Having a medical condition that affects one's appearance can be a source of major psychological stress.
Likewise, suffering from stress can sometimes lead to unfavorable changes in one's appearance.
As mental well-being is closely linked to conditions that affect one's appearance, patients need support and care for both kinds of conditions.
One person who needed such care is a 35-year-old woman in Yokohama.
She developed alopecia when she was 9, and by the time she was 26 she had lost all the hair on her body--not just on her head, but her eyebrows and eyelashes too.
For several years after the hair loss, she felt apathetic and helpless.
Whenever she went out, passersby would say insensitive things like, "That woman's wearing a wig, isn't she? It's so obvious!" She felt hurt by such comments and became increasingly introverted.
Looking back on those days, she said: "I lost interest in the things I used to like, and I stopped wanting to look nice. I even thought about committing suicide."
Having a condition that affects one's appearance can often lead to psychological scars and illness.
Nobuko Okamura, 36, who heads a self-help patient group for those suffering from alopecia, was herself treated for depression.
Back then, she had difficulty sleeping and had a tendency to overdrink.
For three to four years, she was on medication and underwent counseling.
While being treated for alopecia, she often felt doctors and nurses lacked compassion with regard to her psychological anguish.
They brusquely told her to take off her wig before examination, and this left her feeling hurt.
Okamura said: "Through meeting and chatting to other people who enjoy looking nice even though they wear a wig, I was gradually able to return to my cheerful self. To overcome psychological issues you need good support."
Alopecia aside, similar hardships have been experienced by people with other visible blemishes, such as scars and birthmarks.
Withdraway from society
One man who has a birthmark on his face was bullied and went through a period of withdrawal.
"Now I have no confidence in forming relationships with other people, probably because I haven't had many opportunities to communicate with others," he said.
According to Ayako Toyoda, a 41-year-old psychological counselor in Tokyo who deals with those suffering from physical blemishes and other problems, many of them are worried about whether they can find a job or form a romantic relationship.
"They've experienced failure several times in life, such as being bullied or withdrawing from society. As a result, they've lost confidence and tend to feel more anxious about things than other people do," Toyoda said.
Some people who interact with sufferers of such conditions tend to play down their importance because they are not life-threatening, while others are overly solicitous, believing they must be suffering a lot.
Such attitudes can often be a burden to the sufferers.
Toyoda's advice for those who spend time with sufferers is: "Don't presume to understand [how they feel]. The important thing is to deal with them naturally."
In some cases, patients develop physical problems as a result of psychological stress.
Nippon Medical School Hospital in Bunkyo Ward, Tokyo, offers a psychodermatology consultant service once a week for outpatients suffering from chronic hives and itchy skin rash induced by stress they feel from work and relationships.
Doctors treat the patients with medication, but they also sit down and take the time to really listen to the patients, in an attempt to understand their situation and work out what psychological factors are behind the symptoms.
Once they've worked through their feelings, patients tend to become less obsessed with their symptoms and gradually get better.
Jun Yajima, a 61-year-old doctor in charge of outpatient consultants, said: "Invariably there's something that triggered the problems, such as an incident that came as a shock. The patients' mind and their appearance are just like two sides of a coin. It's important to focus not only on treating the external, affected part, but also on the sufferers' hidden mental issues."
What sufferers say
-- I'd like to have a romantic relationship, but I don't feel those of the opposite sex see me as a potential partner.
-- I'm worried about whether I can find a job that I want.
-- When I talk about my worries with people around me, they just brush them off, saying, "It's not such a big deal."
-- I seem to be causing problems for my family because I was born, and I feel bad about that.
-- I hate my parents for making me look like this.
-- I'm so worried about the way people look at me that I can't open up to interact with them.
-- I was told I should learn a vocational skill because I'm not marriageable, and that hurt.
(From some cases psychologist Ayako Toyoda dealt with in the past)