Diseases of the skin play a profound role in the way the affected patient interacts socially. If located on visible skin surfaces, long-standing skin diseases may actually interfere with the emotional and psychologic development of the individual. The attitude of a person toward self and others may be markedly affected. Loss of self-esteem is common. The adult with a skin disorder often faces limitation of sexual activity. This disruption of intimacy can foster or increase hostility and anxiety in the patient. Skin is a sensitive marker of an individual's emotions. It is known that blushing can reflect embarrassment, sweating can indicate anxiety, and pallor or ''goose bump'' skin may be associated with fear.
Patients with rashes have always evoked feelings of revulsion. Rashes have been associated with impurity and evil. Even today, friends and family may reject the individual with a skin disease. Patients with skin that is red, oozing, discolored, or peeling are rejected not only by family members but perhaps even by their physicians. At other times, skin lesions cause others to stare at the patient, which causes further discomfort. Some skin disorders may be associated with such extreme physical or emotional pain that marked depression may result and, on occasion, lead to suicide.
Skin diseases are often treated palliatively. Because numerous skin disorders have no cure, many patients go through life helpless and frustrated, as do their physicians.
The role of anxiety as a natural stressor in producing rashes is frequently observed. Stress tends to worsen certain skin disorders, such as eczema. This creates a vicious cycle, because the rash then exacerbates the anxiety. Rashes are common symptoms and signs of psychosomatic disorders.
Clinicians should discuss these anxieties with the patient in an attempt to break the cycle. The interviewer who tries to elicit the patient's feelings about the disease allows the patient to ''open up.'' The fears and fantasies can then be discussed. The examiner should also be comfortable in touching the patient for reassurance. This tends to improve the doctor-patient relationship because the patient has a lesser sense of isolation.
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