Interphase between skin, psyche, and society: A narrative review

Disorders of the skin affect the psyche of a person significantly. The interplay between internal and external world can be depicted through the various skin reactions in regard to psychological or physiological stimuli. Psychocutaneous illness could be exclusively psychological or stress related or due to strong psychogenic factors. As per biopsychosocial model, it could be primary, multifactorial, or secondary to disfigurement. Whichever is the condition, invariably stress is a major contributing factor in prognosis and onset of disorders of the skin. Self-explanation, myth, stigma, and diminished self-confidence often lead to depression and suicidality followed by active avoidance of the workplace, in turn, causing significant disability in the individual. The conflict between self-image and perceived image frequently causes fear of rejection leading to social anxiety, reduced self-confidence, interpersonal communication, and impaired sexual intimacy with a partner. Maladaptive sets of coping strategies such as alexithymia, shame proneness, avoidance, concealment, and escape are very common among the sufferers which impair the attachment with family and friends. Children are the extreme sufferers as they develop inferiority, low self-esteem, loss of body image, and social withdrawal leading to rejection from parents and faulty development of attachment pattern. Hence, disorders of the skin can lead to impaired coping, impaired compliance, limitations in quality of life, negative body image, and stigmatization which invariably cause psychological comorbidities such as depression, anxiety, phobia, and somatoform and adjustment disorders. Hence, there is a direct relationship between skin, mind, and society which we are going to explore in a detailed fashion to understand its impact on the psyche and the society