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The Mind-Skin Connection

Does stress cause your acne or rosacea to flare up? Or do you chew your nails to the quick? Experts say emotions can have an impact on your skin.

WebMD Feature

Any time Amanda feels nervous, she breaks out all over her 13-year-old face. Jeremy often feels so sorry for himself that he has eczema that he shuts himself off from the world during bad flares. And the only way that Kim can stop her obsessive thoughts is by pulling out her hair.

In these and many other ways, the mind and the skin are intimately intertwined. You name it: acne, eczema, hives, rosacea, psoriasis, alopecia (hair loss), vitiligo (depigmented white spots on the skin), trichotillomania (hair pulling) and self-mutilation disorders, many skin disorders take their roots from or place their roots in the psyche.

Experts are calling this new field "psychodermatology."

"Psychodermatogy is a field that addresses the impact of an individual's emotion as it relates to the skin," says Karen Mallin, PsyD, an instructor in the departments of psychiatry & behavioral sciences and dermatology & cutaneous surgery of the University of Miami/Jackson Memorial Hospital in Miami.

"I think [psychodermatology] is going to be growing by leaps and bounds [because] dermatology is ready for a more integrated approach with other fields such as psychology, psychiatry, and even complementary medicine," says Mallin, who recently completed a postdoctoral year in psychodermatology at the same hospital where she now works. Such an integrated approach allows for new treatment possibilities including antidepressants, relaxation therapy, or counseling that can alleviate the mood problems that result from or cause skin problems.

"The mind and skin are connected on many different levels," Mallin tells WebMD. "A lot of nerve endings are connected to the skin, which wraps around the organs, so as emotions are played out neurologically, they can be expressed through the skin just as stress can be expressed through gastrointestinal symptoms, increased anxiety, or hypertension."

Take acne, for example. When you are tense, your body releases stress hormones including cortisol, which may increase the skin's oil production, making you prone to pimples.

And, Mallin says, "in some autoimmune diseases such as alopecia (hair loss) and vitiligo, scientists now show markers that a stressful event can trigger the autoimmune reaction."

In other cases, people have truly psychiatric diseases that present as dermatological ones, including cutting, nail biting, hair pulling, some tic behaviors, and delusional parasitosis, a mistaken belief that one is being infested by parasites such as mites, lice, fleas, spiders, worms, bacteria, or other organisms.

Bruce Katz, MD, director of the Juva Skin and Laser Center and the director of the cosmetic surgery and laser clinic at Mount Sinai Medical School, both in New York, explains it this way: "It's the target organ theory, and certain people have different target organs that channel stress," he tells WebMD. "Some people get ulcers, some people get migraines, and other people get rashes as the skin is their target organ," he says.

That's why when "we have patients who come in with stress-induced or neurotic conditions related to psychological issues, we refer them to a psychologist or psychiatrist or even acupuncture," Katz says.

The good news is that by consulting with other specialties and using new treatments for skin disorders including lasers, doctors are better able to treat both the skin and the emotional issues than ever before, he says.

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