Have you ever heard of a pyschodermatologist? I hadn’t either, but it’s a person who looks at the links between the skin and the mind. Living with a skin condition such as eczema or psoriasis can have a profound effect on a person’s mental well-being while, on the flip side, stress and anxiety have been linked to the onset of acne. As we’re learning more and more, our bodies comprise complex and intricately linked systems, so when you’re looking at a problem such as skin flare-ups, you need to take a holistic, well-rounded approach to find a solution. Just as the gut and the mind are linked, so too are the mind and the skin.
But just how much does our brain inside affect how our skin looks on the outside and, with mindfulness a real buzzword right now, can changing our mind-set improve our skin? Here's what we found out.
How Stress and Anxiety Affect the Skin
To understand how stress and anxiety can affect the skin, we need to understand a little about the endocrine system (I’ll keep it brief, promise). Essentially, our endocrine system comprises glands that pump out various hormones, which are essentially chemical messengers. When all the checks and balances are in place, the human body is a well-oiled machine, but outside factors such as stress can cause this intricate system to slip out of sync.
“Hormones are incredibly important in dermatology, especially when considering the role of psychological stress in triggering, or exacerbating, common skin diseases including eczema, psoriasis, and acne,” says Daniel Glass, a consulting dermatologist at the Dermatology Clinic. “There is increasing evidence that stress hormones such as CRH, ACTH, prolactin and substance P can aggravate skin diseases.
“Stress hormones have an effect on the sebaceous glands found within the skin, which can lead to a worsening of acne levels. However, the level of stress required for this to occur varies from each individual. There is evidence that both the stress from exams and sleep deprivation can make your acne worse.”
And of course, while there is a direct link between stress hormones and skin disease, there are also the lifestyle consequences that come from being under pressure. “In times of stress, many people turn to sugary foods and alcohol,” says Glass. “Evidence suggests alcohol makes the symptoms of psoriasis worse whilst other findings show a link between a high–glycaemic load diet and the symptoms of acne. This would suggest a low-GI diet may help prevent flares of acne,” explains Glass. So reaching for that large glass of red or packet of biscuits when you’re stressed out won’t be doing your complexion any favors.
A Holistic Approach to Treating Skin Disease
At The Dermatology Clinic London, Glass works in tandem with the resident pyschodermatologist to treat patients. “Skin disease needs to be treated holistically. In other words, the whole of the patient’s situation needs to be taken into account during a consultation. Treatment may be a combination of medical intervention and the use of sessions with a clinical psychologist. As there is such a strong link between stress, anxiety and skin disease, the two professionals work almost seamlessly together, and it’s important patients with skin diseases have access to both.”
“You cannot separate the way you feel about your skin; it’s the first thing you see every day. By combining the physical and mental factors, then you are meeting all the needs of the patients: their skin condition and the psychological distress that they presented with. When people neglect the psychological factors over the physical, then often their skin condition remains a problem,” says Glass’s colleague Reena Shah, senior clinical psychologist, whose focus is on psychodermatology.
While certain skin diseases can’t be cured, such as eczema and psoriasis, therapy has proven helpful in managing the symptoms. “Certain studies show that cognitive behavioural therapy can be used as a useful additional therapy in psoriasis," explains Glass.
Of course, stress and anxiety are only part of the puzzle, “in cases of eczema, stress may make your skin disease worse, but food allergens, aeroallergens, cold weather and the use of soaps can all be contributing factors,” says Glass, but it’s safe to say that a calm mind will only benefit the quality of your skin in the long term.
So how exactly does a psychologist work with a patient to help ease their skin problems? "We conduct thorough psychological assessments involving issues such as asking about how clients feel about their skin, their sleep, impact on relationships, their everyday life, appetite, past significant events and their history. We then put all the information together and create a formulation and hypotheses of what may be precipitating, maintaining and protecting the difficulties. This could range from scratching, adherence problems, anxiety, depression, stress, low self-esteem and so forth,” explains Shah.
“This is shared with the client, and then together we look at their goals for therapy and how they would like their life to be. As a clinical psychologist, I am trained to tailor the therapy to the patient’s needs using the most appropriate therapy models (using the clinical evidence-base), such as cognitive-behavioral therapy, acceptance and commitment therapy, systemic family therapy, habit reversal therapy, and solution-focused therapy, to name a few."
How to Manage Stress-Related Skin Flare-Ups
We called on ESPA founder Sue Harmsworth, MBE, for her tips and tricks for managing stress. ESPA is a skincare brand that encourages a more rounded approach to beauty, offering holistic treatments at its flagship spa in the Corinthia Hotel, London, including acupuncture, as well as a Mindful Facial and Mindful Massage.
“If you can pinpoint your skin breaking out or turning dry to a time in the month when your stress levels might be rising or you’re under more pressure, this would suggest conditions are lifestyle-related rather than caused by products or medication, for example.”
“In an attempt to resolve the issue, people often change everything at once, including diet and products, which makes it tricky to make a diagnosis. If you think it is stress-related, I recommend keeping your products the same and trying to find a way to reduce your stress.”
“It’s important to manage your stress, and you’ll need to find the best way for you as an individual.
“I begin the day with some gentle stretching to open up the body, and I always reinforce my gratitude for what I have. If I feel a bit down, I will say some positive thoughts out loud as feeling positive in myself makes everything else more positive. I also like to do some deep breathing exercises before I go to sleep, using my favorite ESPA oils. I breathe in through the nose for four seconds and out through the mouth for eight seconds. During this time, I go through my day from end to beginning so that I can let any anxiety or stressful situations go.
American Psychological Association. Stress effects on the body. Updated November 2018.
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