Skin disorders are often associated with appearance-based symptoms like rashes, patching and scarring, along with discomfort, soreness and pain. But beyond the physical, they can have a significant psychological and emotional impact too - although we might not tend to talk about that as much.
"The psychological or psychosocial distress associated with skin conditions is often minimised," says Dr Andrew Thompson, professor of clinical psychology at Cardiff University and spokesperson for British Skin Foundation (BSF; britishskinfoundation.org.uk), who says that although things are improving in certain regions, there's still a "gap in services" on this front.
There's been growing emphasis among healthcare professionals on the need to address these gaps. Right now though, Thompson notes things are "patchy", and in a BSF survey of 245 dermatologists last year, 87% agreed that people with skin conditions in the UK do not have sufficient access to psychological support.
'Skin disorders' covers a vast range of conditions, Thompson notes, and some involve complex systemic symptoms. "There's a whole range of symptoms that can cause distress," he explains. "Many skin conditions affect appearance - and appearance is important to us all. That can be associated with additional worry of what people might think, (and) your perception of yourself due to having an altered appearance or noticeable condition."
"Many are associated with some degree of pain," he continues, "and many are itchy - which in itself can be distressing and can also attract attention, which can then be additionally distressing."
These feelings are far from being vain or superficial - appearance is deeply connected with our human sense of identity, belonging and self-worth. "Anything considered detrimental to our appearance is going to have an impact on our self-image," says Dr Elena Touroni, consultant psychologist and co-founder of My Online Therapy (myonlinetherapy.com).
"If a skin condition leaves physical marks, it might make us feel self-conscious, spurring on feelings of defectiveness. Because it's something we can't necessarily 'hide', it can feel exposing and shaming."
Thompson says there's "no direct correlation between the actual medical severity of the condition and the psychological impact". In other words, even skin conditions that may seem relatively minor to the outside world can be very significant for the person experiencing them. "And it's really important to flag up," he adds, "people do suffer discrimination and also softer forms of prejudice, like double-takes and staring, and maybe refusal to shake hands and so on."
Everybody is different and the extent of these experiences can vary hugely - but there's certainly no shame if your mental wellbeing is affected. In fact, it's very common.
In 2018, Allergy UK and Sanofi surveyed people living with eczema: 80% of respondents said the condition had a direct impact on their mood, with many saying they experience anxiety and around 70% saying they felt depressed as a result. In terms of people with skin disorders who experience "significant levels of anxiety and depression", Thompson says it's "around 10-20% - so there is an increased risk of having lower mood etc than the general population, but it's not everyone, and it's not all the time," he adds.
However, he acknowledges that worrying about being seen to be "not coping" can be an "additional strain" in itself. "Especially if you're worried about the visual side of it and people seeing that as vain," he says.
This is why raising awareness of the mental wellbeing overlap can be so important - acknowledging these things are real and very common can be a huge weight off your shoulders, as well as being the first step towards seeking support or finding ways to address it.
"It is a common experience and it's understandable that there might be psychological consequences," says Touroni. "It's important to acknowledge this so people receive the appropriate support, and learn strategies for managing any psychological difficulties that come up."
While access to specialist psychological support via dermatology services can be hit and miss, if you are experiencing depression and/or anxiety, or any form of psychological distress that's impacting your life, it's always worth having a chat with your GP who can refer you for talking therapy, such as cognitive behavioural therapy (CBT) or counselling.
Understandably, finding effective treatments for physical symptoms is often a primary concern - but Thompson stresses there's strong evidence around the benefits of psychological therapies.
Therapy is just part of the picture though. Thompson says there's growing availability of online support too. The British Association of Dermatologists has been developing a range of resources people can access via their Skin Support website (skinsupport.org.uk) - and self-help measures can make a world of difference.
For Matthew Lightfoot (27), a producer for a game studio with Microsoft, building confidence among people living with chronic skin disorders is something he's incredibly passionate about.
Lightfoot has psoriasis and a form of epidermolysis bullosa (EB) - a relatively rare and severe condition that causes his skin to blister with the slightest friction. This has resulted in lots of very visible scarring. "For me, it's mainly the knees, shins and elbows," he says. "When I was younger, I used to absolutely despise wearing shorts or short sleeves, primarily because people would stare. It made me very self-conscious and drove me away from, I guess, being visible."
Things started to change when he joined the local Cub Scouts - "one of the few clubs I was accepted in. They were willing to take me outdoors and let me just join in. Whenever there was a problem with my skin, they would just deal with it and take it in their stride. That really built my confidence from a social perspective, being in that supportive environment," Lightfoot recalls. "By the time I'd reached my mid-teens, I started to accept myself a lot more."
These experiences enabled him to discover a love of the outdoors too, which now also plays a key role in his wellbeing and enjoyment of life. "I love the outdoors - and a lot of that isn't conducive to making sure my skin is all right, but for me, if I want to never injure myself, the only way to really do that would be to sit indoors all day, but that's no life." Instead, he focuses on finding the balance between managing risks and prioritising his quality of life - but central to it all has been the journey to acceptance.
"A big thing for me has been the realisation that everybody is imperfect. Every single person in society has something wrong with them, however big or small, and it's often something we have no control over. But those imperfections are what make us unique and, in a way, what make us special," says Lightfoot, who became determined to "make the most" of his own "imperfections" by giving something back.
Lightfoot now volunteers as a Scout leader, encouraging the next generation of kids to gain the confidence skills and access to the outdoors that helped change his life.
Getting involved with DEBRA, the charity that supports children and adults affected by EB (debra.org.uk), has also been hugely rewarding and given him a chance to share his story to help others.