Psychotrauma and the skin- How it affects the indiviudal?
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The field of psychodermatology gives essential insights into how skin interacts with the person's environment. Many factors have been investigated in several skin diseases, for example the prevalence of depression and anxiety. Some other eminent research topics are the effects of stress on skin barrier function, body image distortions and their significance, and stigmatization. One of these fields is the effect of psychotraumas.

Psychotraumas are potentially devastating life events that take their toll on an individual's psychological immune system. Several types of traumas exist, for example history of severe neglect, sexual abuse. These events may affect a patient years after the initial event, as they may get triggered by a person or event that reminds them of the experience, and these experiences may be associated with autonomic nervous system dysregulation.

Hidradenitis suppurativa is a disease that has many psychological factors, which can have an impact on patient's quality of life. HS is associated with depression and anxiety. It may cause diminished work productivity. The disease is in connection with major body image impairment. Impairment of sexual life is frequent in HS patients.

In a European multicentre study when participants were asked ‘Over the last week, how much has your skin caused any sexual difficulties?’, 66.7% of HS patients gave positive answers. There may be a tendency among HS patients that younger individuals feel depressed, unworthy and unlovable, while older patients to some degree find ways of influencing their conditions, for instance by taking pain killers, wearing loose?fitting, dark?coloured clothes and tight bandages, being fit and healthy.

Researchers noted that childhood maltreatment can contribute to a significant and persistent compromised immune dysregulation, with an anti?inflammatory buffering system. The authors investigated retrospectively types and number of experienced psychotraumas of 71 HS patients and 213 controls.

Their main outcomes were that 91.5% of HS patients reported one or more lifetime traumatic events (yes vs. no), compared with 81.2% of the controls. The mean number of different traumas was 5.2 for HS patients, and 2.6 for the controls. Regarding childhood traumatic events, 57.7% of HS patients reported one or more of these experiences and 28.6% of the controls. The mean number of different childhood traumas was 2.3 for the patient group and 0.6 for the controls.

Researchers suggest that children that suffered from maltreatment should receive early preventive psychotherapeutic intervention to avoid the biological embedding of HS or other immune?mediated diseases. They stated that stress management and psychological support may lead to disease modulation and may be beneficial for children and adults also.

These results shed light to the fact that dermatologist's play a big role in identifying psychotraumas of their patients. It is worth approaching the treatment that involves essential psychodermatological factors with a good doctor?patient relationship to develop empathy and increase patient adherence and satisfaction.

The multidisciplinary work is very important in the field of psychodermatology, and the involvement of dermatologists, psychologists, psychiatrists and social services can be essential for dealing with psychotraumas that effect HS patients' lives.