This article is part of a special issue investigating key questions about skincare. Find the full series here.
Even if you don’t wear your heart on your sleeve, your skin may betray your mental state.
“There is a very strong connection between the brain and skin, and a connection between stress and skin diseases,” says at the University of Miami, Florida. This is evident, he says, in his encounters with patients: “I always ask, for instance, does anything aggravate your itch? And many patients will tell you it’s stress.” This observation is also borne out in clinical studies.
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On a physiological level, it all comes down to hormones. Psychological stress, whether it be chronic or acute, causes our bodies to produce hormones called glucocorticoids, which keep us more alert and provide energy for the fight-or-flight response in dangerous situations. But they also harm the skin in two ways.
Anxiety-induced acne and eczema
First, they can diminish the functioning of the epidermis. This top layer of skin locks in moisture and serves as the first layer of defence between our bodies and the environment. Consistently high levels of some of these hormones, like cortisol, can also cause inflammation. Second, glucocorticoids decrease the production of antimicrobial proteins in the skin.
The combined effect is skin that is dry or inflamed, is prone to infections and heals more slowly, leading to a heightened susceptibility to clinical skin conditions. “There is a direct connection between stress and a tendency to get sick,” says , San Francisco.
In , Yosipovitch and his colleagues found that this is true across various sources of stress, ranging from marital strain to insomnia and isolation. A study by Yosipovitch and others, which examined a sample of 94 secondary students in Singapore, is a case in point. They found that, on average, the adolescents’ acne right before an important exam, compared with when they had just returned from a school vacation.
Mental distress can also aggravate skin conditions in a more mechanical way – through scratching. For example, how people with atopic dermatitis, or eczema, which makes the skin dry and itchy, respond to a stress test. Here, study participants had to deliver a short presentation as part of a mock job interview, then quickly complete a mental arithmetic task. “The itch intensity was not affected, but the amount of scratching the subjects did was way above [their baseline] during this stressful event,” says Yosipovitch. Consequently, “a vicious itch-scratch cycle” can take hold and exacerbate the skin conditions of a patient, he says.
The healing response
The connection between mental health and skin may offer new avenues for treatment. A examined the available evidence for the benefits of meditation and mindfulness for psoriasis. Of the six randomised controlled trials considered, five reported significant improvements in symptoms after eight or 12 weeks of practice. Other studies indicate that relaxation techniques, such as progressive muscle relaxation, where a person tenses and relaxes one muscle group at a time, are beneficial for and that benefits people with eczema.
In view of this increasing evidence, dermatologists should be more aware of their patients’ mental health, says Yosipovitch. This isn’t yet common practice and diagnostic tools that are used in research, such as questionnaires, typically aren’t used in busy dermatology clinics.
There are still open questions about how exactly our skin “feels” what we feel. “The skin makes almost everything that’s also made in the brain. It makes cannabinoids, it makes opioids, it makes all kinds of agents that can potentially be released in response to stress. But which among them are the major players is not yet clear,” says Elias. Future studies could elucidate this – and offer new routes towards better skin health in the process.
