psychodermatology march 15.cdr
Transcription
psychodermatology march 15.cdr
skinpsychology The aesthetics industry has progressed significantly in the past decade. Today, aestheticians are armed with greater knowledge, expertise, products, ingredients, equipment and results, thus potentially improving the health of the skin and condition of client's skin to a greater extent than ever before. Skincare clinics have therefore become a real option for clients who are desperate for your professional expertise and knowledge to treat skin disorders such as acne, hyperpigmentation, rosacea, eczema, elastosis, psoriasis, or manifestations that are as a result of illness, medication, poor treatment outcomes, etc. Even ageing can be a deep-rooted emotional issue for some women. Clients place their trust in you to improve their appearance and meet their expectations. Some clients may have already exhausted the medical option, and so seek the help of skincare clinics to solve their skin issues. However, reports of negative experiences with therapists/aestheticians (as there is with doctors and dermatologists) are common. Therapists/aestheticians were reported as not only having poor comprehension of the pathogenesis and correct treatment protocol for skin disorders (unrealistic promises made, poor treatment outcome, disease or scarring is worsened), but they were also often insensitive to their client's e m o t i o n a l s u ff e r i n g , a n d e v e n trivialising their client's disease. The complexity of clinical scenarios and the constraints on the therapists should be acknowledged, however, therapists should also be educated in the potential psychological effects of skin diseases, and how to correctly manage these problems with empathy and care for best longterm results and benefits. PSYCHODERMATOLOGY More than skin deep Considering the emotional, psychological and social implications of skin disorders By Matoyla Kollaras The need to deal with the whole person when addressing their skincare needs is not a new concept. As a skincare practitioner you are constantly increasing your knowledge, skills and training to better understand, treat and manage skin conditions. This will no doubt mean that you will frequently encounter challenging skin conditions that will also significantly impact the client's emotional and psychological state of mind. Matoyla is a qualified therapist and the Director of Skinfactors Cosmeceuticals. She is passionate about skin health and skin treatments and is highly committed to constantly staying at the forefront of research and new advances in skin science and cosmetic ingredients. In this article she addresses the allimportant issue of psychodermatology and innovatively approaches the topic through the eyes of patients that reveal their emotional turmoil. “…You become introverted, avoid contact, and become depressed, obsessive in looking at other people, hoping to see someone else who is affected. You undergo a personality change very slowly, and bit by bit, a strong person is reduced to isolation. You become angry, sad and desperate. After time, it becomes an operation just to go out your front door…” This is a 27 year-old female discussing her 15-year vitiligo history1. APJ 30 THE SKIN YOU'RE IN IS ALL YOU HAVE “A shocking 47% of people with a skin disease in the UK have been victims of verbal abuse one or more times from a member of the public. A total of 729 people were asked a series of questions relating to their skin disease, or that of the person they care for. Questions were asked on the ways skin disease affects daily life, including forming of sexual relations, social life and work life. The results show that the long-term effects of skin disease can have a devastating impact on sufferers' lives that few would expect.”2 The skin is extraordinary, and when you learn to read it correctly it is potentially an excellent diagnostic tool; indeed, quite often being the first 'red flag' that something is not quite right internally. The skin is also our largest organ, and has long been recognised as an 'organ of expression' (Sack, 1928); it is, after all, our first point of contact between the outside world – environment, meeting people and our own selves. The skin is an organ that can directly respond to external stimuli (a rash caused through contact of a toxic substance), and reflect what is happening inside our bodies, both physiologically and psychologically (blushing when embarrassed, acne due to hormonal factors, auto-immune lupus butterfly rash, dry, itchy skin due to organic disease such as diabetes). Dermatological diseases have been shown to have a negative impact on physical communication, sexual contact and, in particular, are often implicated in an elevated sense of fear, anxiety, shame, and in severe cases, thoughts of suicide. Are you the parent of a teenager, who is continually bullied at school and would rather hide in their room, excluding themselves from social involvement due to their acne condition? Does your child refuse to take swimming lessons, or show any part of their body because of their psoriasis? Do you have a friend who refuses to be without makeup, even in front of their partner, due to melasma? Does your partner live with stage 2 or 4 rosacea and every day deals with day the ruddy, red skin coloration and the unsaid question of “Have you been drinking?” Or perhaps you have a client whose hands are riddled with eczema, and so they are too afraid to touch people lest they receive a negative response? yes, it does matter but they don't have to live with acne marks all over their face. When people talk with you, the first thing they see is your face. And what do I feel? I feel like they're looking at my flaws, like they're disgusted for even talking to me. I can't tell you how much I've cried because of my look. I feel like a monster. And if I had one wish, it would be for my skin to be clear. It's the only thing I need to be happy again.”5 Sadly, having a skin disease can also have implications for romantic and sexual relationships. Many sufferers have cited their skin disease as the reason for relationship breakdowns, or lack of finding a partner. Some people will even go as far as not marrying and/or not having children for fear that they will pass on the skin disease. Furthermore, approximately 50% of those living with skin disease suffer from sleep deprivation caused by pain and/or itching. As a result this creates more stress due to fatigue and frustration. This state Unlike most internal illnesses, skin disease is often immediately visible to others, and thus can prove to be a hugely stressful and a heart-breaking experience for the individual that has to live with the skin disease on a daily basis. To add to this problem, “relatively little attention has been paid to the psychosocial problems experienced by skin diseases sufferers”.3 And yet it has been estimated that between 40% and 80% of people with dermatological conditions have experienced significant emotional, social and psychological problems. “Patients with skin disease often feel enormously upset about their skin condition, as it affects their confidence and self-esteem in so many different ways. All too often the impact of skin disease is underestimated, and our research makes it very clear that it is common for individuals with skin disease to consider suicide. Many patients consider skin conditions to be more psychologically damaging than diabetes or heart disease.” 4 Many skin diseases such as psoriasis, vitiligo, etc., are very noticeable, visually striking and often provoke a response. As a result many people with these manifestations often fall victim to regular bullying, and yet more concerning is that one in eight had suffered from some form of physical abuse from a member of the public. Negative reactions and a fear of negative reactions from others is a real challenge for those living with skin disease. More common conditions such as acne and eczema, which often have a chronic manifestation, can affect people on a long-term basis. Clients who suffered from severe acne as teenagers and adolescents can quite often carry the burden of lasting physical, psychological and emotional scars long into adulthood. Acne scarring is a daily reminder of a difficult period, and its impact on self-esteem, confidence and depression is well established. I am sure we have all come across the introverted acne client, who has chosen a life of the avoidance of behaviours, places and events, or doesn't care for the way they dress, or perhaps is working in a menial job rather than chase their career dream because they fear rejection in the interview process. Are they really introverts? Do they really not care about themselves and their life? I would probably guess that they are not introverts, and actually care very much for how they look and their life's path. However, their acne has rendered them unable to look beyond the pain and disfigurement; instead, the acne has become who they are. “I feel disgusted when I look at myself. People don't understand. They say to me “your look doesn't matter; it's who you are on the inside”. And of being of course in turn impacts on the emotions, and most importantly due to the stress, cortisol spike, skin immune suppression cycle, the disease is worsened. There are clear indications that stress plays a profound role in the exacerbation and at times onset of skin disease such as acne, eczema, vitiligo, psoriasis and urticaria. There are two further significant concerns that are faced by those living with skin disease: 1. Because skin diseases are noticeable and draw people's attention, this can “remove the feeling of personal control from the sufferer”,6 thus rending the disease 'public property', unlike in the cases of many internal diseases where the sufferer is able to “control who knows about their condition and when”.7 2. Skin disease has often been associated with myths surrounding poor hygiene and contagion. This often means people will act negatively towards the sufferer, and hence often trigger feelings of stigma by the sufferer. CLINICAL MANAGEMENT “I had acne when I was a teenager. After it went away I was left with indented scars. I went for laser resurfacing at the age of 53 that made things much worse for me. He burnt my face and left me with dents, fat loss and more scars. I have been homebound for the past seven years because of this. I stopped doing everything and I mostly stay inside. I don't want friends or family to see me. I shake when I get up seeing the damage the laser did to me, day after day. I wouldn't wish this on anyone.” 8 Until you have walked in the shoes of skin-disease sufferers you cannot possibly comprehend the daily torment that they face. In the greater scheme of things, it may seem quite insignificant to one who APJ 31 does not, or has not experienced such skin conditions, but imagine for just one moment that you awake one day to a condition that becomes the first thing people see when they look at you, and perhaps a defining characteristic such as: “Hey, you know who I am talking about, the woman with brown patches on her cheek.” 9 Clinical management of skin conditions therefore requires a perspective beyond the skin and its lesions. Through heightened awareness and support you can help these clients, not only through your skills, treatments and products you offer, but by your ability to develop an empathetic, trusting and caring client/therapist relationship. Your initial consultation therefore, is a crucial component of the treatment process. Allow ample consultation time, ask many relevant questions, and more importantly, listen with your ears, eyes and heart. When a client is struggling with their appearance, they often feel alone in their struggle. For this reason, you should also aim to become your clients' skincare partner or coach by gaining their trust and confidence. Be mindful in your approach. It is critical to treat these clients with sincerity, respect and sensitivity. Most importantly, be honest and realistic. Don't make promises that you cannot guarantee by making exaggerated claims of what treatment outcomes you can achieve – always under-promise and over deliver. Be honest also with your own capabilities, and be realistic with what your clinic can offer the client. Consider whether you can truthfully help this client. Do you know how to best approach and treat their skin condition? Do you have the appropriate tools and knowledge, or will you make compromises and make do with what you have on hand, which may not be the best approach, or potentially worsen the condition? You may also need to discuss the possibility that your client may need to consult health professionals such as a dermatologist, psychologist and nutritionist – skin diseases can generally respond well to dietary improvements and a thorough health assessment of digestive abnormalities and other underlying inflammatory conditions. Know when to refer. On the other hand your client may have already exhausted all medical avenues and you could be their last resort. Again approach the problem truthfully. Can you offer a solution, or should you refer your client to another reputable skin clinic who may have products and treatments better suited to the treatment of their problem? IN CONCLUSION When dealing with problematic skin conditions there is clearly a necessity for the therapist to also carefully consider the non-tangible need of the patient's or client's emotional and psychological state when determining treatment choice and protocols. More specifically, there is a need to ensure consideration is also given to the important role of empathy and compassion in supporting their road to recovery and improving self-esteem. Always remember that for many living with a skin disease, which is often chronic in nature, has had a life-altering impact. Professionals must always remember that aside from the physical manifestation that the skin disease will have on the sufferer, there is often emotional consequences, social aspects and psychological stresses involved. Furthermore, these clients have more than likely had many treatments, used many products, and spent hundreds if not thousands of dollars in the hope for better skin and happiness. Therefore, you must avoid being the reason for further disappointment; these clients already come to you in a fragile state of being. Ensure that expectations are realistic and never set your client up for greater grief and yourself up for losing a client. Work together with them within realistic parameters, and aim for improved, healthier skin on the outside, and a confident, healthier customer on the inside. Sometimes all it takes is a 10% improvement to give them hope, and although this small change may not be obvious to you, to the client it could well mean the world and a step in a more positive direction. References: 1. Psychodermatology: The Psychological Impact of Skin Disorders, Carl Walker, Linda Papadopoulos 2. British Skin Foundation press release – Half the people with a skin disease have been verbally abused. 3. Psychological Impact of Skin Disorders – Carl Walker, Linda Papadopoulos 4. Dr Anthony Bewley, British Skin Foundation press release – Half the people with a skin disease have been verbally abused. 5. Castiel – Readers Respond: How Has Acne Affected Your Life? http://acne.about.com/u/ua/yourselfesteem/Emotional AcneScars.htm 6 & 7. Psychological Impact of Skin Disorders, Carl Walter, Linda Papadopoulos 8. STS Readers Respond: How Has Acne Affected Your Life? http://acne.about.com/u/ua/yourselfesteem/Emotional AcneScars.htm 9. The Emotional Aspect of Treating Skin Conditions, Michelle D'Allaird APJ 66