Starting With Their Own Skin
PA Buchi Neita opens this episode by inviting new SkinSync co-host PA Jenny Laminack to be vulnerable and share a personal experience with skin disease. Laminack recalls the self-consciousness of teenage acne, and admits that even now a single pimple can leave her feeling self-conscious walking into a room of patients who are there to be treated for their own skin.
Neita echoes the same experience, quoting a line she attributes to Dr. Julie Harper: 'How many pimples does it take to ruin your day?' The answer, universally, is one. For Neita, the lingering hyperpigmentation is often more frustrating than the acne itself. She also shares a more painful memory from over a decade ago—a chronic, undiagnosed rash on her hands, elbows, and knees that persisted through multiple derm visits and biopsies. When a close friend physically recoiled at her hands, the sting stayed with her for years, even though the rash was never contagious. Her takeaway: put yourself back in that moment of embarrassment and use it to connect with patients.
The Conditions That Carry the Heaviest Psychosocial Load
Laminack points to acne first, noting it develops during adolescence—the exact years patients are forming their personality and self-esteem—so the consequences can be long-lasting. She looks for body-language cues: young male patients wearing bangs to cover their skin, kids who won't make eye contact. She and Neita agree that seeing a shy teenager 'blossom' on isotretinoin is one of the best feelings in dermatology. Neita adds a reminder not to overlook the sequelae—scarring and hyperpigmentation often outlast the acne and are worth treating.
On psoriasis, Neita cites higher rates of depression, anxiety, suicidal ideation, and substance use (particularly alcohol and smoking), plus one study finding increased anger in this population. Her key clinical point: clinical severity does not always match how bothered a patient feels. A patient with 50% BSA may be fine, while a patient with 1–2% BSA on the scalp, genitals, or palms may be devastated. Ask the questions rather than relying on BSA alone.
For atopic dermatitis, Laminack highlights the unpredictability of flares and the enormous impact on sleep—up to 80% of children and 90% of adults report sleep disturbance from itching. Neita references a prior SkinSync episode with Dr. Tina Bhutani on sleep in dermatology, noting that poor sleep can worsen disease and compound cardiovascular and mental health risks.
Vitiligo, Alopecia Areata, and HS: Visibility, Stigma, and Silent Suffering
Laminack walks through the stigma of vitiligo, which is often highly visible and carries cultural weight—associations with reduced career advancement, lower marriage prospects in some countries, notions of being cursed, and even a link to leprosy in Nigeria. Neita adds that the highest quality-of-life burden is seen with greater than 5% BSA, darker skin tones (Fitzpatrick IV–VI), and facial or hand involvement. She flags a 2024 study describing a bidirectional relationship: patients with moderate to severe anxiety and depression may have less effective vitiligo treatment, for reasons that remain unclear.
With alopecia areata, both note that even small amounts of hair loss can devastate self-esteem depending on location. Neita ties hair loss to personal identity, especially for Black women whose self-image can rely on healthy, natural hair. Patients with more extensive loss also face assumptions that they are undergoing chemotherapy. She cites a small study of 75 patients showing 66% with depression and 73% expressing anxiety.
Neita calls HS one of the most devastating disorders they treat—patients often suffer in silence because it is not on the face or visible to others, so it gets minimized and misunderstood. Beyond anxiety and stress, HS carries a career impact: patients miss on average about 39 days of work per year and have higher rates of long-term disability. Laminack shares a patient close to her own age whose inability to be intimate with her partner weighs heavily. Neita notes the lack of control over flares drives self-medication, with higher rates of alcohol, marijuana, and opioid use, and a 2.4 times higher risk of suicide.
Screening Tools and Practical Support
Laminack introduces the Rosenberg Self-Esteem Scale, a quick 10-item self-report on global self-worth with statements like 'On the whole, I am satisfied with myself' and 'At times, I think I'm no good at all.' Neita highlights the Dermatology Quality of Life Index (DLQI)—the most widely used patient-reported outcome measure in derm—which asks about itch, embarrassment, and interference with daily activities. Both admit they don't currently use these tools routinely and commit to doing better; Laminack suggests handing the DLQI to patients in the waiting room. They also point to the PHQ-9 for screening depression severity and guiding referral decisions.
On support, Laminack's number one intervention is listening—many patients, especially those with HS, have been dismissed and simply need to feel heard and validated. Neita adds the value of normalizing distress so patients know their feelings are common and not exaggerated. Both direct patients to reputable advocacy groups—the National Eczema Association, NPF, NAAF, the HS Foundation, and the Global Vitiligo Foundation—and Neita provides HS patients a handout listing vetted resources, many of which offer support groups and events.
Psychiatric and psychology referrals can be difficult given long wait lists and limited availability; Neita suggests looping in the primary care provider when possible. Both acknowledge referrals require a delicate balance so patients don't feel dismissed. Sometimes, as Neita notes with a longtime HS patient who never follows through on therapy referrals but finds relief just talking through visits, the clinician becomes the sounding board—another hat APPs wear.