Ever sat in a stressful meeting and noticed a burgeoning zit ? If yes, you can attest to the connection between stress and skin. But that link between mind and skin is much closer — and stronger — than previously thought, and it runs deeper than stress alone. This realisation has led to the up-and-coming field of psychodermatology, in which dermatologists and mental health professionals work together (and in some cases, are board-certified in both dermatology and psychiatry) to treat patients from the inside-out. This absolutely blows my mind; such an interesting area and certainly one we still learn something new from every day. But what does it entail? This isn’t just a zit that grows on your nose and turns you into a unicorn. It can actually develop much deeper inflammations that come through the surface as a skin disorder.

Appreciating the Mind-Skin Connection

According to Royal Free NHS Hospital, psychodermatology factors such as stress have an effect on many skin disorders. Having a skin disorder can also affect your mood and behaviour. Psychodermatology addresses the interaction between mind and skin. Psychiatry is more focused on the “internal” nonvisible disease, and dermatology is focused on the “external” visible disease. (Jafferany, 2007)

It’s a two-way approach. On one hand, you have the mental-health issues caused by skin conditions. Evidence shows a link between acne and increased depression, while those who suffer from eczema have a higher risk of anxiety. The emotional problems due to skin disease include shame, poor self-image, and low self-esteem.

On the other hand, emotional issues can trigger skin conditions. Stress is a big one, as is depression. “It has been reported that psychologic stress perturbs epidermal permeability barrier homeostasis, and it may act as precipitant for some inflammatory disorders like atopic dermatitis and psoriasis.” Basically it starts as an inflammation from within and then moves to the surfaces. It is no surprise that one says “Your skin is shows your soul” as body expresses his stress response.

And while inflammation-based conditions are the most common manifestation, there are a range of expressions in the skin. Once you rule out a biological cause, itchiness can then be a symptom of anxiety and depression.

The interaction mental health and skin concerns can create a cycle that’s hard to break — and treat.

How Psychodermatology Works

Typically, seeing a dermatologist is the first step. While a dermatologist likely won’t recommend therapy on your first visit, it may come up if the standard course of treatment doesn’t help your concern. Recently I have experienced more blemishes than usual. And my usual treatment I have been using has failed to help. That’s when I check in within myself. As due to the current situation and new world we are living in, it might be deeper than skin-seep. So if you had beautiful and glowing skin, and all of a sudden, bam you have acne – then reflect what has changed.

Some dermatologists work closely with mental-health providers. Once that happens, “it’s a little bit of a chicken-and-egg concept”. It is conducting your own detective work trying to identify what, where, when and why.

  • What has changed? Or what has happened?
  • When has it started? Or when is this happening?
  • Where is it happening? In terms of on your face, body?
  • And then why could it happen? A particular stressful time, or difficult period of time for whatever reason.

Getting to the root of the issue this way is key, particularly when it comes to what’s known as body-focused repetitive behaviours, such as dermatillomania (skin picking) and trichotillomania (hair pulling). While a dermatologist can help a patient heal the physical wounds, a mental-health professional can get to the bottom of what compels them to pick or pull in the first place.

For conditions beyond that, such as acne or eczema, this approach still holds. If, for example, you notice that your eczema flares during a stressful event, then a therapist can work with you on stress management and coping skills to reduce stress — as well as try to understand and address what exactly about that event stresses you out.

When to Consider Psychodermatology

The giveaway of a psychological factor in a skin condition is, well, having a psychological factor. If you’ve experienced a job loss, death in the family, or are even studying for a big exam, COVID-19, you may notice a flare-up. That’s not to say that something like that causes skin conditions. But if you’re predisposed to them or are already suffering from them, it can be the catalyst.

The other sign is when a treatment that’s been working well to control the condition in question suddenly stops working. If that happens, it’s worth considering taking stock of how you’re feeling emotionally and mentally and addressing it accordingly.

The field is still growing, so there isn’t a dedicated guideline on what to do if you suspect that stress is causing flares in a particular skin condition. But it also doesn’t hurt to take steps to manage your stress.

How to calm your senses? 

We all have stress and anxiety triggers and then using certain strategies to reduce it, such as deep breathing, exercise, journaling, and practicing mindfulness-based strategies, like focusing on the present versus the past or future. Mix your favourite essential oils in an oil-based solution, and roll them onto your temples, wrists, and chest before; essential oils such as ylang ylang, lavender, frankincense, and other aromatics, can help calm and soothe the senses. Or apply the Hydration Mask, set your phone on Do Not Disturb mode, and read or meditate before turning in.

While these steps may not make your skin concerns disappear overnight, you may be surprised by what’s possible when you put your mind to it. Worst case scenario? You may feel a little better.


REFERENCE

1. Jafferany, M. (2007), “Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders”, Prim Care Companion J Clin Psychiatry. 2007; 9(3): 203–213. doi: 10.4088/pcc.v09n0306

2. Sands GE.. Three monosymptomatic hypochondriacal syndromes in dermatology. Dermatol Nurs. 1996;8:421–425. [PubMed[Google Scholar]

3. Faulstich ME, Williamson DA.. An overview of atopic dermatitis: towards bio-behavioral integration. J Psychosom Res. 1985;29:415–417. [PubMed[Google Scholar]