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Richard L. O'Sullivan, MD; Graeme Lipper, MD; Ethan A. Lerner, MD, PhD

Arch Dermatol. 1998;134:1431-1435.

Skin does more than present one's "face" to the world; it plays a vital role in the maintenance of physical and mental health. As our most ancient interface, skin retains the ability to respond to both endogenous and exogenous stimuli, sensing and integrating environmental cues while transmitting intrinsic conditions to the outside world. As such, it has long been a target for the application of both medical and nonmedical therapies of healthy and diseased states. Our understanding of how the skin and topical therapies affect health is in its infancy. Conversely, we know little of how our internal systems affect our skin. By exploring an elaborate web of neuro-immuno-cutaneous-endocrine (NICE) phenomena, we seek to shed light on the generally acknowledged, but inadequately defined, relationship between mental and physical health. We use skin as our window, noting some of the biological mediators linking nervous, immune, cutaneous, and endocrine functions. It is likely that these mediators are important in homeostasis, and that they affect several dermatologic and psychiatric conditions.

From the Department of Psychiatry, Massachusetts General Hospital Psychiatric Neuroscience Program (Dr O'Sullivan), and the Department of Dermatology, Massachusetts General Hospital–Harvard Cutaneous Biology Research Center (Drs Lipper and Lerner), Charlestown, Mass, and the Departments of Psychiatry (Dr O'Sullivan) and Dermatology (Drs Lipper and Lemer), Harvard Medical School, Boston, Mass.

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