The Skin is the largest organ in the body.
It is a sensory wrapper and the interface between us and the world we live in. Laid flat , it could measure 18 sq. feet. It functions as a barrier and a body temperature regulator. It is is a part of the immune system, the excretory and the endocrine system. It enables movement and growth without injury. The skin can develop tell tale markers of a medical disorder. Sometimes the Dermatologist picks up a Hyperthyroid state, Diabetes Mellitus, an internal Malignancy from the cutaneous markers that the present in the clinic.
Lesions on the skin are out there in the open. If you had a lesion in the kidney or the liver, the person sitting next to you in a bus would not know about it . Not so with the skin lesions. You can see it and everyone else can see it, if it is not hidden by clothing or hair. Skin lesions cause embarrassment, fear and anxiety,. However the psycho-cutaneous morbidity can be disproportionate. Some may agonise over a blemish . Others with disfiguring skin disorders may go through life unaffected, accepting their lot in life.
Skin lesions , unfortunately are associated with stigmata to a varying degrees. Every hypopignented patch in the patient’s mind is Leprosy, unless proved otherwise. Every hypopigmented patch would have been poked repeatedly, with a pin before it came to the clinic.
Skin lesions, innocuous or otherwise, have been known to prevent marriages and they have been known to break up marriages. By the time the patient reaches the clinic door, he or she is a mess and worried sick whether they will transmit it to their near and dear ones. Mothers were scared to cuddle their children. Intimacy in the marriage would have taken a toll. Dysmorphism was at its worst in the Dermatology clinics.
Dermatology patients come with baggage. Undiluted fear. The line between the Psyche and the Soma is a thin one. They are anxious , depressed, tired and often sleep deprived, especially if they are in on an itch-scratch cycle. Dermatology patients with chronic illnesses need to be handled with kid gloves. Sometimes they need a psychiatric evaluation and a small dose of an antidepressant to tide them over. Suggesting this in the Dermatology can sometimes cost you the patient. I came to see her about my skin and she is referring me to the Psychiatric Clinic . What is wrong with her ?
Dermatology patients are often bruised and battered and they need empathic handling and counselling.