It may come as no surprise that a connection between skin and mind exists. Some folks break out into hives when stressed, while others flush red if embarrassed. But in recent years, studies have shown that a person’s mental and emotional state can have a profound effect on the body’s largest organ. Stress, depression, anxiety and other psychological conditions can contribute to a host of skin diseases including acne, rosacea, eczema, psoriasis, alopecia and vitiligo.
“The skin and the central nervous system are intertwined,” says Dr. Adam Friedman, director of dermatologic research at Montefiore Medical Center in New York. “Therefore, it’s not surprising that almost any and all skin diseases can be impacted by changes in the nervous system.”
Stress, especially, can leave a mark. Bodies under stress produce more skin sebum, oily discharge that can contribute to clogged pores and aggravate acne. Stress can also increase inflammation in the body, which can worsen eczema, a chronic inflammatory skin condition. And stress is known to trigger cold sores, caused by the herpes simplex virus, on and around the lips.
Research published in 2008 in the Indian Journal of Dermatology, Venereology & Leprology revealed that more than a quarter of 50 subjects suffering from psoriasis – a chronic skin condition resulting in thick scaly patches – were experiencing stressful life events such as unemployment, major personal illness or family death. And a 2012 study in Dermatology Research and Practice found that 45 percent of 100 patients with psoriasis had anxiety.
“Many psychological conditions that affect the skin can be traced back to elevated levels of stress and anxiety,” says Dr. Carla Marie Greco, a clinical psychologist based in Santa Rosa, California.
When the body is free of worry and stress, hormone levels remain relatively balanced, Greco explains. But when faced with conditions that are psychologically or physically stressful, the body’s “flight or fight” response is triggered, and the sympathetic nervous system sends signals to the adrenal glands to flood the system with adrenaline and cortisol, both major stress hormones.
Under normal circumstances, Greco says, the parasympathetic nervous system helps bring the body back into balance once the danger has passed. But when faced with relentless stress or anxiety, the body is always bathed in these stress hormones. As a result, Greco adds, the skin suffers from the body’s chemical responses to psychological stressors. “The skin – the human body’s barrier against the damaging effects of the outside world – is less able to act as a shield,” Greco says.
Skin serves as the body’s primary system of protection. “[It] provides the first level of defense to infection, not just as a physical barrier, but also as a site for white blood cells to attack invading bacteria and viruses,” explains Dr. Jeanette Raymond, a clinical psychologist practicing in Los Angeles.
A 2007 study from the University of California–San Francisco found that mice subjected to psychological stress experienced a decrease in the expression of antimicrobial peptides in their skin, thus making them more susceptible to skin infections than mice cared for under normal conditions.
Given that the skin is the most visible organ, the emotional impact of skin diseases can be overwhelming and damaging. “Social ostracism and feelings of insecurity only fuel the pathophysiology of these conditions, often making them worse. It becomes a vicious, perpetual cycle between the skin and the nervous system, both having a cause-effect impact on one another,” Friedman says.
Friedman advises going to a dermatologist early for relief, education and the management of chronic debilitating skin conditions and a possible referral for mental help. “I often tell these patients that the skin condition, their primary concern, is causing them stress, and seeing a psychologist could help them manage the stress so as not to exacerbate the condition,” he says. “Psychologists can be helpful in addressing the emotional burden and can be a helpful part of the overall treatment regimen, which can include both topical and oral medications.”
Raymond describes the two main types of psychological treatment typically given: One method works on challenging irrational beliefs and fears while enhancing coping skills; this may include stress-reduction techniques for self-soothing. The other method tries to get to the root cause of stress – attachment insecurity, fear of loss, unprocessed childhood trauma. “It provides a vehicle through which people can learn about emotional experience and speak rather than somatize their emotions,” Raymond says. “Gaining power over their emotions in this conscious way will be of lifelong benefit.”
Janice Pastorek, a registered nurse and medical skin care specialist based in New York City, emphasizes the need to address psychological issues, which can accelerate recovery. “Our bodies offer us personal guidance, showing us where and why we are holding tension,” she says. “We just haven’t been shown how to interpret the messages or how to incorporate good wellness practices into our everyday [life] to quell the anxiety or stress that contributed to triggering the condition.”
Along with a change in diet (think more water and less sugar, Pastorek says) and exercise (what Pastorek calls “the No. 1 treatment for depression”), Pastorek also adds that the most important thing her patients can do is to change the predominant focus of their thoughts – “stress is a thought you keep thinking that doesn’t make you feel good.” And activities such as meditation and writing can help do just that. “Writing is a powerful way to focus your thoughts.”
Greco also adds that guided relaxation, visual imagery, breathing exercises and yoga are among the practices useful for stress reduction, while proper sleep – key to a healthy immune system – is an important factor in treating skin conditions.
So if you’re suffering from a skin disease and conventional treatments alone don’t seem to work, the solution to your skin issues could be in your head.
“A balanced mind equals a balanced physical body,” Pastorek says.