening of theiremotional state and can lead to further worsening of the skin problem.Dermatologists can play a key role in helping patients not only alleviatethese physical symptoms, but also help enhance their quality of life during adifficult time."

Psychodermatology Interventions

Stress can manifest itself on one's appearance in many ways, primarily bymaking the skin more sensitive and more reactive. For example, Dr. Friednoted that stress can make rosacea more red, result in acne lesions that aremore inflamed and more persistent, cause brittle nails and ridging of thenails, cause hair loss, cause or worsen hives, and cause excessiveperspiration. In addition, stress also is a known trigger or can be aworsening factor for fever blisters, psoriasis, seborrheic dermatitis and haseven been shown to impair skin barrier function and dehydrate the skin --allowing more irritants, allergens, and infectious agents to penetrate theskin and cause problems. Stressed skin often appears stressed, distressed andolder.

"When it comes to treating patients who we suspect may be experiencingskin, hair or nail problems as a result of stress or other emotional factors,it is helpful to ask them whether their skin seems to look or feel worse whenthey are stressed," said Dr. Fried. "Beyond the direct physiological effectsof stress, patients under stress also tend to neglect or abuse their skin,lacking the energy and motivation to adhere to their skin care regimens. Therealso might be signs of stress-related behaviors -- such as scratching, pullingor rubbing -- that can exacerbate problems."

To successfully treat stress-related dermatologic conditions, Dr. Friedrecommends that traditional dermatologic therapies should be used inconjunction with appropriate stress management strategies. For example, Dr.Fried discussed how stress reduction interventions and techniques can reducethe culmination of negative events that can worsen many of these problems.

To illustrate the seriousness of living with skin problems, Dr. Friedpoints to studies showing that people tend to be more distressed by skin, hairor nail problems since they are so visible and uncomfortable, than by otherserious medical conditions, such as heart disease or diabetes.

"When dermatologists treat both the skin and stress, the skin often clearsmore quickly and completely as the native influences of stress arediminished," said Dr. Fried. "Consequently, their overall anxiety level candecrease and they may start to feel better about how they look and how they'refeeling emotionally."

Moving to the microscopic level, Dr. Fried added that stress reduction candecrease the release of pro-inflammatory stress hormones and chemicals. Forexample, release of neuropeptides (or stress chemicals released from the nerveendings) can be reduced with stress management techniques. This often resultsin skin that looks and functions better. These interventions can reduce bloodvessel over-activity, resulting in less blushing or flushing. Decreasingstress allows the patient to focus more positive energy on good skin carerather than negative behaviors.

"It is fair to say that when people are under stress, they tend to 'falloff the wagon' in terms of practicing good skin care," said Dr. Fried. "Theymay not use their sunscreen or their skin care products when they're feelingstressed, because all of their energy and focus is being diverted by theirongoing stress. They also might not be eating or sleeping as well or stayinghydrated, which all can contribute to a dull or lack-luster appearance."

With accurate diagnoses by a dermatologist, effective treatments improvethe appearance and function of the skin. This alone can substantially reducepatients' stress and improve their skin, hair and nail conditions. However,Dr. Fried noted that if stress is clearly interfering with patients' overallwell-being and ability to cope, simultaneous stress management interventionsare warranted. In some instances, referral to a mental health professionalwho has an interest and understanding of skin problems may be warranted.

Cosmetic Interventions

While skin rejuvenation procedures have been shown to significantlyimprove a person's outward appearance, studies suggest these types of cosmeticinterventions also can have positive effects on how people feel and how theyfunction.

"When people feel more attractive and more confident in their appearance,they tend to perform better in other areas of their lives -- in their work,family life, social life, and marriage or personal relationships," explainedDr. Fried. "Under the right circumstances, cosmetic procedures can be apowerful ally. But it's important for patients to understand that theseprocedures are not a panacea. Realistic expectations are the key toeffectively delivered promises."

Currently, Dr. Fried is analyzing data from a 2008 study designed tomeasure the positive ripple effects of botulinum toxin injections on otheraspects of patients' lives. In this study, 76 middle-aged patients weretreated with one botulinum toxin injection and then asked to complete aquestionnaire during their follow-up visit to gauge how they felt followingthe procedure.

"The results of our study clearly showed that patients treated withbotulinum toxin experienced substantial benefits," said Dr. Fried. "In fact,29 percent reported feeling less anxious, 36 percent said they feel morerelaxed, and 49 percent were more optimistic. Even a portion of patientsdiagnosed with seasonal affective disorder, or SAD, prior to treatmentreported they felt less sadness during the winter following botulinum toxininjection."

A previous study conducted by Dr. Fried evaluated the clinical andpsychological effects of the use of alpha hydroxy acids (AHAs) in 32 patients.After 12 weeks, patients demonstrated significant improvements in facial skintone and fine wrinkling, and reported satisfaction with their physicalappearance and the quality of their interpersonal relationships.

"The results of these two studies echo observations of recognized expertsfrom around the world -- that cosmetic interventions can improve a patient'sself-image and help them feel better about themselves," added Dr. Fried."Feeling stressed, depressed or anxious is exhausting, and patients who reportimprovements in these negative feelings following a cosmetic procedure can usethat redirected energy to pursue new interests that can enhance their lives."

For proper diagnosis and treatment of any skin, hair or nail conditions,Dr. Fried advised patients to consult their dermatologist to determine theroot of the problem and discuss the potential benefits of any treatment.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology(Academy), founded in 1938, is the largest, most influential, and mostrepresentative of all dermatologic associations. With a membership of morethan 15,000 physicians worldwide, the Academy is committed to: advancing thediagnosis and medical, surgical and cosmetic treatment of the skin, hair andnails; advocating high standards in clinical practice, education, and researchin dermatology; and supporting and enhancing patient care for a lifetime ofhealthier skin, hair and nails. For more information, contact the Academy at1-888-462-DERM (3376) or http://www.aad.org.

SOURCE American Academy of Dermatology