Severe Eczema’s Impact on Mental Health & Treatment

Severe atopic dermatitis, a type of eczema, is an inflammatory skin condition that causes many unpleasant symptoms, including very itchy skin, dry skin, rashes, and skin discoloration, according to the National Eczema Association (NEA).

In addition to being a physical problem, these symptoms can also contribute to emotional issues. According to an analysis published in 2022, people with all forms of eczema may be at a 63 percent higher risk of developing anxiety and depression, compared with people who don’t have the skin condition.

This is likely because severe eczema doesn’t just affect your skin. It can have an impact on your quality of life, too.

How Severe Eczema Can Affect You Emotionally

Relentlessly itchy skin can make it difficult to sleep, which makes it hard to function during waking hours.

“People who don’t get a good night’s sleep are often more depressed, more anxious, and unable to focus on their tasks during the day,” says Suzanne Friedler, MD, a clinical instructor of dermatology at Icahn School of Medicine at Mount Sinai and a dermatologist at Advanced Dermatology in New York City. “When you have eczema, it can also be hard to focus during the day, because you’re distracted by the itching.”

In addition, the embarrassment of having large, noticeable patches of red or discolored skin can start to have an emotional impact.

“If somebody has eczema on their arms, hands, or face, it is more obvious to others, and then this can cause more anxiety and self-esteem issues,” says Mohammad Jafferany, MD, a professor of psychiatry, psychodermatology, and behavioral sciences at Central Michigan University College of Medicine in Saginaw and the executive secretary of the Association for Psychoneurocutaneous Medicine of North America (APMNA). “And, people who feel more depressed may opt to be by themselves.”

Signs of Depression and Anxiety

According to Dr. Jafferany, you may be depressed if you are:

• Feeling empty and down “We’re talking about feelings of sadness, tearfulness, hopelessness, helplessness, and emptiness, as well as frustration and anger in some cases,” he says.
• Losing interest in things you normally enjoy You might not relish hobbies you used to love or struggle to take part in fun activities, Jafferany says.
• Experiencing sleep disturbances This one can be tricky, because eczema itself can affect sleep. “Sometimes, a person sleeps a lot, but sometimes they just can’t sleep and toss and turn on the bed,” Jafferany says. “Consequently, they can feel really tired and have a lack of energy.”
• Having difficulty concentrating “This might include ruminating on the past — a person cannot make decisions or remember things, because they can’t focus,” he says.
• Experiencing changes in weight For some people, this might mean not eating as much and losing weight, while others may gain weight from stress eating, according to Jafferany.
• Having thoughts of suicide This could mean thinking you don’t deserve to live or imagining ways to die, Jafferany explains.

The symptoms of anxiety can be similar to the symptoms of depression, he adds. People with anxiety may also overthink and envision worst-case scenarios, obsess over situations, feel restless or agitated and have trouble relaxing, according to Cleveland Clinic. “In addition, a person may be worried about their physical look and appearance… so they might try to hide or isolate themselves,” Jafferany says.

It’s also possible to experience anxiety and depression at the same time, he adds.

How to Treat Anxiety and Depression When You Have Severe Atopic Dermatitis

The good news is that anxiety and depression are both highly treatable, and addressing them can also help you live better with atopic dermatitis. Here are some tips for managing these common mental health disorders if you have severe eczema:

1. Get the right treatment for your eczema. “Make sure you’re seeing a dermatologist and learning the right skin-care habits, because your behaviors really do influence the health of your skin,” says Dr. Friedler. “Treating the itch of the eczema is really important for quality of life.” This includes taking short, warm (not hot) showers with soap for sensitive skin and moisturizing afterward, as well as taking appropriate medications to control itching, such as antihistamines and steroids. If you’ve tried all of this and still haven’t experienced any relief, Friedler says, there are more potent medications available for severe atopic dermatitis, including oral or injectable biologics, such as Janus kinase inhibitors.
2. Talk to a therapist. Talk therapy can help you cope with depression and anxiety, because a therapist can give you the tools to help you deal with your emotions. You may need to add an antidepressant medication to your therapy. Fortunately, antidepressants shouldn’t cause any issues when added to eczema treatments, according to both Friedler and Jafferany. In fact, for people with atopic dermatitis who scratch when anxious, “[Certain] antidepressants can actually help with the compulsion to scratch,” says Friedler.
3. Consult a psychodermatologist. Psychodermatology is a new field that focuses on how the mind and skin affect each other. A psychodermatologist is generally both a dermatologist and a psychiatrist, and as such, they can treat your skin while also teaching you how to manage stress, according to Jafferany, who specializes in the field. If you want to focus more on how your skin is having an impact on you emotionally, a pscyhodermatologist can be a good person to add to your treatment team. You can search for a psychodermatologist on the APMNA website.
4. Get support from others. It can feel isolating to live with eczema, especially if you don’t know anyone else who has it. Ask your doctor to refer you to a local support group, or find other people with eczema by visiting the National Eczema Association (NEA). The NEA also hosts an annual Eczema Expo for people with the condition. You can join online communities, such as AltogetherEczema, too.
5. Follow a healthy lifestyle, including meditation and exercise. According to a review published in 2020, meditation may reduce the urge to itch in people who have chronic itching. Exercise can also lower stress and improve mood, which is good for your skin. Experiment with different exercise routines to see which works without aggravating your skin, according to the NEA. That might include low-impact exercises such as yoga.

“Relieving stress and helping with your anxiety or depression will play a positive role in the management of eczema,” says Jafferany. “It’s good for your overall well-being and health.”