Evan Rieder, MD: Equipping Patients With Tools for Skin Acceptance

Earlier this week, AbbVie hosted a media roundtable event, Science of Skin: The Psychosocial Impact of Chronic Skin Disease, featuring insights from 5 expert, patient, and advocate panelists. Science of Skin is a multi-year AbbVie initiative aimed at addressing important issues for patients chronic skin diseases through the elevation of diverse voices in dermatology.

The discussion was hosted and moderated by television personality and interior designer, Nate Berkus, who has now shared his private journey with psoriasis. Panelists included Alexis Smith, eczema patient, influencer, and community advocate; DaQuane Cherry, psoriasis patient, community advocate, and artist; Leah Howard, JD, psoriasis patient, president & CEO of the National Psoriasis Foundation; dermatologist Mona Gohara, MD; and dermatologist and psychiatrist Evan Rieder, MD.

Rieder, of Weiser Skin in New York, is just 1 of 3 physicians in the US to be dual-board certified in both dermatology and psychiatry.

Rieder spoke with Dermatology Times® following the panel discussion to discuss the relationship between chronic skin conditions and mental health and the importance of equipping patients with the necessary tools to guide them toward self acceptance.

Transcript

Evan Rieder, MD: Hi, I'm Dr. Evan Rieder. I'm a board certified dermatologist and psychiatrist in private practice in New York City.

Dermatology Times: What perspectives can you offer regarding the relationship between chronic skin conditions and mental health?

Rieder: I think at this point, most dermatologists are onto the link between chronic skin conditions and psychology, or psychological dysregulation. I don't think as many psychiatrists are aware of that link, but dermatologists are certainly onto that.

I think what differentiates me is that a lot of times, I may know what to do in the situations where we think that there is a problem psychologically with our patient that we can't necessarily meet with even the best and most comprehensive dermatologic treatments. That may mean that I know some of the questions to ask, which I'm not saying that everybody doesn't know, and some people are doing that. I may give people a little bit more luxury of time, because of the way that I have my clinical appointments set up. They may know what sort of modalities to use in the office that may not involve dermatologic care.

Dermatology Times: How can these conversations improve dermatologic and mental health care and individualized treatment?

Rieder: I think when you're thinking about mental health comorbidity and patients with chronic skin conditions, the first and most important thing is getting the diagnosis correct. And the second most important thing is building rapport. One of the things that doesn't work is telling people, 'you're depressed,' or, 'I think you need to see a psychiatrist or see somebody for psychotherapy,' because they're going to be completely lost in your clinic immediately. So you have to build rapport, and you have to build trust with your patients. And I think most of us in dermatology realize that. I think that the problem is that a lot of us don't have the luxury of time to build that rapport or to take enough time, even with a single visit, to be able to sort of make those connections, and sometimes we lose a potential bonding experience with a patient because we're just under the gun to see so many patients on a given given day.

But what I would tell people is, and to tell dermatologists and to also tell our patients and our patient advocates, is to understand and be aware of the comorbidity between psychological unwellness and chronic skin disease. I think having that awareness will hopefully allow people to seek additional information from reliable sources, like the National Psoriasis Foundation, which is a wealth of information about psoriasis, where you can get about information about the disease itself, treatments, and comorbidities. Then from there, you can have more exploratory conversations about where to go for more comprehensive care.

I always tell people, that it's a bit of a process to get people into the treatment that they need, not only because it's not easy for everybody to get in to see a mental health provider. There's lots of barriers with insurance and density of providers, cultural barriers, stigma, financial barriers, but just allowing people to make that transition between going from being the primary provider where you're the dermatologist to being a secondary provider, where a mental health provider actually takes that precedent relationship, and you move into the secondary relationship, continuing to have a long-term care with the patient, but getting them into a place where they need it more.

There's there's many different barriers, especially that patients have skin of color face. And I think that one thing that I tell people to do is anytime you're seeing a new dermatologist, or any sort of doctor on your own, you're in charge. This is a job interview, and the doctor is applying for the job, and they may not be the right person for the job. So you can always interview someone else, and you have to find something that you like about that person. As a doctor, you have to find something you like about your patient. As a patient, you need to find something you like about your doctor, especially if you have a chronic inflammatory condition, or you think you're going to be need to be seeing them on a regular basis. And I think that a lot of the problem is we have a huge dearth of doctors, especially doctors who are Black, and I think a lot of patients with Black skin want to see a doctor who reflects their skin tone and understands their experience. It's an interview process, and you can interview people until you find someone that you connect with on a level that you feel like you can develop that long-term relationship.

Dermatology Times: What is the importance of having conversations like these when it comes to the future of dermatology?

Rieder: I think they increase awareness. Again, I think dermatologists are well aware of the comorbidity between psychological unwellness and chronic skin conditions, but I think the general public is not. And again, we hear anecdotes about this all the time, about patient misconceptions about conditions like eczema and psoriasis, and people thinking that these disorders are infectious, and sort of horror stories of people going out and being brave enough to take their clothes off and going he pool and then having everybody else jump back because they're afraid going to get sick or get infected. So I think that the more the general public is aware about this, and the more that dermatologists, and patient advocates, and family members, and friends are aware of patient experience, the better it will be for more communal understanding and for people to feel less stigmatized by having these conditions and understanding that there are resources, both informational, and then amazing treatments that are available now that I still think a lot of people are not aware about.

Dermatology Times: What advice would you give your peers when it comes to empowering patients to advocate for themselves?

Rieder: Seeking information, and sometimes there can be a period of denial that happens, especially when you're given a diagnosis, that is something that you can't get rid of. When someone gets a skin cancer, and that can be taken out, they can breathe a sigh of relief; they've seen a dermatologist for a check-in in 6 months, but that skin cancer is out, and it relieves anxiety.

If you have psoriasis, hopefully you're getting the right information from your doctor, they're giving you the online resources you can get. But there is that sort of period you have to kind of go through the process of grieving, and you have to move through those stages. And that first stage of sort of denial is a hard one to get through. But once you can arm yourself, come to a level of acceptance that this is the condition that you're living with, you can understand your process, you can understand maybe what it's going to look like, and what your treatment options are going to be. And again, I would sort of harp on the concept of self advocacy and being in charge of your own destiny in terms of who is going on that journey with you, in terms of who your health care provider is going to be, and you can interview until you find the right person. You can also fire people if you think you have the right person and they end up not being the right person for you.

I think that conditions like psoriasis, eczema, and hidradenitis suppurativa, they are difficult conditions to live with. But there's never been a better time to have any of them because we have amazing treatments to offer in psoriasis, some amazing treatments for eczema, and some good ones for hidradenitis, and then some more that are really great that are in the pipeline.

Just remember to self advocate, and that there's a lot of psychological comorbidity associated with chronic skin conditions, and you don't have to suffer in silence. There are amazing treatments available both in the dermatologists' office and comprehensively through a network of your health care team.

[This transcript has been edited for clarity.]