Research Article ISSN 2639-944X

Journal of Medical - Clinical Research & Reviews

Dermatology and Mental Wellbeing in the Era of COVID-19 Pandemic

Hanaa Elsherbiny*

*
Correspondence:
Hanaa Galal Ibrahim Elsherbiny, Department of Dermatology,
Department of Dermatology, Mubarak hospital, MOH, Kuwait Mubarak hospital, MOH, Kuwait, Sulaibkhat - Jamal Abdel
Sulaibkhat - Jamal Abdel Nasser Street, 13001, Kuwait. Nasser Street, 13001, Kuwait, Tel: +965 66019766.

Received: 20 July 2020; Accepted: 17 August 2020

Citation: Hanaa Galal Ibrahim Elsherbiny. Dermatology and Mental Wellbeing in the Era of COVID-19 Pandemic. J Med - Clin Res
& Rev. 2020; 4(8): 1-3.

ABSTRACT
The appearance of COVID 19 pandemic has revealed the ‘centuries-old’ relation between Dermatology and Mental
wellbeing. It appears that, in addition to the multiple efforts attempted at different levels to combat the spread of the
disease, special attention should be made to the mental health issues of patients with skin diseases during this tough
period, concerning the inseparable bond between psychological status of dermatology patients and the existing
pandemic. Since the outbreak of the COVID-19 pandemic, a thoughtful re-structuring for the dermatologic practices is
needed.

Keywords the ‘itch–scratch cycle’; therefore, treatment of such cases may be

Mental health, COVID-19 pandemic, Chronic skin disease, difficult without addressing stress [4].
Depression, Psychodermatology, Teledermatology.
Effect of skin diseases on psychological status (Dermatologic
Introduction disorders with psychiatric symptoms)
The link between mental health and the burden of physical Patients with skin conditions such as psoriasis, eczema, and skin
conditions is stressed by the World Health Organization ‘‘there is cancer frequently face psychologic challenges which, in turn,
no health without mental health’’ [1]. Emotional factors influence impact their social functioning and the kind of life that they lead
[5]. Acne vulgaris has been associated with psychiatric disorders
many skin diseases and the correlation between stressful life
varying from clinical depression, social phobia, and certain anxiety
events and disease flares is well-recognized in dermatology [2].
disorders. The patients suffering from acne have reported greater
The current COVID-19 pandemic has clearly revealed the close
levels of anxiety and depression than other medical populations
connection between mental health and skin diseases. Therefore,
[6,7].
it is essential that dermatology patients should be aware of the
potential mental health impact of the pandemic and have clear Effect of psychological status on skin diseases (Psychophysio-
knowledge about how to practice a balanced mental health and logic disorders)
seek for assistance in case of distress [3]. Acute stress may trigger several disease manifestations, such
as allergic reactions (e.g., eczema, urticaria and asthma) and
Skin diseases and mental wellbeing angiokinetic phenomena. The pathogenesis of stress-induced
The skin and the psyche are linked from embryologic, biological, disorders can be due to increased secretion of the major stress
psychological and cultural perspectives. Both the skin and the mediators and their effect in the context of a vulnerable background
brain are developed from the same ectodermic germ layer. New [8].
evidence in psychoneuroimmunology suggest that both the skin
and the psyche are affected by immunologic vulnerabilities and Psychiatric disorders with dermatologic symptoms
endocrine reactions. Emotional stress may exacerbate many These are primarily psychiatric conditions with symptoms
chronic dermatoses and can initiate a vicious cycle referred to as involving the skin, such as delusions of parasitosis, trichitillomania,
J Med - Clin Res & Rev; 2020 Volume 4 | Issue 8 | 1 of 12
dermatitis artefacta, neurotic excoriations, psychogenic pruritus disease are a major component of illness, which is a concerning
and dysmorphophobia [9]. statistic [19].

COVID 19 pandemic and its psychological effect on general The present COVID-19 pandemic has enlightened the inseparable
population bond between mental health and chronic skin disease. Immediate
The coronavirus disease 2019 (COVID-19) outbreak was declared stressors during the COVID-19 pandemic such as statutory
a public health emergency of international concern by the World shielding and social distancing are likely to have a direct effect
Health Organization (WHO) on 30 January 2020 when all 34 on patients’ mental health. There is evidence that the pandemic
regions of China had cases of infection [10]. As of 22 February, may also constitute a traumatic or stigmatizing event, with long-
more than a month into this epidemic, 77,816 people worldwide lasting consequences such as post-traumatic stress disorder
have been infected, of which 21,147 have recovered from the (PTSD). The further likely severe socio-economic impact is
illness and 2,360 have died [11]. likely to contribute to the psychological burden of the population,
including suicidality. Given that people with chronic skin disease
Previous research has revealed a profound and broad spectrum are at higher risk for mental health disease and many (especially
of psychological impact that outbreaks can inflict on people those on immunosuppressant medications) have been advised to
[12]. Significant psychiatric morbidities have been found to vary shield and self-isolate, the psychological impact of the pandemic
from depression, anxiety, panic attacks, somatic symptoms, and on these patients is particularly important. We expect these
posttraumatic stress disorder symptoms, to delirium, psychosis patients to experience higher rates of health anxiety and social
and even suicidality [13,14]. isolation and probably low mood during the shielding and social
distancing period, as well as reduced physical attendance at
The proliferation of fear resulting in erratic behaviour among people medical services. Some patients may experience changes in their
amidst infectious outbreaks is an understandably not-uncommon immunosuppression therapy subject to infection risk, leading to
phenomenon since anyone of any gender, and sociodemographic acute flares and creating a vicious cycle with further worsening
status can be infected. This is especially true for COVID-19 of their mental health. The psychosocial stress of the pandemic
when there is much speculation surrounding the mode and rate of may itself present a trigger for inflammatory skin conditions.
transmission, with the disease spreading at such an unparalleled Notably, individuals who develop stress-related disorders such
magnitude, and there is currently still no definitive treatment. as PTSD after traumatic or other stressful events are at increased
A survey was conducted in China during the initial outbreak of risk of subsequently developing autoimmune diseases, including
COVID-19. This study found that 53.8% of respondents rated psoriasis [3,20,21].
the psychological impact of the outbreak as moderate or severe;
16.5% reported moderate to severe depressive symptoms; 28.8% Attaining responsibility of dermatologists along with other
reported moderate to severe anxiety symptoms, and 8.1% reported health care providers to promote an environmentally
moderate to severe stress levels [15]. sustainable health care system for the patients
It is clear that the COVID-19 pandemic has led to a vigorous and
COVID 19 pandemic has affected dermatology practice multifaceted response from psychiatrists and allied professionals,
through different conducts: directly and through psychological and that mental health is clearly being taken into consideration
impact on vulnerable patients with skin diseases at multiple levels in the general population, among healthcare
A. COVID 19 pandemic and skin disorders (dermatological workers, and in vulnerable populations [22].
manifestations of COVID 19 pandemic)
Interestingly, there have been many COVID-19 cases reporting In a recent study aimed to assess the Chinese mental health burden
cutaneous manifestations. Majority of the studies reported no during the COVID-19 pandemic, a major mental health burden of
correlation between COVID-19 severity and skin lesions [16]. the Chinese public during the COVID-19 pandemic was identified,
younger people and healthcare workers were at a high risk of
The dermatology clinical findings on COVID-19 patients were displaying psychological problem. They recommended an ongoing
cutaneous manifestations as contact dermatitis-like itch, urticarial surveillance of the psychological consequences for pandemic-
lesions, chicken-pox lesions, exacerbation of pre-existing skin potential, life-threatening diseases, establishing early targeted
diseases, including seborrheic dermatitis and acne, and vasculitic psychological interventions and should become the routine as
skin lesions [17]. part of preparedness efforts in China [23].

B. COVID 19 pandemic and its psychological impact on Presented programs for the screening of psychiatric disorders
vulnerable patients with skin diseases including anxiety and depression among patients and even
Although specific skin changes due to COVID-19 infection have caregivers and treatment and management of cases by employing
not been described, and one could expect iatrogenic secondary psychiatrics, psychologists and other relevant medical groups,
involvement of the skin [18]. The British Association of especially in quarantine cases, due to the severity of the
Dermatologists has previously suggested that 85% of patients with vulnerability and the availability of sufficient information for other
skin disease have reported that the psychosocial impacts of their groups of society, in order to know the status quo and create a
J Med - Clin Res & Rev; 2020 Volume 4 | Issue 8 | 2 of 4
sense of trust, seem necessary [24]. alleviate any anxiety and fear they may have about COVID-19.
Signpost to sources of online information (such as the British
It is known that the situations which involve the skin together with Association of Dermatologists' patient hub), support groups and
the nervous system and the mind, is associated with a diversity government guidance on the mental health and wellbeing aspects
of psychopathological problems, which affect the patient's family of COVID-19 [33].
and social life. Dermatologists should become familiar with
basic psychopharmacology and simple non-pharmacological Conclusion
interventions. They also need to have good access to the patient, After All, to be particularly beneficial to the patients, controlling
which depends on considering the situation from the perspective the disease requires proper and comprehensive management and
of those who experience the disease. In treatment, they should attention to their mental health care. Adhering to all the roles
include pharmacological and non-pharmacological resources and mentioned, along with cohesion and relying on social capital,
always use stress reduction techniques, It is convenient, given the seems to be a feasible way to overcome the existing situation [34].
current level of knowledge about the mind-skin connection, that
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© 2020 Hanaa Elsherbiny. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

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