Why do the elbows turn ashen


Atopic dermatitis (neurodermatitis) - psoriasis vulgaris (psoriasis) - contact dermatitis - acne vulgaris - perioral dermatitis - urticaria - lichen planus - vitiligo - collagenoses (lupus erythematosus, scleroderma) - somatoform disorders - pruritus (pruritus) Munchausen Syndrome)

Appendix: Skin and depression, mania, schizophrenia or other delusional disorders (dermatozone delusion), alcoholism, drug use, etc.

Most skin diseases have an organic cause. For some, however, emotional and psychosocial reasons can also play a role. Therefore, the following is a brief overview of the most important skin conditions in which psychosomatic reasons are crucially involved.


The Skin as a mirror of the soul is an old knowledge. Skin diseases can have an organic (biological), but also an emotional cause. It is not uncommon for it to be both, namely an organic disposition (tendency, possibly even hereditary burden) as well as an emotional or psychosocial trigger (partnership, family, professional, neighborly, etc.). This close connection goes back to an early experience:

The skin as a psychological medium

The skin is an important mediator in the connection between child and environment, especially the mother. Above all through the physical contact with the mother and the security it provides, the child perceives the skin not only as a body surface, but also as a psychological dimension.

From a psychoanalytical point of view, the so-called "tactile phase" (from the Latin: tactus = touch), i.e. the earliest phase in the psychological development of humans, is of decisive importance for the later personal development. If it is disturbed (too little or experienced as unpleasant), the child can later attach certain emotional states from this time to the sense organ "skin".

In contrast to congenital skin changes, which rarely cause problems in personality development, interpersonal difficulties from later phases of life (e.g. so-called closeness-distance problems) can very often be traced back to corresponding developmental disorders in childhood (see later).

In addition, there is the vicious circle of the mostly visible skin changes, which in turn affect the personality of the person concerned. Because body image and skin are closely related. Visible - above all disfiguring - skin changes that trigger at least secret insecurity, if not disgust, naturally affect self-esteem. The result is inferiority complexes, fear of contact, a tendency to withdraw, the danger of isolation and a vicious circle that is constantly fueling itself.

In fact, in our society, skin diseases with some mental disorders (e.g. schizophrenia and addictions) are at the top of the negative rating by the general public. "Sick skin" most often provokes fear of infection and thus antipathy, rejection, reluctance or even disgust.

The skin

Although we care so intensively about the skin and its appendages (especially hair), we are far too little aware that it has not only an aesthetic but also a diverse, even vital organic task. The skin is an organ like the heart, lungs and liver, just not compact, but spread over an area of ​​1.6 to 2 square meters (and thus the largest organ in the human body). It also has several functions, namely as a protective organ, sensory organ, thermoregulatory organ, secretion organ (excretory organ) as well as respiratory and metabolic organ.

It becomes a sensory organ through the skin nerves with their tactile bodies. This gives us constant information about shape, weight, surface properties, hardness and softness of bodies, temperature, air movement, etc.

The skin also has a special relationship with the nervous system. Certain skin areas (so-called segments) have close connections to certain body organs (e.g. heart, gastrointestinal, liver) via the spinal cord. So you can therapeutically influence internal organs from the outside (from a brush massage to injections into certain skin areas). And vice versa, internal organs, if they are sick, can announce this by corresponding abnormal sensations on "their" skin areas (e.g. the heart in the area of ​​the left shoulder and arm; frequent misdiagnosis: rheumatism, although it may be a heart disease).

An important aspect of the skin, which is still largely unknown to the general public, is the possibility of illness on a psychological basis. The following chapters explain this.


One can divide skin diseases under
- dermatological aspects (i.e. the theory of the skin and its skin diseases) as well as
- psychosomatic aspects (i.e. organic, physical illnesses which, however, go back to psychological causes).

From a psychosomatic point of view, skin diseases can be divided into three groups:

1. Skin diseases in which psychosomatic aspects (= mental problems express themselves physically) play a role = psychosomatic skin diseases. Examples: Atopic dermatitis (neurodermatitis), psoriasis vulgaris (psoriasis), contact dermatitis, acne vulgaris, perioral dermatitis, urticaria, also lichen planus, vitiligo, the collagenoses (scleroderma, lupus erythematosus etc.) and some hair diseases (see the section on hair and mental disorder).

2. Skin conditions resulting from a psychiatric condition. Examples: somatoform disorders (mood disorders, hypochondriacal aspects), pruritus sine materia, dermatological delusional syndromes (e.g. dermatozoal delusions - see this one) as well as simulated disorders (artifact diseases of the skin).

3. Skin diseases that cannot be traced back to any emotional or psychosomatic causes, but which have corresponding consequences (somatopsychic skin diseases, i.e. first the skin ailment and then its emotional and psychosocial consequences).

The following is a brief summary of the most important examples of the phenomenon "skin and mental disorders" (according to Deter and co-workers - see bibliography):

Atopic dermatitis (neurodermatitis)

The Atopic dermatitis or Eczema is a recurring or ultimately chronic skin disease with severe itching. About 1.5 to 3% of the population are affected (every fourth patient at the dermatologist?).

Clinical picture: typical eczema (itchy lichen), but especially pruritus (itching). This depends on the part of the body, time of day and subjective stress (excitement, anger, anger, less often also joy, can occasionally even be triggered psychologically). Often at night.

consequences: Loss of concentration and performance, sleep disorders, constant scratching. The latter leads to a short-term alleviation of the itching, but to no end and, above all, to inflammatory reactions in the scratched skin with renewed itching and thus a vicious circle. The following sequence is also possible: internal tension> itching> scratching> release of tension> scratch-related itching> vicious circle. This can end in veritable "scratching attacks" ("itching scratching circles" as a discharge of tension in unconscious emotions).

A hereditary disposition (tendency and thus possibly weak point) seems to be certain, but the actual cause of the disease is not yet. Psychological aspects definitely have a (decisive?) Part. There is probably no specific personality structure, but there are certain abnormalities (impaired or restricted contact behavior, shyness, insecurity, etc. - cause or consequence?). The early childhood form is called "cradle cap" (already in the first months of life, especially the hairy head and the side of the face). Later, especially the large bends of the joints, neck, feet and hands.

therapy: dermatological treatment (dermatologist). Pay attention to subjective stress factors. Try to break the itch-scratch vicious circle. A so-called "scratch diary" is helpful here: When does the itching and thus scratching occur and, above all, what triggered it? This makes it easier to differentiate between psychological and allergic influences. From a psychotherapeutic point of view, relaxation exercises, psychological training and so-called dermatological training are recommended.

Psoriasis vulgaris (psoriasis)

The psoriasis (Greek: psora = scaling, scabies) is a chronic inflammatory skin disease and the second most common skin disease after eczema (1 to 2% of the population).

Clinical picture: These are round to oval red spots (plaques) with silvery-white scaling, especially on the extensor sides of the elbows and knees, on the hairy head and buttocks. Often there are also mycosis-like changes (fungal attack) of the fingernails and toenails, the palms of the hands and the soles of the feet, as well as so-called speckled nails and an "oil stain" in the nail.

Hereditary problems are likely. Trigger factors are inflammation on the one hand, and psychological impairments on the other, but also climatic, mechanical and chemical stimuli and drugs (e.g. lithium and beta-blockers). Middle age is particularly affected.

In mentally One cannot generally assume a neurotic development or personality disorder in psoriasis patients, on the contrary: sociable, relaxed, extroverted, etc. On the other hand, the tendency to eat into anger, i.e. to be inhibited by aggression, is always apparent. However, this could also have something to do with the external appearance of the suffering ("best of all, you don't even notice"). Depressive (more specifically: subdepressive, i.e. more subliminally resigned-depressed) attitudes as well as compulsive character structures and experiential reactions are not uncommon, mostly even before the onset of psoriasis.

Stress and emotional distress can trigger real attacks of psoriasis. Examples: Accident, war experience, death of close relatives, but also test anxiety, etc. The severity of psoriasis is related to the severity of the psychosocial stress. Alcoholism and suicidal (suicidal) tendencies are also common.

A particular problem is the danger of a vicious circle: psoriasis are prone to stress, which leads to the triggering of a new, mostly unforeseen episode of illness. The consequence is a renewed heavy burden and impairment by the external appearance, an emotional and psychosocial "labilization" and thus increased susceptibility. The consequences, however, depend on coping with illness, social contacts, interpersonal and sexual relationships and specific disabilities in family and professional life.

The outbreak of puberty has serious consequences, which can then lead to depression, withdrawal, social isolation and a tendency to suicide at a young age.

Therefore, the older the patient at the onset of their first illness and the better they are integrated into their environment (partnership, family, professional life), the easier it is to cope with the disease and the less likely it is that what is called a "distortion neurosis" (ie the neurotic neurosis) Development with fears, depressive moods, withdrawal, etc. is mainly due to the impairment of the external appearance and the associated fears).

Another big problem is the (unjustified!) Fear of contagion in the environment, which manifests itself primarily in sexuality, but also in public appearance, especially in appropriate sports or swimwear (training, sauna, swimming pool).

In the negative case, the patient can experience himself as sick in practically all areas of life. Nevertheless, it is not uncommon to find an almost astonishing denial of this disease state and an often seemingly uncritical hope for a final cure. In some cases, this coping mechanism seems to be halfway effective, especially to protect against helplessness and depression. That it doesn't always work is proven not only by the frequently encountered resignation and depression, but also by unsuccessful attempts at self-treatment (alcoholism) and attempts at self-reward (obesity = obesity). And the aforementioned increased tendency to commit suicide.

therapy: Outwardly, many psoriatic sufferers appear to be more impartial and communicative because they have halfway successfully suppressed the consequences (keyword: inconsequential small talk). Here, the therapist has to work in a targeted and topic-centered manner, which in reality makes you fearful, depressed and helpless. The aim is to improve the attitudes of the psoriatic person to his body and a more stable self-confidence in relation to the feared or real reactions of the "skin-healthy environment".

The self-help groups of the Psoriasis Association (in which, for example, an "experienced" and a new psoriasis patient work together) are an important support tool. Autogenic training and other relaxation techniques (avoiding stress as a relapse prophylaxis) are useful. The same applies to biofeedback methods (greater control over physical processes through feedback from physiological processes) and hypnosis.

The basis is supportive psychotherapy, possibly oriented towards psychoanalytical or behavioral therapy. In the case of more serious secondary diseases such as the alcoholism, obesity, depression, etc. mentioned, a special therapeutic approach is required.

Contact dermatitis

The Contact dermatitis is an inflammation of the skin (usually an erythema: inflammatory reddening of the skin) caused by contact with a substance to which the person concerned has an allergic reaction. The diagnosis is not easy (in contrast to "jeans button dermatitis", which can be recognized relatively quickly). Most likely it is costume jewelry (e.g. nickel), professional or medicinal triggers. But contact dermatitis in particular is a good example of the interplay of several causes, in this case allergic and emotional causes.

A typical "allergy personality" does not seem to exist, but individual psychological aspects are more pronounced, e.g. depressive or aggressive tendencies of the person concerned. It is also known that pronounced anxiety can make the skin more sensitive to possible external triggers.

Allergies caused by autosuggestion (emotional self-influencing) have also been proven. Not wanting or not being able to perceive one's own feelings or the inappropriate handling of feelings in conflict and decision-making situations can also have an unfavorable influence on the course of the disease.

That is why one believes in some forms of contact dermatitis (e.g. certain hand eczema) to be able to recognize certain, recurring personality types: high expectations of one's own performance, relentless treatment of oneself through excessive performance demands, inevitable failure, anger, feelings of inferiority and incompetence, guilt and frustration.

From a depth psychological point of view, some things seem to have a symbolic character: hand eczema as a conflict of dependency on others, at a time when one should actually "take life into one's own hands".

The therapy is not easy. For details, see the relevant information for atopic dermatitis (neurodermatitis). In psychotherapy, one works primarily with behavioral therapy (e.g. biofeedback, self-assertion training), furthermore with hypnosis and depth psychological-analytical. The most important goal: to raise self-esteem. In the case of hand eczema, it is particularly about problems of dependence and detachment from others.

Acne vulgaris

Also the Acne vulgaris is a multi-layered clinical picture on a seborrheic basis (increased sebum production, blackheads). The onset often falls in the 12th year of life, in girls especially before the first menstrual period. The intensity can be very different, hereditary factors are likely. The earlier it begins, the more difficult the course. Both sexes are affected equally often, with the male sex suffering from cysts and scars, hormone-related long-term consequences. The disease usually ends with puberty, but there is also acne in adulthood, in which psychological factors are said to play a role.

Acne vulgaris can be classified according to different aspects: form and course, cause and emotional or psychosocial aspects. In detail:

- Adolescent acne: age-related, normal, no psychotherapeutic measures required.

- Persistent acne or starting after the age of 25: often neurotic backgrounds, appropriate clarification recommended.

- So-called Acne excoriée: Consequences of scratching, psychotherapeutic treatment useful (see below for further details).

- Dysmorphophobia (see this) with a large disproportion between the subjective level of suffering and the objective finding (e.g. only minimal acne recognizable, which the affected person can turn into an almost life-critical burden): psychotherapeutic treatment is essential. Risk of suicide cannot be ruled out.

There is apparently no typical acne personality (if one disregards the corresponding consequences of stress, which also includes acne itself). Some sufferers show increased fear reactions, which are mostly due to pronounced feelings of inferiority and difficulties in interpersonal contact, which is understandable. As a rule, the earlier, the faster the impairment, especially in the interpersonal area (risk of withdrawal and isolation). But there are also psychologically stable acne patients whose self-esteem is not affected.

The one mentioned above Acne excoriée with the consequences of its scratching, it often seems to be neurotic self-harm. It is often supposed to cover up a severe depression (so-called "social tendency to suicide"), which can be traced back to corresponding conflicts, often of an erotic or sexual nature. Sometimes it is also a protective mechanism against the risk of incest (defacing and protecting yourself - see the relevant chapter on incest).

The level of suffering associated with acne in general is mostly underestimated, even if the deliberate belittling tendency of some acne patients speaks against it. In general, the expected vicious circle burdens: increased attention of the viewer (acne sometimes falsely feared as a risk of infection)> increasing avoidance reactions of the person concerned, also anticipating> tendency to withdraw and the danger of isolation> ever weaker self-esteem> vicious circle.

therapy: As is so often the case, the doctor is only consulted relatively seldom, usually after several unsuccessful attempts at self or non-medical third-party treatment. If the family doctor or dermatologist is finally consulted, the psychosocial situation must be taken into account in addition to the organic clinical picture. Therefore, in addition to the exact examination, an exact survey of the previous history (technical term: anamnesis).

If psychotherapy is necessary, behavior therapy should usually be the case. In doing so, one mainly uses self-confidence and relaxation techniques, biofeedback and, if necessary, hypnosis, in particular to get the stress factors under control. Family therapeutic treatment is recommended for family conflicts.

Perioral dermatitis

The perioral dermatitis burdened by small inflammatory papules (vesicles) on diffuse or blotchy reddened skin around the mouth region. While they are not very annoying, they are a significant cosmetic nuisance. The actual cause is unclear, but ultimately multi-layered. On the one hand, the excessive use of skin care products in general and ointments containing corticosteroids in particular (prompt improvement, relapse after discontinuation, finally so-called corticosteroid damage), on the other hand, psychosomatic aspects.

It often affects well-groomed and intellectually differentiated women with corresponding social demands or in high professional and social positions between 30 and 45 years of age. Often the complaint of increased vegetative instability (e.g. drop in blood pressure with corresponding symptoms, headache, sleep disorders, constipation, etc.). The skin manifestations usually occur irregularly, but repeatedly, not infrequently in connection with partnership or professional conflict situations or permanent stress.

In psychological terms, there is usually a relatively high level of intelligence, but emotional immaturity up to "hysteria-like" behaviors (see hysteria). Above all, however, disturbances in interpersonal contact, which cannot be reduced even through predominantly willful or intellectually directed adaptation efforts.

In terms of depth psychology, the basic disorder of most patients is said to be a problematic father-daughter relationship (too much or too little attention). The result is a compensation mechanism (e.g. independence, activity, success) up to the idealization of this problematic father figure.

You even think you can differentiate between different types, but all of them fail because of the same problem. Example: The idealized father figure is transferred to the partner, which often (inevitably?) Leads to disappointment and thus to an unsatisfactory long-term relationship or even to a change of partner. If the unstable mental equilibrium is threatened, the irritating skin image then occurs, namely around an "emotional zone" that is particularly problematic in this regard, namely the mouth area.

The therapy is not easy under these conditions, which is why often only psychoanalytically oriented psychotherapy leads to a reasonably satisfactory result.


The Urticaria is one of the most common skin diseases: hives with redness and itching due to the build-up of fluid in certain skin tissues. It is triggered by cold, heat, pressure, as well as certain foods and drugs. But in more than half of the cases there is no clear cause. Psychological factors therefore seem to be of importance, especially for chronic urticaria.

A satisfactory psychological explanation is still pending here, despite numerous examinations and interviews. Stress factors seem most likely to play a role, above all unjustified criticism from people close to you and the conviction that you will not be able to cope with the stressful situation. According to the knowledge so far, this can be summarized as follows:

- Increased willingness to overreact to certain stressful situations in the interpersonal area emotionally and thus also in the skin area.

- Unfavorable, especially inactive, strategies for coping with stress.

- Increased anxiety and depression, which explains the above stresses, at least in part, but mainly increases them.

Two aspects become particularly clear in the interpersonal relationships and relationships that are conspicuous when visiting the doctor: On the one hand, a mostly submissive attitude that is ready to adhere to all the intervening measures (especially diets in therapeutic terms). From a technical point of view, this is called an anti-aggression. On the other hand, not only increased anxiety and depression, but also resignation and discouragement, i.e. it is too quickly assumed that everything makes no sense, there is no way out.

This is the psychosomatic one therapyOpportunity, which, in addition to drug treatment (mostly antihistamines), is primarily concerned with recognizing and controlling stress factors. Often the targeted therapy (focal therapy) of specific current conflicts and stressful situations is enough to initiate a lasting improvement.

Lichen planus

The Lichen planus is a mostly very itchy skin disease with small nodules (therefore also called lichen planus), which does not occur too often and, above all, is not contagious. Their causes are ultimately unclear, which is why psychological aspects are also brought into the conversation.

In fact, "over-nervous people who tend to be hectic" are said to be particularly affected. Adults more often than children, mostly in their mid-twenties, but no age is completely excluded.

According to previous knowledge, the proximity to the psychosomatic disorder is rather difficult to prove because it ultimately attaches itself to frequent and unspecific impairments such as "emotional instability", excessive demands, tension, anxiety, etc. That is why they persist psychotherapeutic recommendations within limits.


The Vitiligo or white spot disease is a relatively common depigmentation (i.e. loss of pigment, i.e. body color). This creates white patches of skin, especially on the hands, face and trunk, whereby even the hair in the diseased skin areas becomes pigmentless, i.e. white. The course and distribution of these spots are irregular and, above all, unpredictable. Vitiligo can occur in isolation, but also in connection with other diseases (e.g. thyroid disease, diabetes mellitus, pernicious anemia, sometimes with malignant melanoma and alopecia areata hair diseases - see these).

However, since mental disorders can also play a role, it is possibly a so-called autoimmune disease with psychosomatic interactions. An autoimmune disease, also known as autoaggression disease, is a condition in which the organism can be damaged by endogenous substances. If there are also emotional complications, everything becomes even more problematic.

In fact, in some Vitiligo patients a tendency to neurotic development was found earlier, although cause and consequence cannot always be clearly distinguished (a neurosis is an emotional or psychosocial mental health disorder without a demonstrable organic basis with a diverse and depending on the focus differently pronounced Bewerdebild: fears, compulsions, moods, hypochondriac and psychosomatic disorders, etc.).

At least in Vitiligo with neurodermatitis and alopecia areata (see this), emotional stress factors are the triggers, about 2 to 3 weeks after the respective cause. Vitiligo also seems to occur more frequently in children, especially in severe personality disorders and behavioral abnormalities. In any case, the white spot is aggravated by stress.

The emotional and psychosocial consequences of such a - cosmetically not inconsiderable - disfigurement are usually expressed in depressive states, sexual and anxiety disorders as well as changes in behavior, especially withdrawal and the risk of isolation.

The therapy is based on a supportive doctor-patient relationship and the possibility of constant discussion, especially with regard to everyday worries (e.g. sexual contact, especially since the depigmentation also occurs in the genital and chest area).


The Collagenoses are the generic term for various diseases with systematized changes in the connective tissue. These include, for example

- the Lupus erythematosus: characteristic changes to the skin, joints and even internal organs with cosmetically very disturbing changes (hence also lupus = "eating lichen").

- The Scleroderma: Infestation of vessels, joints and finally skin with doughy or knotty swellings, pigment shifts, hardening and dying tissue (which can eventually even spread to the internal organs).

Scleroderma in particular has sparked many discussions in psychosomatic circles, regardless of the depressing psychosocial consequences for those affected. In the case of collagenoses, in addition to certain personality factors (cause or consequence?), One speaks above all of emotional instability and unspecific stress factors (not infrequently everyday, albeit often permanent) that cannot be adequately processed. The consequences are obvious: vicious circle of impairment or even pain and depressive reaction, hopelessness, tendency to withdraw and the danger of isolation, sometimes even intensified suicidal fantasies.

The psychotherapy is above all supportive and thus strengthening self-esteem.

Other skin diseases

Finally, we would like to point out a number of other skin diseases in which emotional aspects are in the foreground (so-called psychiatric skin diseases). These include somatoform disorders, pruritus sine materia (itching), chronic simulated disorders (artifact diseases of the skin) and chronic tactile hallucinosis. Skin changes in depression, mania, schizophrenia, alcoholism, toxicomania, etc. are also briefly touched upon, even if the causes there are probably more organic than psychosomatic causes. In detail:

Somatoform disorders

The somatoform disorders (from the International Classification of Mental Disorders - ICD-10 of the World Health Organization - WHO) belong to the chapter "Neurotic, Stress and Somatoform Disorders".

These are in turn divided into somatization disorders, hypochondriac disorders, somatoform autonomic dysfunctions (cardiovascular, gastrointestinal, respiratory system, bladder, etc.) and persistent pain disorders. From a dermatological point of view, itching, sweating, blushing, fear of hair loss and certain forms of pain play a role here.

For details, see the respective technical terms or chapters.

Itching (pruritus) without an organically detectable cause

Itching or itching of the skin (pruritus) without an organically tangible cause is a relatively common mental disorder. However, organic causes must first be ruled out.

Itching as a symptom of physical ailment can be found, for example, in skin diseases (atopic dermatitis, lichen planus, urticaria - see these), fungal infections), in parasitic diseases (e.g. scabies), in metabolic or endocrinological diseases (uremia, cholestasis, iron deficiency, gout, diabetes mellitus, over- or underactive) thyroid gland) as well as tumors (Hodgkin, leukemia, etc.).

Itching does not seem to be - as previously assumed - a ("diluted") sub-form of the pain sensation. It is almost reflexively answered with a defensive movement, namely scratching, which possibly corresponds to an itching inhibition by triggering pain. The intensity of the itching depends not only on the underlying disease (see above), but also on the body part, time of day and subjective resilience.

Itching can not only be triggered by certain diseases and mechanical, electrical or chemical stimuli, it can also be mentally provoked. Emotional excitement occurs with remarkable frequency, i.e. anger, anger, excitement, sometimes even joy. Apparently, life-changing events can induce itching (or lower the itching threshold); in the case of corresponding illnesses, even the memory of previous ailments.

A particular problem is itching as a so-called "itch-scratch circle" in skin diseases that can be interpreted psychosomatically, such as atopic dermatitis (see this). There, even rubbing and rubbing with the palm of the hand has a tension-reducing character.

Therapeutic In the case of such skin diseases, it is advisable to look for the causes of the itching (stress, strain, life changes). The patient must also be made aware of the "itch-scratch circle" that may already have been used, which in itself helps. Otherwise mainly relaxation procedures, behavior training and antipruritic ointments if necessary.

Self-manipulated (simulated) skin diseases

Self-harming behavior has been known since ancient times. This has various aspects (initiation rituals, religious rites, etc.), but also self-harm, in which symptoms are simulated, made difficult or artificially induced in order to force a patient role. Differentiation possibilities between simulation, aggravation and self-damaging behavior see box.

- Aggravation: deliberate and mostly purposeful exaggeration of actually existing symptoms.

- simulation: willful "production" of physical and emotional symptoms with the conscious intention of influencing the environment in order to gain a discernible advantage. Examples include avoiding work, forcing hospital admission, obtaining compensation or medication, avoiding military service or prison, etc.

- Self-harming behavior (Münchhausen syndrome): Illness in which the person concerned artificially induces, simulates or intensifies physical and / or mental symptoms in order to force a patient role or admission to a hospital. Although this behavior is voluntarily controlled, it is compulsive in nature. The person concerned pursues unconscious goals to which he is "involuntarily" subject.

Originally this was known as Munchausen Syndrome, later than Artifact disease, Mimicry phenomenon and finally as fake disorder (English: factitious disorder). The most neutral term seems to be self-manipulated disease to be.

The most common are probably simulated disorders (artifact diseases) of the skin. The frequency is difficult to estimate. Women are clearly over-represented (men are more likely to be found in simulation, i.e. more conscious (!) Pretense). In terms of age, the period between puberty and early adulthood dominates.

The methods skinThere are many ways to provoke injuries: chemical burns from alkalis, acids, turpentine, gasoline, etc., mechanical effects from rubbing, rubbing, squeezing, thermal injuries from cigarettes or hot liquids, injections under the skin of urine, flower water, saliva, drugs with abscesses - and blistering etc.

Self-manipulated skin diseases are found primarily in those body regions that are easily accessible with the hands: arms and legs, less often the face, chest, stomach and - of course - very rarely the back. What is important is the diversity, which hardly corresponds to "real" skin diseases, as well as the sudden transitions from healthy to diseased areas of skin. In addition, you almost always see the full picture and never earlier stages of development of the disease. If the healing process can be monitored, there will be rapid improvement - and later the disease will suddenly come back.

Also in mental and psychosocial those affected are different from the majority of "normal" patients: often very unemotional (appearing almost callous) and submissive, quiet and mute, patient (even with numerous and possibly painful diagnostic interventions), but then again disgruntled, irritable, yes aggressive or even hostile.

In the prehistory there are often drastic experiences, especially in childhood: serious physical illnesses, separation, abuse, incest, etc. In terms of depth psychology, one speaks of a re-enactment of the injuries at that time in the form of self-inflicted (skin) diseases. The whole thing goes up to an increased tendency to suicide (increased risk of suicide). The common occurrence of self-manipulated diseases as well as certain other ailments such as eating disorders or addictions is not uncommon.

Self-manipulated diseases refer not only to the skin (although this is likely to predominate in numbers), but to practically all organs that can be damaged in any way: gastrointestinal, cardiovascular, spine and joints, liver, kidneys, bladder , Blood count, blood pressure, female organs, etc.

The number of hospital stays, surgeries and accidents that occur on this route is therefore sometimes unbelievable.

Before self-harm, most of those affected feel that they are under strong inner psychological pressure and can almost no longer bear the resulting tensions. On the other hand, after self-harm, they feel relieved, relaxed and liberated. Hence the psychiatric descriptions: self-manipulated illnesses as a "masked act of suicide", but also as a "mechanical tranquilizer" (sedative), in any case as "cutaneous (= skin) emergency signals", which should all draw attention to a serious mental illness.

The therapy of self-manipulated skin diseases is - understandably - not without explosiveness. A very specific pattern is common, but it can be extremely stressful - for both sides. See the dedicated chapter for details self-manipulated diseases or Munchausen Syndrome.


The skin is not only the mirror of the soul in psychosomatic terms, but also in the case of psychiatric illnesses. Because even there, psychosomatic aspects play a role, even if the biological, i.e. physiological, part is likely to predominate. This means that so-called neurohormonal changes in the central nervous system are reflected in the organ "skin" (e.g. depression and mania). In addition, there is a risk not only of internal psychological consequences, but also of poisoning, which take their toll on the skin (e.g. alcoholism and drug consumption). In detail:

Depression and skin

Depressed people you don't necessarily have to look at their melancholy (e.g. "smiling depression"), because the majority are initially irritated, impaired or even tormented on a physical and psychosocial level, until finally you also see the mental symptoms such as depression, listlessness and joylessness, feelings of inferiority, etc. . starts to register.

What can be determined relatively early, however, mostly by relatives, friends, neighbors and professional colleagues, is the fact that the person concerned "looks worse and worse" and ultimately "threatens to deteriorate". This manifests itself not only in an increasingly powerless movement, dull gestures, bent forward posture, in dragging steps and generally reduced performance ("picture of woe"), but also in three of the most important interpersonal areas: language, eyes and skin .

The language becomes more and more monotonous and quieter, the eyes appear duller, dull or even veiled, often with a suddenly increased crease in the upper eyelid, which actually only develops in old age.

The facial expression becomes serious, tired, resigned, in the end bleak and almost frozen. And the skin takes on an "unhealthy" color, becomes gray-pale and wrinkled ("aged years ahead").

And all of this not in advanced age, but in the "prime" or even in the first third of life, when something like this is only expected through severe physical illnesses, if at all. Although this - sometimes even rapid and therefore particularly shocking - "decay" triggers great consternation, fears, even panic and even thoughts of suicide, it is precisely the external aspect that is the impairment that would cause the least headache in the case of depression. Because everything goes away again, and nothing, at least none of the terrifying outward frailty, remains when the depression has subsided.

However, this implies a targeted one therapy advance, namely an overall treatment plan with psychotherapy (treatment with psychological means, here mostly supportive conversations), with sociotherapeutic corrections and aids, with physiotherapeutic support measures (especially the unpopular but helpful "healthy march in daylight") and antidepressant pharmacotherapy, which in the majority of cases should not be dispensed with today. For more details, see the multi-subsection post on depression.

Mania and skin

The mania, the opposite pole of depression, when it comes to a manic-depressive illness, is also the spectacular counterexample when it comes to the external aspect. This becomes all the more apparent when the same patient "turns" from mania to depression or vice versa, possibly overnight. Then sometimes you can hardly recognize the same patient, that's how he has changed - for better and for worse. Unfortunately, the good here is not good, but pathological, albeit in an apparently positive way. And so the "glamorous manic appearance" will disappear as well as the "depressive decay".

But first of all, the mania, the pathological elation, the apt example of a vital development: blooming appearance, upright posture, spirited and yet natural, smooth movement, lively and shining eyes, impressive, expressive facial expressions, shiny hair that lies well (in contrast to the depressed) - and healthy, firm skin that leaves a great impression even without make-up (although female manics in particular make extensive use of the latter).

The depressive is a "picture of misery", the manic is the "blooming life" - and both not least because of the (pathological) changes in the skin.

Therapeutic the manic would actually not need any treatment, at least according to his own ideas, but in reality he should receive anti-manic treatment as quickly as possible (lithium salts, carbamazepine, valproic acid, possibly neuroleptics) because he is in danger of ruining himself a lot from a psychosocial point of view (partnership, family, Neighborhood, job, finances, but above all reputation) - not to mention the sooner or later threatening danger of turning into depression. See the special chapter on mania for more details.

Schizophrenia and skin

The Schizophrenia belong to the psychoses, that is to say the mental illnesses, which have a difficult position in general. This is mainly due to the prejudiced image that people have of such a condition ("madness of division") - still. This negative impression does not necessarily have to be wrong, it is only one-sided. Because the vast majority of the 1 million schizophrenic sufferers in Germany alone (worldwide: approx. 60 million) live inconspicuously among us, do not attract attention and do their work successfully. But if there is a horror report in the media again (although this has become much more cautious and helpful in recent years), the old stereotypical prejudice comes through again - and destroys all clarification.

But are schizophrenics actually not (no longer) recognizable from the outside? Yes, there are still seriously ill patients, mostly long-term patients in appropriate clinics or homes, "who can be seen from afar." But - as mentioned - the overwhelming majority have been enabled by modern treatment methods (see below) to live a life like others, because above all they are not externally marked, but people like everyone in their environment.

When one speaks of schizophrenia, however, then most of the people think of particularly spectacular emotional symptoms: delusions, hallucinations and thus possibly unusual behaviors, etc. But if there are really corresponding impairments, then some schizophrenics also suffer from so-called vegetative dysregulation with different ones physical complaints: head pressure, disorders of the heart, circulation, sleep, gastrointestinal tract, urination, libido and potency, in addition inexplicable pain conditions etc.

And the skin can also be affected: e.g. tendency to have a greasy ointment face and an almost pasty swelling (even without the antipsychotic neuroleptics, which can occasionally cause similar side effects). In addition, there is an unstable vascular system, i.e. constantly cold hands and feet, edema (i.e. water in the tissue) and a disturbed central temperature regulation center (sensitivity to weather). However, this all declines to the extent that the (drug) therapy is used and thus successful.

Because the therapy Schizophrenia has made such great progress in the last few decades that the specialist clinics - mostly occupied by schizophrenic patients - have been able to reduce their beds by half. In the meantime there is also a new generation of neuroleptics (antipsychotic drugs) that no longer have the dreaded side effects that were previously used against such treatment. For more details, see the special sections on Schizophrenia and Neuroleptics.

Dermatozoa delusion

A special sub-form of the delusional disorders regarding the skin is that Dermatozoa delusion.

This is the uncorrectable conviction that you are infected with skin parasites, for which skin flakes, dirt particles, laundry fluff are brought in jars or boxes as evidence. Women are more often affected than men, the older age predominates. Sometimes even close relatives adopt such delusions.

The skin of those affected is actually badly damaged and mostly very dry, due to the frequent cleaning procedures, sometimes with aggressive substances, in order to finally be able to successfully fight the supposed "parasites".

The therapy is mainly medication (neuroleptics), but rarely occurs. In return, those affected rush desperately from doctor to doctor to finally find help, which would also be possible, but not with "anti-parasitic" ointments and tinctures, as is repeatedly demanded, but with antipsychotic neuroleptics. For details, see the chapters delusional disorders and dermatozoal delusions.

Alcohol sickness and skin

The Alcohol sicknesswhich is much more common than is generally assumed and above all affects all social classes in the same way, after a while it leads to not only emotional and psychosocial but also physical changes. The skin is also involved, often:

In addition to a pronounced tendency to sweat (at night, but also during the day), this applies to a face that is often spongy and puffy in an advanced state with a tendency to corresponding skin changes (acne) such as pustules, nodules, crusts and finally scars. The well-known "drinker's nose" (technical term: rhinophyma) is rare in its extreme form, but it is more common when it comes to minor changes (but of course not exclusively attributable to alcohol abuse, the diagnosis is solely incumbent on the doctor).

Sometimes you can also find an elapsed contour of the jaw angle due to enlargement of both parotid glands. More common - especially in the final state - are a gray-brownish to pale-brownish basic tone of the skin and a shrinkage of the skin due to shrinkage of the connective tissue under the epidermis. Not infrequently a so-called "parchment skin" or "banknote skin" as well as white spots on the extensor side of arms and legs. Also noticeable are finer to coarser vascular dilation in the face (but also possible in people who are in the fresh air a lot) as well as so-called vascular spiders (red, spider-like vascular asterisks that fade at the touch of a finger, but fill up again immediately). Reddening of the ball of the thumb and little finger as well as corkscrew-like twisted vessels in the outer solid shell of the eyeball (dermis) are possible.

With regard to the skin appendages, one can sometimes find white or opal colored nails with transverse ligaments, increasingly shaggy head hair with increasingly brittle hair and a tendency to skin bleeding with sometimes extensive bruises, mostly in the area of ​​the shoulder, pelvis and shins (blood count changes with increased Bleeding tendency as well as intoxication-related balance disorders with frequent bumping into these parts of the body).

In alcoholism, especially in the terminal stage, the skin is an organ that is affected relatively frequently and, above all, visibly by this chronic poisoning. The therapy is known (abstinence from alcohol, if necessary through clinical withdrawal with specialist rehabilitation). For details, see the chapter on Alcohol Disease.

Drug addiction and skin

The Drug addiction apparently increasing. At the same time, new active substances are constantly pushing their way onto the market (e.g. ecstasy and successor substances). But even the older generations of intoxicating drugs are still ruining numerous (mostly young) human lives. Depending on the substance, different emotional, psychosocial and physical consequences can be expected.

The skin plays a not insignificant role, especially through the puncture points after injection (elbow, back of the hand, forearm sticking side, but also the back of the fingers and feet, lower legs, even tongue, heels, nose, skin folds between fingers and toes, penis, eyelids, etc. ). The consequences are scarred skin changes, darkening, bruises in all colors, inflammation of veins and lymphatic tracts (red stripes and hardened, coarse vascular cords due to blood clot formation = thrombosis), injection abscesses and boils, enlarged armpit lymph nodes, etc. In an advanced stage, sunken face, deep in the Hollow eyes, gray-ashen, pale or bluish skin, reddening of the conjunctiva or yellowing (syringe hepatitis), etc.

A specific substance-dependent reaction on the psychological level is "cocaine paranoia" ("cocaine madness"): With the hallucinations threatening there, those affected feel mainly because of "cocaine animals" or "cocaine crystals under the skin" impaired, which can exacerbate the arousal that is typical of cocaine (acts of violence in the context of delusional ideas of persecution).

The therapy is known: intoxicating drug withdrawal (preferably under the supervision of a specialist) with a corresponding rehabilitation program. See the chapter on intoxicating drugs for more details.

Dementia and skin

Finally, it is also under a dementia (Example: Alzheimer's dementia) numerous emotional, psychosocial and physical consequences can be expected, whereby the skin can also play a role. It is true that the well-known losses such as loss of memory, judgment and orientation, disorders of language, recognition and naming etc. also dominate. There are also a number of functional deficits, the details of which can be found in the special chapter on Alzheimer's dementia the skin as a sensory organ is also involved. Examples: impaired recognition of the shape and quality of an object by touching it with closed eyes or of letters or numbers written on the skin. This means that the skin as a sensory organ and thus the aforementioned orientation is impaired. And the brain functions can lead to hallucinations when seeing (e.g. sees yourself appearing on television), when hearing (noises, voices), when tasting (over-sweetened, too salty), when smelling (putrefaction, gas) and with the skin organ, i.e. when Keys. Here there is a risk of discomfort and even the apparent impact of violence ("stranger in your own room or even in bed").

The therapy It has its limits, but in the elderly it consists not only of drugs that are supposed to improve the impaired brain functions (nootropics, today antidementia drugs), but also of sedatives, antipsychotic (e.g. neuroleptics that act against delusional impairments) for the spectacular symptoms mentioned above possibly antidepressants, etc. And here, in fact, some things can be mitigated.

More details in the special chapter on Alzheimer's dementia.


Extensive, constantly growing number of scientific publications and specialist books on the subject of "skin and mental disorders", but only a limited range of well-founded articles and non-fiction books.

The basis of the present statements are

Dieter, H.C. (Ed.): Applied Psychosomatics. Thieme-Verlag, Stuttgart-New York 1997 (there also a detailed subject bibliography)

Faust, V. (Ed.): Psychiatry. A textbook for clinic, practice and advice. Gustav Fischer-Verlag, Stuttgart-Jena-New York 1996

Faust, V.: Mental disorders today. Publishing house C.H. Beck, Munich 1999

Faust, V.: Melancholy. Hirzel-Verlag, Stuttgart-Leipzig 1999

Faust, V.: Depression primer. Gustav Fischer-Verlag, Stuttgart-Jena-Lübeck-Ulm 1997

Faust, V.: Drug and psyche. Knowledge Verlagsges., Stuttgart 1995

Faust, V., C. Scharfetter.: Psychiatry in brief. Psychopathology 1-13. Enke-Verlag, Stuttgart 1997-2000 (Internet: http://www.roche.de/depressionen)

Uexküll, Th. V. (Ed.): Psychosomatic Medicine. Urban & Schwarzenberg, Munich-Vienna-Baltimore 1996 (there also a detailed subject bibliography)