Skin Care Today

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6 SKIN CARE TODAY 2017,Vol 3, No 1
SKIN CARE MATTERS i
` 17% of patients need help with
psychological issues secondary to
their skin condition
` 14% of dermatology patients
have a psychological issue that
exacerbates their skin disease
` 85% of dermatology patients have
indicated that the psychosocial
issues are a major component of
their skin condition.
While assessing and treating a
person’s physical skin disorder may
not be a problem for nurses, dealing
with the underlying psychological
consequences can be a great deal
harder.This is made even more
difficult by the fact that when it
comes to skin conditions, perception
is everything — one person with
debilitating acne, for instance may
cope very well with their symptoms,
adhering to their treatment and
maintaining a positive outlook; another
may find their outward appearance
intensely disturbing and become
depressed and isolated as a result (‘The
emotional impact of skin problems’—
.
In a 2013 report, the All Party
Parliamentary Group On Skin
highlighted the‘extensive impact skin
diseases have on all aspects of people’s
lives from schooling, relationships,
self-esteem and career choices to
social, sexual and leisure activities’
(‘The psychological and social impact
of skin diseases on people’s lives’
— , while at the
There is plenty of evidence that living with a skin condition can result in
psychological distress, which can manifest in a range of feelings, symptoms or
mental health conditions such as anxiety and depression.The British Association
of Dermatologists (BAD) working party report states that 85% of patients
have indicated that the psychosocial issues are a major component of their skin
condition.That is a huge figure and as healthcare professionals, we cannot fail to
address this in our practice. Efforts should be made to assess and care for people
with skin conditions in a holistic manner. Anecdotally, I hear nurses and doctors
express reservations about making enquiries into mental wellbeing as they feel
they may ‘open a can of worms’ that they are ill-equipped to deal with, both in
terms of their clinical skills and resources available.
Psychologists generally recommend that gentle enquiry about how people are feeling about their
skin condition can, in itself, help — by asking you are acknowledging that there may be an impact on
psychological wellbeing and this normalises and makes acceptable the thoughts that people may be
experiencing. It also provides the opportunity to build trust, which can further help develop a therapeutic
relationship and improve communication in your consultation.
If you are concerned about low mood in a patient, there are two questions to ask, as recommended by the
National Institute for Health and Care Excellence (NICE, 2009; , namely:
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’; ‘During the
last month, have you often been bothered by having little interest or pleasure in doing things?’
If the patient answers ‘yes’ to either of these questions, this can be explored a little further to establish
more context and the patient then referred on to a specialist or GP for further assessment for depression
and management as appropriate. For milder mood disturbance or anxiety or a specific problem like
difficulty sleeping, there are also many resources and materials available to signpost patients to. As a
starting place, get to know the materials on the Skin-Support website , an
online portal set up for patients by the BAD.
Karina Jackson, nurse consultant, St John’s Institute of Dermatology, Guy’s and St Thomas’NHS Foundation
Trust, London
same time acknowledging the lack
of services dedicated to tackling the
psychological needs of patients with
skin disease.
The report made the following
recommendations:
` The Department of Health (DH)
should alert commissioners to the
financial benefits of psychological
interventions
` Clinical commissioning groups
(CCGs) should arrange for primary
and secondary care professionals to
have access to services, including
psychological support, medical
social workers, camouflage services
and occupational therapy
` Healthcare professionals should
be made aware of patient support