Hello! My name’s Erica Aukerman, and I’m a fourth-year medical student at Indiana University School of Medicine. I recently matched into dermatology, and my interest in the field traces back to before medical school. The ability to have a profound impact on a patient’s quality of life drew me to dermatology originally. I also value the innovative nature of the field and the continuity of care. I want to establish longitudinal relationships with my patients and see them improve over time. Growing up with severe eczema, I understand firsthand the psychological toll that skin conditions can take. As a result, I am passionate about addressing the psychosocial impact of skin disease. Throughout medical school, I have collaborated with dermatologists, psychiatrists, and therapists from across the country on projects within the realm of psychodermatology and hope to continue contributing to this niche field in the future.

Can you tell the readers about what it took to get to this point and what it means for you to have matched at IU? What will the next few years of your career look like, and when do you finally get to claim the title of Dr.?

I truly cannot put into words how excited I am to have matched at my home dermatology program, Indiana University. I am so grateful to continue training under my incredible mentors and alongside wonderful colleagues. It took a lot of hard work to get this point, but I’ve truly loved every step of the way. I worked hard to excel academically in medical school, and I devoted most of my time to learning how to best take care of patients as a physician. I spent any extra time I had establishing connections and exploring the field of dermatology. I will officially become a doctor at the conclusion of medical school (this May). I will complete an intern year in general medicine before entering my three years of dermatology residency. At the completion of residency, I will officially be able to call myself a dermatologist.

2. How did you become interested in psychodermatology? Was there a personal component to your interest?

My interest in psychodermatology stems from my personal experience with eczema, but it has been fueled by my interactions with patients who suffer from life-limiting skin conditions. My involvement with Camp Wonder, a camp dedicated to empowering children with severe skin diseases, sparked my interest in the psychosocial impact of skin disease. Spending prolonged periods of time with children who have conditions like epidermolysis bullosa and harlequin ichthyosis opened my eyes to the daily hardships they face. I want to serve as a pillar of support for these patients and their families and learn as much as I possibly can during my training to provide them with the highest level of evidence-based, compassionate care.

3. Can you name one or two of the most fascinating things you have learned about the mind/body/skin connection?

One thing that fascinates me most about the mind/body/skin connection is the intimate link between mental stress and exacerbation of certain skin conditions.

4. What research have you been involved in recently that you would like to share with my followers who are interested in body-focused repetitive behaviors?

I recently helped Stacy with a write-up focused on the benefits of psychodynamic therapy for patients with body-focused repetitive behavior disorders. We shared the story of a patient with multiple psychiatric comorbidities whose skin-picking disorder responded well to intensive psychodynamic therapy.

5. How do you hope to use your knowledge to advance the field of psychodermatology?

I hope to use my platform to draw more attention to the importance of this field. Skin conditions do not exist in isolation, and it’s important to address the mind/body/skin connection for comprehensive patient care. I want to find more ways to incorporate quality-of-life metrics into dermatologic care and continue researching ways to improve the everyday lives of patients who suffer from dermatologic conditions with strong psychological implications.

6. Can you give a sneak peek of your thoughts about my book for your upcoming book review through Dermatologic Therapy?

It is an easy-to-read book that supports the efficacy of a psychodynamic approach in the treatment of body-focused repetitive behaviors. Stacy does a wonderful job weaving compelling case studies with the practicalities underlying her therapeutic approach. Her patients' treatment responses speak volumes to the work she does and her work warrants expanded use of psychodynamic therapy across the field of psychodermatology. This book not only benefits those who serve patients from a medical or therapeutic standpoint but also offers support and validation to those who personally struggle with body-focused repetitive behaviors.

Although I had decided never to write another word about body-focused repetitive behaviors, I have to admit I was thrilled to be invited by Dr. Muhammad Jafferany to contribute a chapter to this book, which will be published by the APA in 2023. Why? Because I am so excited that the field of Psychodermatology will be getting more attention, and I can’t decline the opportunity to include my research into the efficacy of the psychodynamic approach into this book!

For those of you who aren’t familiar with the field, Psychodermatology is a combination of psychiatry and dermatology that has gained popularity in Europe over the past two decades and is gaining traction in the U.S. Some practitioners, like Dr. Jafferany, have degrees in both psychiatry and dermatology. The psychodermatology model is a team approach, in which a dermatologist, psychiatrist, and therapist all treat an individual struggling with body-focused behaviors such as skin-picking, hair-pulling and cheek-, nail- or lip-biting.

Dermatologists treating these disorders discovered that connection between mind, skin and emotions means that skin disorders contribute to difficulties with mental health and, conversely, mental health conditions can lead to negative interactions with the skin.

My chapter will cover 6 categories: introduction to BFRBs, clinical presentation, diagnosis, differential diagnosis, management, and teaching points.

I am attaching a draft of the chapter outline. The points I will emphasize:

Perfectionism is a key personality characteristic of those struggling with BFRBs. Perfectionism in this population should be understood as a defense mechanism to hide unwanted feelings, especially anger.
Difficulty with sensory processing is common among those who struggle with BFRBs.
Co-morbidity of other mental health diagnoses, including PTSD, OCD, ADHD, body dysmorphic disorder, anxiety and depression is very high in people struggling with BFRBs. BFRBs serve to regulate emotions, so that they can counteract the various uncomfortable feelings that come up for people with these diagnoses, e.g. help focus the attention for those with ADHD, calm the body down for those struggling with anxiety, or create a trance-like state for those with PTSD to avoid intrusive thoughts.
Precipitating events often include attachment disruptions, including divorce, loss of a beloved grandparent, or traumatic experiences.
Psychodynamic therapy is a good fit for treatment for BFRBs as it addresses attachment disruptions and the therapeutic relationship is key to developing new adaptive emotional regulation skills.
Therapy must go beyond talk therapy to include somatic experience.

I have three weeks to finish the chapter, wish me luck!

Guest blog with future psychodermatologist Erica Aukerman!

Writing a chapter for inclusion in Clinical Dermatology: From Diagnosis to Therapy