Consider the following scenarios. You have done something embarrassing in public - you messed up at an office presentation. Everyone has noticed. Your face turns rather red and you begin to feel an itch on your arms and legs. Or maybe, you’re combatting several stressful situations at once - trouble in your personal life and mounting deadlines at work. Your eczema begins to flare up and you need to keep putting band-aids on your fingers. You have acne, and family members, friends keep pointing it out, and you feel more shame, humiliation. Your skin begins to reflect what you feel inside.
This complicated relationship between the brain and the skin - known as psychodermatology and psychoneuroimmunology - is the interplay between mind, skin and the nervous system. Simply put, what you feel, tends to show up on your skin.
What is psychodermatology?
Psychodermatology is a multi-disciplinary field that involves dermatologists, psychiatrists and clinical psychologists. It shows how skin disorders can affect mental health, and vice-versa. While there has been intense study on the connection between the skin and the mind for decades, there have been more concrete developments in the field recently. Dr Nazli Balkir, clinical psychologist from the German Neuroscience Center in the UAE, cites a recent study where 87 per cent of the patients in a dermatology clinic reported a psychiatric illness. She also observed that among the dermatology patients, 48 per cent reported depression, 35 per cent reported anxiety, and 2 per cent reported obsessive-compulsive symptoms. Thirty per cent of the patients who suffer from acne, pruritus, alopecia and herpes virus infection reported mental distress.
Nazli explains, “Skin has an important role in our socialisation process throughout childhood, adolescence in particular and adulthood. Skin disorders cause acne, psoriasis, vitiligo or hyperhidrosis (sweating profusely), which lead to feelings of shame and anxiety.”
She also mentions that what worsens the situation is that people with skin conditions are met with discrimination, as sometimes others don’t wish to shake hands with them as they see them as contagious. Thus, depression, avoidance of social events become the only resort.
Skin has an important role in our socialisation process throughout childhood, adolescence in particular and adulthood. Skin disorders cause acne, psoriasis, vitiligo or hyperhidrosis (sweating profusely), which lead to feelings of shame and anxiety
The impact of stress on mental health
As issues with the skin are so visible to others, it culminates in much psychological distress and humiliation, with one’s self and finally a withdrawal from social activity and situations. Combined with physical pain that skin problems like eczema and acne already cause, this leads to individuals withdrawing socially, which if unaddressed, culminates in depression, low self esteem and moreover distorted perception of themselves.
In his extensively researched book Handbook of Psychodermatology, American professor Mohammed Jafferny elucidates how psychological stress can cause disruption of the immune system, which results in a ‘weak’ skin defence. It causes inoculation of new pathogens and a reactivation of dormant pathogens.
He writes, “In recent decades, the connection between stress and dermatological disease has been researched. Skin plays a crucial role in maintaining homeostasis [a state of balance among all the body systems needed for the body to survive and function correctly] when dealing with internal and external stress.”
He goes on to define psychoneuroimmunology as the studies that focus on the interactions between the behavioural, neural, endocrine and immune systems and how they form a response to psychosocial stress. When the interactions between the systems are overwhelmed or disturbed by extreme stress, it results in a disease.
Dr Tooba Siddiqui, a clinical psychologist at Medcare Medical Centre Jumeirah, asserts that chronic skin disorders cause stress responses in the body that can act as triggering factors for inflammatory autoimmune and allergic diseases.
“When you feel stressed, your body produces more of the human cortisol,” explains Siddiqui.“Cortisol causes a part of your brain, known as the hypothalamus to produce a hormone called corticotrophin-releasing hormone (CRH), which stimulates oil release from sebaceous glands around your hair follicles. Excessive oil productive by these glands can clog your pores and lead to acne.”
In situations of chronic stress, the body produces high levels of cortisol, which leads to severe inflammation. This subsequently sees the immune system reaching a stage of burn-out and prevents acne from healing, and leads to different skin conditions. Cortisol also has an adverse effect on white blood cells, says Nazli, making your immune system weaker and this puts the body at greater risk to viruses.
When you feel stressed, your body produces more of the human cortisol. Cortisol causes a part of your brain, known as the hypothalamus to produce a hormone called corticotrophin-releasing hormone (CRH), which stimulates oil release from sebaceous glands around your hair follicles. Excessive oil productive by these glands can clog your pores and lead to acne
Stress has strong effects on the immune system
A weakened immune system leads to an imbalance of bacteria in your gut and skin known as dysbiosis, she continues.
This shows up on your skin as a redness or rash. Autoimmune diseases like alopecia (hair loss) can also be triggered due to stress. Mukta Tewani, the founder of Miss Pallettable, a UAE-based skincare brand, explains the unusual phenomenon further by using her own example saying, “Stress and anxiety can have an effect on skin health, especially if you suffer from eczema, psoriasis or sensitive skin. I have sensitive skin and keratosis pillaris [dry, rough patched and bumps] on my arms. Many a times when I’m under a lot of mental pressure I have seen my keratosis flare up.
"This has got to do with the fact that when we are stressed, our body releases adrenaline and cortisol. These hormones can cause inflammation in our body, which is why you also see inflammation in your skin health.”
Unfortunately, the internet, has also played a role in heightening this anxiety within people.
Stress and anxiety can have an effect on skin health, especially if you suffer from eczema, psoriasis or sensitive skin. I have sensitive skin and keratosis pillaris [dry, rough patched and bumps] on my arms. Many a times when I’m under a lot of mental pressure I have seen my keratosis flare up.
The more we see that perfect glowing skin by celebrities - many of us start feeling embarrassed of our own skin and frantically try to elevate it to extremely high standards.
Sayema Wasi, a 27-year-old PR account manager, recalls her own battles with skin health and how it deeply affected her. She notes the heightened standards of beauty that the internet was intrinsic to creating, and how it led to more anxiety.
“As a young woman who grew into adulthood during the internet age, the images I saw most frequently and was therefore most influenced by, were those of women and girls, who had flawless skin. I do remember seeing different ethnicities and races, but invariably women had perfect skin. As someone who has always struggled with one kind of skin imperfection or the other, I associated my own worth with the appearance of my skin.” She said that this led to her developing an obsession with skincare products.
“Every time I feel like I am having a bad skin day, I know I will keep thinking about how my skin is looking like, and even a small bump can send me into a downward spiral and literally ruin the day.” For Wasi, make-up doesn’t help either, as she feels that it is ‘making up’ for what she lacks - which is that beautiful, flawless skin, endorsed everywhere on the internet and in ads.
As a young woman who grew into adulthood during the internet age, the images I saw most frequently and was therefore most influenced by, were those of women and girls, who had flawless skin. I do remember seeing different ethnicities and races, but invariably women had perfect skin. As someone who has always struggled with one kind of skin imperfection or the other, I associated my own worth with the appearance of my skin.
Is there a way to protect your skin?
For starters, before dermatology, professional help is crucial for some, in the cases of those dealing with severe anxiety and depression. As Nazli points out, cognitive behaviour therapies, mindfulness-based therapies and habit reversal trainings are known for their benefits.
Combined with this, we could also slowly start paying attention to our food habits that get badly affected by stress. While junk food seems like a comfortable resort, it has a negative impact on your skin, as it has a high glycemic load that can elevate your blood sugar levels. This puts you at risk for certain diseases and increases inflammation in the body. Siddiqui asserts that anti-inflammatory, antioxidant and low glycemic foods like fish, eggs, vegetables along with fruits can benefit your mood as well as your skin. As the confidence and motivation builds up, inculcate exercise into your daily activities along with a healthy skincare regimen with a more positive mindset.
As you begin to focus more on your mental wellness, you can incorporate other practices like meditation and relaxation into your daily routines - and if you feel at a loss on how to craft a routine for yourself, don’t beat yourself down - consult your dermatologist and doctors and gradually, you’ll find your way to be at peace with yourself, and your skin will begin to reflect the state of your mind.
