Anyone who’s ever noticed a burgeoning zit in the middle of a budget meeting 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 realization 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. Here’s what it entails.
Uncovering the Mind-Skin Connection
“Psychodermatology is essentially a treatment of skin conditions but using psychological techniques to address the interaction between mind and body,” says Matthew Traube, MFT, a licensed clinical psychotherapist in California who treats a number of skin conditions.
It’s a double-sided 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. “Conditions like alopecia, severe acne, and vitiligo have an impact on self-esteem because our skin is the first thing we show the world,” says Gina Caputo, DO, a board-certified dermatologist in Delaware.
On the other hand, emotional issues can trigger skin conditions. Stress is a big one, as is depression. “Acne, rosacea, eczema, psoriasis, and even perioral dermatitis are triggered by stress,” says Caputo. It’s understandable, seeing as inflammation — which doesn’t always cause but certainly exacerbates many of these skin conditions — is the body’s standard stress response. “Certain chemicals [released with stress] trigger pathways that are shared with these diseases,” she explains.
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 be a symptom of anxiety and depression,” says Caputo. Even those who experience chronic pain of some kind may experience burning and stinging in various areas of the skin — though again, there’s no biological reason for it.
The interaction mental health and skin concerns can create a cycle that’s hard to break — and treat. “It’s hard to tell if our psychological factors are increasing and exacerbating the skin condition, or if our skin condition is causing psychological symptoms,” Traube says.
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. “If I’ve been seeing a patient with acne that’s very cystic and their treatments have failed to help, that’s when I have that conversation,” says Caputo. “Or if they’re doing well and then, bam, they have acne — then I talk to them about it.”
Some dermatologists work closely with mental-health providers. Once that happens, “it’s a little bit of a chicken-and-egg concept,” says Traube. “Part of what I do is detective work trying to help people figure out the who, what, where, when, and why. What’s behind it? Where’s it happening? When is it happening? Is it at a particular time when it’s stressful or difficult 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 behaviors, 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, 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,” says Caputo.
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. “There’s no evidence based studies to support it, but if a patient notices that yoga and meditation decrease their flares, I would support it,” says Caputo.
Traube recommends identifying your 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. For a little zen in a pinch, roll the Stress Relief Essential Oil Blend onto your temples, wrists, and chest before taking a hot shower or bath; its science-proven blend, featuring tarragon, frankincense, and other aromatics, can help calm and soothe the senses. Or apply the Moisture Lock Overnight 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.