Psychosomatic dermatology

San Francisco

- Because the mind can initiate physical symptoms of dermatologic disease, an expert says that providing lasting relief could require dermatologists to look beyond the symptoms at hand and addressing a patient’s underlying psyche or biopsychosocial issues.

"In the United States, the concept of psychosomatic medicine is misunderstood and underappreciated," says Roy Stern Seidenberg, M.D., assistant clinical professor of dermatology at the New York University School of Medicine, New York.

Psychosomatic medicine isn’t about acupuncture or homeopathy, he says. Rather, it’s built on the concept that the mind and body are connected.

"Some experts say the body essentially is the subconscious mind, and that the unconscious mind can initiate real physical changes, causing real physical disease."

If the unconscious mind wants to bring unpleasant motions to consciousness, he says, "The mind employs a defense mechanism by creating physical symptoms to suppress those emotions."

When Dr. Freud encountered a patient who couldn’t move his or her arm though the patient was perfectly healthy, he diagnosed a conversion disorder, Dr. Stern Seidenberg says. "That’s very similar to psychosomatic medicine. But the main distinction is that in psychosomatic medicine, there are real pathologic changes."

In dermatology, physicians can see these changes on the skin and under the microscope. Accordingly, he says, "When I say psychosomatic, I don’t mean the patient is faking it. The problem is real - it just means that it’s initiated by the mind."

The mind-body connection can produce a host of diseases, such as acne, hives, acid reflux disease, irritable bowel syndrome or back pain, he says.

Pioneering research in the field performed by John E. Sarno, M.D., focused on back pain. "The psychosomatic origins of back pain are easier to argue because the anatomical changes are objective. We can see a disc on an MRI, whereas in the skin it's hard to administer a test that illustrates cause and effect," Dr. Stern Seidenberg says.

Psychosomatic medicine also incorporates the concept of the placebo effect. "Virtually any doctor will agree that a sugar pill will improve many diseases about 30 percent of the time. That"s the effect of the mind working on the body," he says.

Another key element of psychosomatic medicine is that it seeks to approach disease from a perspective that looks beyond genetics, Dr. Stern Seidenberg says.

Genetics will determine whether a person is susceptible to a given illness, but it’s the mind that sets off physical changes that result in actual illness, he explains. Adult acne represents a prime example of this dynamic.

"Fifty years ago," he says, "we didn’t commonly see adult acne (or carpal tunnel syndrome, plantar fasciitis or restless leg syndrome). Now it’s very common to see adult acne in women - even women who have never had acne as a teenager."

Treatment for patients with psychosomatic illnesses starts with making them aware of the mind-body connection. In this regard, Dr. Stern Seidenberg says, "Just knowing about the mind-body connection can break the cycle." DT