I took my kids to see Inside Out 2, and was so impressed with the depiction of what anxiety, when out of control, can feel like. Also, displaying that not all anxiety is necessarily negative. It is an emotion that keeps us on our toes, keeps our eyes observing, our minds processing the “what if’s” so that we can be prepared for what life brings us.

The feelings of worry, rumination, and dread that are so common in anxiety disorders, can manifest in various ways. Examples include chest pain and shortness of breath with panic, the jitters, and insomnia to name a few. When anxiety manifests in relation to dermatology, we see it with hair pulling, hair loss, rashes and skin sores.

For this article, I’ll touch on two diagnoses we see in dermatology: excoriations and lichen simplex chronicus.

Lichen simplex chronicus is fairly common. It generally starts as an itch on the back of the neck or front of the shins. After repeated scratching, which often times occurs without the patient being aware of it, the skin will thicken up and feel like lizard skin. This itch-scratch cycle, which causes the skin to thicken, then creates more itching! It’s like a snowball effect. It is very common in women, and they generally relay that the rash or itching is worse when under stress.

The treatment for this is generally a potent topical steroid to stop the itching and inflammation, and to address the anxiety and stress behind it.

I recently saw a gentleman in clinic who presented with scabs and sores on his scalp. He had been afflicted with these sores for 20 years. He can pinpoint the exact time the scabs began and the pressure he was under during his stressful career.  Over the years, he had been treated with antibiotics, steroids, topical medications and injections. Despite all these treatment efforts, he continues to pick and scratch at the scabs, peeling off newly forming scabs with his fingernails. Never during those years had anyone addressed the anxiety and stress that sparked the picking and scratching behavior. Also, no one had addressed the tool used the pick…the nails.

During our visit, I listened while he recounted the high pressure career, and the subconscious scratching at his head. Since retirement, the scratching is less frequent, but he is very frustrated with the ongoing problem. My treatment is to start an antidepressant that also helps calm anxiety, and to trim the nails very short, so that he isn’t able to scratch the scabs off. This should allow them to heal.

It’s a common complaint in dermatology where patients feel they aren’t being heard, and with rashes like these, it’s important to take the time to listen. This way, we can get the root cause of the issue. Come visit us at Twin Falls Dermatology & Aesthetics, where patients are given the time they deserve.