Skin. It's where our inside meets the outside. A defense against the external world, but it's also a way to explore new sensations and to caress what we find desirable.
There's a connection between the mind and the skin, says Ted A. Grossbart, PhD, a psychologist at Harvard Medical School in Boston and author of Skin Deep: A Mind/Body Program for Healthy Skin.
How Do Your Emotions Really Suit You?
"All parts of the body react to our emotions, but the skin is the one suit we never take off. Because it's the border between the inside and the outside, it's full of all the intrigue and byplay that accompanies being on the border," says Grossbart.
Because mind and skin are intimately connected, Grossbart and others are encouraging people to use mind-body relaxation and stress-reduction methods in addition to conventional medicines when dealing with skin problems.
"Our bodies respond to an imagined situation as if it were real," Grossbart says. "If you picture yourself sitting by the fire, your toes actually get warmer. Since some skin conditions respond to external conditions, visualizing an image of dry sunlight or cool moisture may help your skin feel more comfortable."
"There does seem to be a relationship between the mind and the skin, though proving this scientifically can be quite difficult," says Derek H. Jones, MD, a dermatologist in private practice in Los Angeles and clinical assistant professor at the UCLA school of medicine. "It's well-known that when someone has psoriasis, stress tends to make the problem worse."
Sometimes, Your Skin Needs You to Take It on Vacation
When Jones trained at Columbia-Presbyterian Medical Center in New York City, people with a bad case of psoriasis were often admitted for two or three weeks of inpatient treatment.
"We gave them a variety of treatments, including topical and light therapies, and we saw rapid improvement," he says. "We did believe that taking them away from the stresses of their everyday lives was a definite factor in this improvement, though it's impossible to prove. Nowadays, insurance won't cover inpatient treatment for psoriasis."
"Eczema and psoriasis in particular are exquisitely sensitive to increases in stress," says Audrey Kunin, MD, a dermatologist with a special interest in cosmetic dermatology, who practices in Kansas City, Mo.
"It is so common for my patients to report when they leave town on some relaxing vacation, their psoriasis or eczema almost magically resolves. It is not uncommon for new patients to report they are 'allergic' to something in their environment, when in fact they are responding to an increased level of stress in their environment," says Kunin.
People with cold sores often say they flare up when they're under stress. "The reason is that stress really does alter immune-system responses," Jones says. "The herpes virus responsible for cold sores is present all the time, but most of the time, the immune system has it controlled."
Acne flares are notorious before a big date or special event, Kunin says.
"This may have something to do with elevated cortisol levels," she says. "I encourage my acne patients to exercise regularly and try to keep stress down, especially when there is a planned event."
Shingles: Byproduct of Aging ... and Stress, Too?
Shingles is a painful skin problem caused by the same virus that's responsible for chickenpox. The virus remains inactive in nerve root cells for many years, until something rouses it, causing inflammation of the nerve. The patient experiences pain and a rash with small blisters in a narrow band on one side of the body.
"While it has long been suggested that stress may aggravate this condition, I have not found it to be true in the real world," Kunin says. "The dermatology community now feels that as people live longer, the majority of adults will eventually experience a bout of shingles. This is normally a one-time event. You can get it again in a different part of the body, but most people aren't that unlucky."
Kunin routinely treats shingles with oral antiviral agents to reduce the risk of postherpetic neuralgia, a painful condition that sometimes remains after the rash goes away.
Grossbart, however, says he believes stress can tip the balance between the virus and immune system and lead to an outbreak of shingles.
"We know the immune system is exquisitely sensitive to a range of emotional issues. We know the shingles virus lives in the body for decades. Why is it activated at a particular time? Because the person is under stress," he says.
Grossbart has found that hypnosis is particularly effective in dealing with pain control if pain persists even when the rash has disappeared.
Feel Emotions in Your Heart
In many cases, skin problems may be intimately linked with emotional issues the person is dealing with.
"Skin symptoms like other symptoms are often well-intentioned but doomed attempts to make our lives better," says Grossbart. "They are doomed because we're trying to use our skin to do things the skin is not designed for. I tell my patients, 'try to feel your emotions in your heart, not in your skin.'"
For example, Grossbart recalls one patient who was caring for a difficult baby, with little help.
"She developed a rash on her hand, on her ring finger, and it was so severe her wedding ring had to be cut off," he says. "Meanwhile, she was wearing similar rings on other fingers with no problem. This is a kind of body poetry, a physical metaphor."
One way to deal with stress is to use mind-body techniques, forming mental images of a safe, nurturing environment. Hypnosis and self-hypnosis can be effective too, Grossbart says.
"But when you're dealing with stress, the problem may not be the stressful situation, as much as the effort to avoid that situation and the feelings it arouses," he says.
Grossbart urges patients to use focused psychotherapy to explore and deal more effectively with situations that trigger skin symptoms.
"When you look at what's going on underneath, most often we find unacknowledged anger. Next, we often find people crying out for more love and caring." How, and whether, to express these emotions will depend on each person's particular situation. "The first thing is to feel what you feel. Experience your emotions and don't kid yourself," Grossbart says.
Originally published Nov. 5, 2001.
Medically updated July 20, 2004.