Atopic dermatitis (eczema) comes with an increased risk of mental health issues like depression or anxiety. That can be due to feelings of shame or embarrassment about their condition or sleep problems caused by itch, for instance. But, many with atopic dermatitis don’t receive the mental health support they need, according to a new study from the National Eczema Association (NEA).
“Our data really does indicate that many individuals — even with milder disease, or even clearer skin — are dealing with mental health issues,” says senior study author Wendy Smith Begolka, who is the chief strategy officer at the National Eczema Association, where she oversees research, medical, and community affairs. “So there’s certainly an opportunity to talk about mental health alongside treatment in a more holistic way, broader than what’s just on the skin.”
This link between eczema symptoms and worsened mental health can be a vicious cycle, says Peter Lio, MD, a clinical assistant professor of dermatology and pediatrics at Northwestern University in Chicago, who was not affiliated with the study. For instance, patients may worry whether their treatment is working, about a current or future flare-up, or about their ongoing symptoms — and stresses like these are known to exacerbate eczema, he says.
“There’s a huge psychological component associated with atopic dermatitis and it really isn’t addressed often,” says Dr. Lio. “When your skin is causing you trouble, you’re itchy, you’re uncomfortable, you’re ashamed of how you look and you’re not sleeping well — that’s going to make anybody feel pretty miserable. And when you’re feeling stressed and anxious, that’s been shown to further increase inflammation and worsen the skin.”
How to Know if You Need Mental Health Support
Right now, mental health support isn’t part of the standard treatment for eczema, which often includes options like topical ointments, systemic drugs, medications like antibiotics or antifungals, and self-care strategies like using a humidifier and avoiding tight or scratchy fabrics or lengthy showers in hot water.
- Feeling sad, empty, anxious, or hopeless
- Loss of interest or pleasure in activities you usually enjoy
- Frequent tiredness or lack of energy
- Problems with concentrating
- Restlessness, or an inability to sit still
- Sleep issues
- Weight changes
- Thoughts about death or suicide
These conversations could be as simple as doctors asking patients how they’re faring, if they’re sleeping well, or are under any distress, says Begolka. For patients, this may involve starting the conversation by telling their healthcare provider how they’re feeling, she adds.
“Our [patient] community did feel they could tell the correlation between the increasing severity of their atopic dermatitis and their mental health. They have a strong sense of when something is off,” she says. “If you’re feeling it, try to have that strength and comfort to be able to raise that with your healthcare provider so they can work to address it in a variety of ways.”
Mental Health Resources for People With Eczema
Sixty-four percent of adults and caregivers of young patients in the study weren’t referred by their providers to mental health resources. But when patients were referred, the most common resources were counseling (23 percent), cognitive behavioral therapy (13 percent), and peer and social support groups (12 percent).
“Never feel like you have to go at this alone,” says Begolka. “We recognize this is a disease that has a lot of nuance, it’s a multidimensional burden, and we have a number of resources that can be helpful to support not only healthcare providers but patients throughout their journey.”
If you’d like to seek mental health help, either through counseling given by a mental health professional or a support group, Begolka recommends the following resources:
More research is still needed to pinpoint the most effective mental health interventions for people with eczema, to recognize the current barriers to referring patients to mental health care, and to better understand the role organizations like the NEA or NAMI have in helping to connect patients and doctors to resources, notes Begolka.
Lio adds that it can be tricky for dermatologists to open up the lines of communication for mental health help for their patients. While they can offer suggestions or make referrals, issues like proximity to counseling services, insurance policies, and wait times can get in the way, he says. Some dermatologists may feel out of place recommending mental health assistance to patients, too, he says.
But Lio and Begolka agree the new research is an important step in normalizing mental health discussions within the eczema community. “This is an opportunity for the conversation to occur in a much more standardized way across all atopic dermatitis care, regardless of what healthcare provider is being seen,” Begolka says.
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