PS34 Psychodermatology as a longitudinal and mediated approach

Abstract

Psychodermatology explores the interactions between dermatological conditions, psychological functioning and life history. In a significant proportion of patients, skin symptoms emerge in contexts where emotional experience is difficult to identify, tolerate or verbalize, particularly in the presence of alexithymia, chronic stress, trauma or complex relational dynamics. Rather than conceptualizing symptoms solely as pathological entities to be eliminated, psychodermatology considers them as adaptive compromises that may contribute to psychic equilibrium. Sudden symptom suppression without addressing underlying dynamics may therefore destabilize patients or lead to symptom displacement. Clinical care requires a longitudinal perspective, recognizing cycles of improvement, relapse and stagnation as intrinsic to the therapeutic process rather than as failures of treatment. When verbal expression is limited or avoided, therapeutic mediations – such as transitional objects, genograms, visual supports, narrative tools or family-based interventions – provide alternative pathways for clinical engagement. These approaches allow patients to externalize internal experience while preserving defensive balance and autonomy, avoiding premature interpretation or excessive emotional exposure. Training in psychodermatology emphasizes clinical posture, containment and interdisciplinary collaboration between dermatology and mental healthcare. The focus is placed on understanding the function of symptoms, adapting interventions to individual psychological organization, and integrating medical and psychological perspectives rather than relying exclusively on standardized protocols. This presentation is based on a longitudinal, real-world clinical dataset derived from routine psychodermatology practice. Patient data were prospectively recorded over several years in an anonymized database, including dermatological diagnoses, psychosomatic features, life events and therapeutic trajectories. A qualitative, narrative analysis was performed to identify recurring clinical patterns, cumulative life impairment and psychosomatic mechanisms across the lifespan. The focus is on clinical meaning, relational dynamics and integrative care rather than statistical inference. Qualitative analysis identified consistent psychosomatic patterns across the dataset. Skin disorders were frequently associated with cumulative life stress, emotional regulation difficulties and long-standing relational constraints.