what I really loved about this one was
the notion of disrupting an idea and the
idea that that was disrupted comes in a
very personal place for me um I’m an
only child
I’m super close to my cousin Alexia
she’s like my sister and when she was a
young teenager she developed a skin
condition called vitiligo now gonna Lago
is an autoimmune condition and what it
does is a deep pigmented skin so you’re
left with a white patch all over the
skin now Alexia’s got quite a
Mediterranean skin tone like me so you
can imagine how that would have looked
and I noticed that this affected not
just her skin but it affected her as an
individual I noticed that it affected
people around her the way they spoke to
her the way they look at her I noticed
that it affected with her behavior she
went from being very bubbly an extrovert
to being kind of much more closed off
and not speaking too much I noticed that
it was the first thing that people saw
about her and questioned her about him
so it eventually became the first thing
that she saw about herself so I decided
when I’m not university that I wanted to
study this I want to study how it is
that the way we look impacts when we
feel now my um my experience where I
conceptualize it was very much based on
what Alexia had experienced seeing
doctors she would say that she’d go in
and she’d be asked about whether the
skin condition heard whether it itched
you know what’s worse in summer was
worse in winter but there was very
little about how did it feel when
someone stared how did it feel when
someone stood back before touching her
hand when she mentioned that she was
dropping out of swimming classes the
question was always is the chlorine bad
for your skin isn’t it she instead of
are you dropping out because people are
looking at you differently and armed
with this knowledge I thought I really
wanted to look at what happens how
significant
is the way we look on our behavior so I
began to research this area began
speaking spiel Skin Diseases I began
reading about it and in those initial
stages one of the things that I found
them very quickly honest people were
saying to me you know what I develop my
skin condition after a really stressful
life event after someone died or my
eczema always seems to get worse right
before exam time or I always seem to get
that my acne flares when I had a really
bad time with my boyfriend so what I was
realizing it’s not just the way that we
look a facts the way that we feel but
maybe just maybe the way we feel can
affect the way we look and in fact
there’s a lot of evidence to suggest
that this is actually the case this skin
and the central nervous system develop
out of the same stuff embryologically
out of the ecto dress right at the
beginning right there’s first few days
of conception there is a connection
nerve endings in the skin are in
constant contact with your brain so
there’s a direct connection between the
two
beyond that the brain the nervous system
can influence the skin’s immune cells
through various chemical receptors like
your peptides for example and there’s
many studies out there that suggest the
stress can interfere with their immune
system there’s one quite well-known
study done recently look at levels of
stress preoperatively they found the
people with low stress had a higher
level of il-1 this is a an immune cell
and and what it does is it helps promote
healing house for recovery
so people that were less dressed had
higher levels so what happened
postoperatively they did better
they were healthier than at the hospital
sooner their wounds healed sooner
likewise we know that it can interfere
with the very physical barrier of the
skin so this seems a big part of the
immune system and when we’re stressed we
know that that permeability is
compromised and we know that this is the
basis of a lot of the skin disorders we
see so this might seem like wow this is
you know this is really new stuff but
actually it’s
not counterintuitive if every time you
think about every time you get worried
and you blush a little bit every time
you’re nervous and you sweat or how
about when you’ve been waiting for that
special day a pimple comes right before
that special day we all know that
somehow the way we feel affects the
function of our skin and we know how it
works now so we know the more stressed I
get the more cortisol comes into my body
higher levels of cortisol higher levels
of testosterone higher levels of
testosterone more sebum production and
there’s the pimple yeah and the thing is
we’ve understood that lifestyle factors
that emotional factors play a part in
gastrointestinal systems or our
hypertension and I think it’s time we
start looking at it in the same way skin
disease has the same capacity so this is
what I wanted to turn research so um
I’ve done many studies in this area over
the years but I I want to tell you
briefly about one in particular um this
was one of my first days actually did
for my doctoral work and I looked at
vitiligo Alexia’s condition and I wanted
to see if cognitive behavior therapy
which is a kind of therapy that impacts
the way we think about things in life in
this case our skin consists disease
could reduce stress and then
consequently if that reduction could
affect audience and self-esteem and
quality of life so we recruited a group
of people and we gave them CBT for eight
weeks another group of people we gave
them just talking therapies they could
talk about whatever they wanted not
about their skin disease not CBT but
just just open-ended therapy and we had
another control group the group that
received the CVT was able to improve
significantly in terms of body image in
terms of quality of life and in terms of
self esteem and this was maintained at
six months in a year but beyond that we
actually also saw an improvement a
significant improvement in the skin
condition of a lot of those people so we
realized that what we’ve done what we
managed to do is is address a central
issue in the illness process and an
issue that very sadly
isn’t addressed a lot of times when
someone comes in and says I have a skin
condition it’s it’s a condition that’s
treated not the person and if in fact
this connection between mind and body
exists and we’re not treating it then
we’re missing something out so what did
we learn well we learned that the
stories we tell ourselves about vilnius
matter I’ve done I’ve done work in this
area as a research scientist as I call
just four years and what I find when it
comes to illness any illness is toys
that we tell ourselves why we got Milnes
what we should do to make it better
these will determine how we act how we
seek help how we stick to treatment
there was one guy remember who came to
see me and he lose July really caught in
those sticky London July so he came and
he had his you know shirt done up and
his sleeves down and I asked him our
work and he said well I just I hate
anyone seeing that the vitiligo we began
talking he opened up and explained that
he developed little I go around his
groin when he was a teenager and so it
was mixed up with all these feelings of
shame and handsome and sexual confusion
and it wasn’t until he was able to get
therapy and and reframe how his audience
and the meetings of the others if he was
able to deal with it emotionally in a
much more healthy way but also he was
able to regain some of his quality of
life back this is someone who four years
after that encounter write to me and say
it’s freezing outside but I refuse to
take my shorts off because this is my
illness and I refused to be ashamed of
it I also learned that the severity of
the condition will have no bearing on
how individual experiences it you know
we made this assumption that the worst
you look the worst you feel but that’s
not the case it’s a really individual
thing and I remember working with the
dancer once a beautiful girl who came in
and she had um exclamations on her legs
and she was devastated
by this her identity was so bound up in
her legs so you can imagine for sitting
across from a doctor that was saying oh
it’s not going to kill you but you know
I can’t see it you must be fine it
doesn’t matter what we see as health
professionals what matters is the
individuals experience I learned indeed
that even though condition isn’t
physically handicapping
it doesn’t mean it’s not psychologically
handicapping you know psychologically
one of the things that we do to protect
ourselves is avoid so I decide this in
condition is something that’s going to
cause me problems you’re going to ask me
about it I’m going to feel uncomfortable
not just make my world smaller I decide
well I’m not going to date until it goes
away I’m not going to go over the job
until it goes away I’m just going to put
my life on hold and this is a
significant problem because a small
world where our worlds get the more
difficult it is to come out of that
comfort zone right the only way to
improve confidence is to do things that
we never thought we could do and illness
is especially those that have this
visible factor getting away of that many
times and finally really importantly I
learned that there is a potential for a
vicious cycle of skin disease whereby
the worse my skin gets the worse I feel
and the worse I feel the worse my skin
becomes so this is what we learned with
this study and ever since then I can
clean up this was way back in the late
nineties when we did this study the
futures like a dermatology really took
off there’s so many more people working
in the area now there’s three permanent
posts of psychologists and your
mythology units in the UK in fact one of
them is held by one of my old PhD
students and
amazing clinician : Alexander Mazzara
now when she was doing her PhD with me
we did some research as she went to the
world for medical school and part of
that she had such an impact on the
department and helping people with her
skin conditions that that that one an
invite and innovation would a clinical
innovation award from the government and
since then she’s one of the most valued
practitioners there I saw her a couple
of weeks ago and I told her I was doing
this talk and I said how are things
going to civil action we’ve just had a
review of the service we’ve had some
great stats she said that in the last
review 44% of the dermatology patients
had been discharged because of the work
that she done him 44%
she said 22% had either discontinued or
avoided systemic therapies altogether
and 18% were long employed because of
their illness or because of the way they
thought about their illness
she’s key had managed to return back to
work so we’re you know we’re really
missing a beat if we don’t acknowledge
the fact that the way we think impacts
the way we feel and we don’t start
understanding and treating people in a
way that allows them to address the
things that really matter to them in
terms of their owns now when I speak
talent Sandra and other collisions in
the field and we look at what patients
tell us they tell us five core things
one is that they need to have the
psychosocial impact address every other
illness you have no one will ask you
about I can’t see if you have an ulcer I
can’t really see if you have diabetes
when you have a skin disease I feel that
I can see it so all of a sudden it’s not
just yours I can ask you I can stare I
can wonder whether to touch it or not so
knowing how to deal with the stairs the
awkward questions is key and
acknowledgement of that is vital
understanding indeed how to improve your
own lifestyle choices how there
action of stress can have an impact not
just on your emotional health but your
physical health it’s so important
developing strategies to deal with
uncertainty now this is an important one
people talk about the disfiguring
component of certain skin diseases but
actually there’s this added pressure
that it’s constantly changing so if I
live in with a scar that’s it I know
where the scar is I don’t wake up
tomorrow and it’s bigger or X move
towards redder if I’m living with the
skin disease I’m constantly adapting to
a change in body image and needing to
constantly adapt means to be learning to
live with that uncertainty and again
that’s a strategy that needs to be
developed as does need to be encouraged
by not being defined by the condition
like I said earlier if that’s the first
thing everybody sees about you you need
to remember what you see about yourself
this doesn’t become definitive of who
you are and finally and really
importantly understanding the links
between our thoughts in our condition we
need to begin to disrupt the way we
think about skin disease
we need to view it in the same way that
we view hypertension that we view ulcers
the we view illnesses that were certain
are impacted by our mental health I
think it was this disruption that
allowed those patients in that first PhD
research to get improvements I certainly
think it was rethinking her illness to
help my cousin Alexia feel so much
better about her condition as well
because she was no longer defined by it
and she’s much happier with who she is
today and I think until we understand
that we give it’s time we give patients
a sense of entitlement to ask for help
that is more holistic until we begin to
treat the patient not just the person
there will never be
looking at the whole story when it comes
to skin disease thanks very much [Music]