Evan Rieder, MD: Addressing the Mental Health Needs of Dermatology Patients

Evan Rieder, MD

Credit: drevanrieder.com

In this Q&A interview with HCPLive, Evan Rieder, MD, spoke on the biggest takeaways from his recent panel discussion hosted by AbbVie titled ‘Science of Skin: The Psychosocial Impact of Chronic Skin Disease.’

Rieder is dual board-certified in dermatology and psychiatry, currently working for Weiser Skin in New York, NY. His expertise is in skin care, cosmetic dermatology, nail disorders, and general as well as surgical dermatology.

HCPLive: Skin disease is known to impact about 1 in 4 Americans or around 85 million. During your panel discussion, you mentioned some of the mental health challenges of dermatology patients with chronic skin disease. Why did you feel this was an important issue to discuss?

Rieder: Well, I've always it's probably no surprise that I've always been an advocate for psychological well being. And one of the reasons that I went into a second residency in dermatology is because I saw how chronic skin conditions could be and go hand in hand with psychological comorbidity, like depression, anxiety, and social anxiety, those being the big 3 that we see in a lot of our conditions.

There's obviously a lot of other things that we see had that have overlap with screen conditions in terms of psychological comorbidity, but I remember being a resident or excuse me, a medical student rotating through the dermatology clinic, thinking that people were getting amazing treatment for their skin disease, but feeling like that I was kind of rotating through clinic where everybody had depression and anxiety as well. And those issues were not being addressed.

HCPLive: How did you respond to what you saw?

Rieder: You know, it's one thing to talk about. And it's another thing to actually have the luxury of time to be able to treat those. And, obviously, those of us who are practicing dermatology, internal medicine, who may be seeing a lot of skin diseases don't have that luxury of time.

But I think it was incumbent upon me to sort of make those connections, and then act as like sort of a conduit between the mental health professions and the dermatology and internal medicine specialties, to relay that knowledge and make sure that people are aware and advocating for their patients and that patients are advocating for themselves, enable and being able to get more comprehensive, 360-degree care.

HCPLive: What elements could be getting in the way of patients having both their mental health as well as skin needs met?

Rieder: So I think there's a laundry list of things that are getting in the way. One is that people when they see a dermatologist, and they have a chronic skin condition, they think that they're there to treat the skin and by and large, that's what they're there for. So they may not think to ask about their emotional well-being. Dermatologists may not ask the questions or may not have time, while they may be amazing doctors and may want to go down that rabbit hole may be told that they need to see 10 patients an hour by whoever is paying them.

And that is just not a realistic way to be able to give people comprehensive treatment. Or people may find that they'd been sort of had a negative experience or felt like they were being blown off by their dermatologist when I saw them in the first place. But I do want to stress that I do think dermatologists are very aware of the association between chronic skin conditions and mental health comorbidities. But just a lot of us are handcuffed and not having the luxury of time and not knowing what's due when we actually recognize that.

HCPLive: What are some of the biggest mental health struggles you’ve seen or heard about with regard to skin diseases (with focus on ones like eczema or psoriasis or vitiligo) or for lesser known diseases?

Rieder: Yeah, I think the most some of our most common psychiatric disorders we also see in patients with chronic skin conditions, like those inflammatory conditions that you mentioned, depression, anxiety are the most common, but often people will develop a personality structure that is avoidant. Or a social anxiety component where they have difficulty going into public places or socially or occupationally functioning in the highest level because they have such levels of anxiety or embarrassment or shame about the way that their skin appears.

And unlike when people have kidney dysfunction or you know, heart attack or problems with their liver, you're wearing your skin. It's there for everybody to see unless you're in a culture where all your skin can be covered. Most times of the year or even in the winter, your face is there for people to see, and your neck. Your hands are there in vitiligo, acne, psoriasis, eczema, all these conditions are chronic and inflammatory and can intermittently affect those unexposed areas.

So it's very difficult to go through life living with one of those things and not having some sort of psychological comorbidity at some point. Pretty much everyone in their life has experienced acne to different degrees. And everyone has, I would venture a guess, had some sort of embarrassment associated with their acne, whether their acne was severe, or it was mild. It makes people have difficulty going out socially, a lot of the time. So I think that there's a major comorbidity there. And I think that's one of the things that I like to stress to people.”

HCPLive: What is a perspective you hope clinicians who viewed your talk walked away with?

Rieder: I think that they should view it in a couple of ways. I think most people are probably aware of these psychological comorbidities…Being aware of this, and then sort of meeting people where they are developing rapport, which I think we all we all make our best efforts to do in the constraints of how we practice in dermatology, or whatever our field is. And then sort of meeting people's patients where they are, and then trying to recognize the symptoms, whether by going ahead and asking them about quality of life, asking them about things like mood and anxiety.

The quotes contained in this interview were edited for the purposes of clarity.