Functional Symptoms in Pediatric Dermatology: The Canary in the Coal Mine

The skin is a window into the state of health revealing genetic predispositions, hormonal balance, nutritional status, and internal wellness. It exposes stress burden, emotional well-being, and psychological health. In this way the skin can operate as the metaphorical canary in the coal mine announcing the body’s hidden alarm signals. Psychocutaneous disorders draw attention to the intimate connections between the mind and the skin. During development, the brain and skin are born from the same embryonic tissue and throughout life they continue to be connected through elegant interactions involving neuropeptides, hormones, and inflammatory mediators, the so-called molecules of emotion. Disfiguring skin disease such as vitiligo, acne vulgaris, and ichthyosis have large emotional and psychological interactions. Perhaps surprisingly, the extent of the psychological fallout that results from these conditions is not necessarily related to the objective nature of the disease. Instead it is highly correlated with its subjective severity, which is dependent on self-perception and is highly personal. Recurrent skin disease often results in anxiety, depression, social isolation, body dysmorphic disorder, and dramatic reductions in quality of life rivaling those associated with debilitating systemic illnesses. Crosstalk between the mind and skin also exists wherein physical or psychological stressors can both initiate and worsen skin disease that has clear organic underpinnings such as acne vulgaris, psoriasis, atopic dermatitis, alopecia areata, and cutaneous warts. Primary psychiatric disorders may result in skin and hair conditions such as trichotillomania, psychogenic excoriation, dermatitis artefacta, and delusions of parasitosis. Although mind–skin interactions can cause obstinate symptoms and skin disease, these same connections can also be harnessed for therapeutic benefit