85% of skin patients could benefit from pioneering government-funded website

Author: British Association of Dermatologists

Date: MAR 2013

The British Association of Dermatologists (BAD) has been awarded government funding for a groundbreaking project that will bring together two major areas of healthcare, to benefit the lives of millions of people.

The Department of Health Innovation, Excellence & Strategic Development Fund grant, of £97,000 over three years, will enable the BAD to develop a website that will act as a hub for psychological support specifically targeted at skin disease patients.

The project, which was highlighted in a speech by Jeremy Hunt on Wednesday*, will be the first of its kind to unite the specialties of dermatology and mental health, which have a significant overlap. The causal link between mental health issues and skin disease is twofold – skin disorders cause psychological traumas, and conversely, psychological factors like stress can trigger or worsen certain skin diseases. However, Psycho-dermatology services (which provide emotional support specifically for skin disease patients) are extremely limited in the UK and very few dermatology departments even have direct access to general psychiatrists.

The website will bring together, and link to, existing disease specific resources, support groups, forums and help-lines. The BAD aims to work in partnership with a mental health charity to assist skin disease patients in need of immediate psychological help to find it more easily.

Currently, support materials and services directed specifically at skin disease patients are sporadic and disparate, and those that do exist are not always easy to find or access. While there are both patient support groups, centred on individual skin diseases, and also mental health charities, there is no centralised hub that provides coordinated resources, appropriate to people with problems that transcend dermatology and are psychological or psychiatric.

Skin conditions are the most frequent reason for people to consult their GP. It is not just the physical symptoms that affect sufferers’ lives – diseases that are visible, disfiguring or long-term can carry a multitude of psychological and social effects, including isolation and depression. In the UK, psoriasis alone is linked to 300 suicide attempts annually. A British Association of Dermatologists’ survey in 2011 revealed that 85 per cent of patients indicated to their dermatologist that the psycho-social aspects of their skin disease were a major component of their illness.

Stress, as well as being a frequent by-product of skin conditions, is also known to cause and exacerbate skin disease; psychological and self-help interventions can be crucial not only for easing mental distress but also for improving many of the physical symptoms of the skin disorder. It may be difficult for a variety of reasons for skin disease patients to access mental health services directly, one being that they may not identify themselves as having a mental health issue, but they may still understand that the skin disease or disorder is having an adverse effect on their mental wellbeing.

The BAD believes that for patients to have access to self-help materials specifically tailored to their skin disease, as well as being signposted to appropriate support services, will have a huge impact on many people’s lives. Through use of these tools it is hoped that the vicious cycle of stress, that is exacerbating an existing skin condition and subsequently increasing stress levels, will be broken.

President of the British Association of Dermatologists Professor Chris Bunker, said: “We think that this project will be an innovative approach to a largely unmet health burden. We know that there is under provision of specialist Pyscho-dermatology services and, whilst a website cannot replace this kind of specialist care, it may help to raise awareness of the services that are available and of resources for both patients and medical professionals that are specific to skin disease.
?By being able to see easily the range of options available, skin patients will be able to make better informed choices about their health and care and understand how to access the help that they need.
?Our proposal to create an interactive, mobile-phone accessible website for sufferers of skin conditions seeking psychological support, will help people by providing guided, personalised access to self-help tools, information on support groups and networks, and advice on types of guided therapies and other psychological interventions that may be of benefit to them.?

Dr Linda Papadopoulos is one of the most well-known psychologists in the UK and has been working in the field of Psychodermatology for 15 years. She said: “Illnesses do not occur in a vacuum, their ramifications have the potential to affect us not only physically but socially and emotionally too. The social significance of our skin in relation to our body image and the mythology that skin disease is contagious can take a significant emotional toll on people, which is why this project is hugely welcome and, indeed, imperative to give people the right type of well rounded care.”

To create the online hub the BAD will set up a multi-disciplinary advisory group and consult widely to create the best possible resource for people with skin disorders.

Key statistics and notes:

A national survey undertaken by the BAD in 2011 to assess the availability of psycho-dermatology services, revealed poor provision, despite dermatologists reporting:

  • 17% of dermatology patients need psychological support to help with psychological distress secondary to a skin condition.
  • 14% of dermatology patients have a psychological condition exacerbating their skin disease.
  • 8% of dermatology patients present with worsening psychiatric problems due to concomitant skin disorders.
  • 3% of dermatology patients have a primary psychiatric disorder.
  • 85% of patients have indicated that the psycho-social aspects of their skin disease are a major component of their illness.

*Jeremy Hunt’s speech on innovation in healthcare

The “Working Party Report on Minimum Standards for Pscyho-Dermatology Services 2012” published in December 2012 highlighted the following: Dedicated psycho-dermatology service provision (both psychology and psychiatry) in the UK is scarce despite a need for such services. There is currently only one service in which a psychiatrist and dermatologist see patients concurrently, and there are very few dedicated psychologists working jointly in dermatology clinics.

Long-term skin conditions can cause considerable isolation for many people. According to a study of 2,579 skin disorder patients, at least one in four also suffer from a significant psychological disorder [Picardi, A. et al, BJD, 2000]

Multiple international studies have identified an even higher level of psychological disorders in dermatology patients, generally ranging from 40% to 60% [Hughes JE et al, Br J Psychiatry, 1983; Wessely SC et al, Br J Psychiatry,1989; Attah Johnson FY & Mostaghimi H, Int J Dermatol,1995; Aktan S et al, Dermatology,1998; Carney O et al, Genitourin Med,1994]. Studies attribute much of the psychological distress to disfigurement, perceived social stigma or undesirable changes in life-style resulting from skin disease [Picardi, A. et al, BJD, 2000].

Acute diseases, including skin disorders, are also associated with depression and in some cases suicide [Depression with a chronic physical health problem: NICE guideline CG91].

Dermatologists manage over 2,000 diseases of the skin, hair and nails in adults and children.

Each year 54% of the population are affected by skin disease, and 23 to 33% at any one time have disease that would benefit from medical care.

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