Dr. Steve Daveluy discusses specific ways in which dermatologists can incorporate mind-body strategies into practice to relieve anxiety, feelings of shame, and other mental health symptoms associated with hidradenitis suppurativa.
Steve Daveluy, MD, Associate Professor and Program Director, Wayne State Dermatology, Detroit, Michigan, and President of the Michigan Dermatological Society
“Anyone who takes care of patients with HS understands that mental health is a major problem that comes along with the disease. There are increased risks of depression, anxiety, and suicidality. Patients face a lot of shame and blame with their diagnosis. Being dermatologists, we don’t always know what we can do about it,” said Steve Daveluy, MD, who presented on mind-body medicine related to patients with HS during the “Mind Body Therapies as Treatment Strategy in Dermatology: What is the Evidence?” session at the 2023 AAD Innovation Academy in Tampa, Florida.
Dr. Daveluy offered these practical tips for teaching and training patients to use mind-body techniques:
“First, it can be hard to bring up the topic in clinic. I recommend asking the patient permission. I often start by saying, ‘HS can have a big impact on your mental health. Would it be OK if we talked about that today?’ That gives the patient the opportunity to say yes or no and to relay their comfort level with talking about the topic.”
Dermatologists should prepare for these conversations by having a mental health professional to which they can refer patients who might have issues beyond the dermatologist’s scope of practice, said Dr. Daveluy.
“Sometimes when you start asking patients these questions, things can come up that are a little bit beyond your skills. If the patient is really facing suicidality or major depression, you may need help from someone else. Having that resource ahead of time is useful.”
Having said that, there are many things that dermatologists can do to help HS patients feel better and have less flare-provoking stress from the disease, said Dr. Daveluy.
“We live in a great age when there are a lot of apps and online resources that patients can use to help them. There are apps that cover meditation, guided meditation, and mental health that you can recommend to patients. There are often YouTube videos, as well.”
According to Dr. Daveluy, shame is a big issue, especially for HS patients.
“It is shown that ‘compassionate mind training’ can be beneficial for helping to combat shame. There are full courses that patients can look into. Or there are easier, smaller online resources like ‘loving-kindness meditation.’ Patients can look those up online or on YouTube and use that as a way to dabble or get their feet wet.”
Another useful technique that dermatologists can employ is teaching patients breathing techniques, which can help to shift the body from a sympathetic to a parasympathetic state, said Dr. Daveluy.
“A couple [of] simple breathing techniques to teach patients are the ‘square breathing’ where you inhale for a count of 4, hold for a count of 4, exhale for a count of 4, and hold for a count of 4. Another is breathing where your exhale is longer than your inhale. You might inhale for 4 seconds, then you can hold or go right to the exhale that is longer—like 7 or 8 seconds.”
When dermatologists practice breathing techniques with patients in the clinic, it can help to solidify the techniques in patients’ minds while relieving dermatologists’ own stress, said Dr. Daveluy.
“It’s kind of a nice relaxation moment for you, too, because sometimes taking care of patients with severe disease, like HS, can be stressful.”
There continues to be more mind-body medicine research going on in dermatology because dermatologic diseases greatly impact mental health, said Dr. Daveluy.
“Anything we can do to help patients to be less mentally affected by their disease is a great thing. I implore you to get out there and try some of the techniques, dabble, and I think you’ll see the benefits and so will your patients.”
