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.

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.

New Field, New Treatment Possibilities

"If appearance is impacted due to a skin condition, you can end up having to deal with self-esteem issues and social stigma, which, if unaddressed, can lead to depression," Mallin says.

"If they truly have depression or a diagnosed anxiety or psychological disorders, medication can be helpful and so can a brief course of cognitive behavioral therapy that works at changing reactions and behaviors," Mallin says.

Relaxation training can help as well.

One study at the Touch Research Institute at the University of Miami showed that children's mood and activity levels improved, as did all measures of their skin condition including redness and itching, after massage therapy. Parents' anxiety also decreased.

Another potential solution is habit-reversal training.

"Say you pick at your acne or eczema and you get scarring and are actually making it worse, you need to be aware where your hands are," she says. "Being more self-aware of what your hands are doing and having alternative behaviors that take the place can help."

For example, every time your hand reaches above your neck, grab a pencil and write a sentence.

When children develop stress-induced skin conditions, the onus may be on adults to ask what kind of impact the skin disease is having on them and what kind of stressful events they are going through because very young children experience stress just like adults do, Mallin says.

"Maybe they are being teased or bullied," she says. A doctor or parent can ask about school and friends to find out if the child is socially connected or excluded form normal social activities," she suggests.

The mind-skin connection makes all the sense in the world to Shelley Sekula-Gibbs, MD, clinical assistant professor of dermatology at Baylor College of Medicine in Houston.

"Studies that show that at least 30% of all dermatology patients have some underlying psychological problem that often goes unaddressed, at least on initial visit, but if addressed, it can have a very positive and powerful impact in improving the skin condition," she says.

[During development in the womb], the brain and skin are derived from the same cells, so there is a connection," she says. "And the other immediate relationship is that when people experience stress in life, quite frequently, their skin becomes a reflection of the stresses."

What to do varies depending on the condition and the cause, she says.

"If the condition is short-lived, such as a college student gets an acne flare during finals, there is not much to do because stressors are episodic," Sekula-Gibbs says." But if the stressors are more chronic, such as a difficult marriage or a person is unemployed and unable to find work, the dermatologist would be well served to try and address the social issues involved."

Perhaps, she suggests, a social worker, marriage counselor, or psychiatrist can help. But if the patient is clinically depressed as a result of a skin condition, depression is causing the skin condition, or they are suffering from a psychosis or obsessive-compulsive disorder and might be hurting themselves, safer and easier-to-tolerate medications are available, she says.

The bottom line is that "if the dermatologist and patient are both aware that the stressors exist, then they are better suited to deal with problem, but if no-one talks about it, it can't be addressed." Sekula-Gibbs urges patients to "speak frankly to your doctor about issues that are bothering you."

Show Sources

SOURCES: Karen Mallin, PsyD, instructor, University of Miami/Jackson Memorial Hospital, Miami. Shelley Sekula-Gibbs, MD, clinical assistant professor of dermatology, Baylor College of Medicine, Houston.

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