How Your Mental Health Affects Your Skin’s Health

For decades, psychologists have been interested in the link between the mind and the body. Yet, psychodermatology (a discipline that combines the learnings of dermatology, psychiatry and psychology) is a relatively new field of study. 

But how are the mind and skin connected? And how does healing one improve the other? We consulted Dr Alia Ahmed, Consultant Dermatologist, Frimley and Barts Health NHS Trusts to find out. Dr Ahmed specialises in psychodermatology, and her practice involves treating the mind and skin together, so she has much to share on the subject. Here’s what we learned. 

The link between your mind and your skin

“My patients often tell me that their skin is impacting how they feel and vice versa,” says Dr Ahmed. She brought to our attention the latest report from the All Party Parliamentary Group on Skin (APPGS) titled ‘Mental Health and Skin Disease.’ Some of the key findings from the report are:  

• 98% of people surveyed reported that their skin affects their psychological and emotional wellbeing. 
• 73% reported a negative effect of skin conditions on intimate relationships.
• 93% reported losing self-esteem because of a skin condition.
• 69% reported that their skin affected their work or education. 
• 83% of respondents reported their skin affecting their sleep.

“There is increasing evidence to suggest that patients with dermatological diseases have higher levels of psychological and psychiatric issues than those with other chronic diseases,” Dr Ahmed reveals. 

The idea that the mind and skin are connected also inspired psychologist and former makeup artist Dina El Adlani to create a psychodermatology-focused skincare line called ESPÉRER.  

“The ability of the skin to respond to both endogenous and exogenous stimuli means that what we use on our skin can affect more than just the surface,” explains El Adlani. “My growing interest led me to study pyschodermatology. Although it’s a fairly new discipline in psychosomatic medicine, it has considerable research to back its plausibility.” 

When asked what prompted her to start the brand, she said: “my biggest inspiration was the clients I spoke to as a makeup artist during my time at university. They would confide in me about their skin insecurities and lack of body confidence. Then, I noticed a pattern – many of them would suffer from low self-esteem due to their skin concerns, resulting in further skin issues.” 

Similarly, Dr Ahmed explains: “My patients are at higher risk of developing poor psychological health. Meaning, they are more likely to feel embarrassed, low, anxious, have body image issues or feel socially isolated. These feelings can then impact their skin and turn into a vicious cycle. I recognise this link and treat not only the skin condition, but also the psychological impact on the patient and their families, carers or loved ones.”

But how does poor emotional wellbeing manifest on the skin?

Psychophysiological skin conditions

Dr Ahmed points out that the brain has a stress-activated pathway that causes the release of various chemicals and hormones that drive inflammation in the body. For example, feelings of emotional distress cause the release of a stress hormone called cortisol. This affects the immune system. It makes the skin less able to defend itself, drives allergic responses, delays healing and disrupts the skin’s natural barrier.  

“The effects seen on the skin can vary,” she elaborates, “including feeling dry, scaly and itchy, as well as the formation of lines, wrinkles, pigmentation, signs of premature ageing and dull skin.”  

When you’re in an anxiety-inducing situation (before an exam or an important presentation, for instance), you may have noticed how your body has an immediate physical reaction – flushing, itching, sweating. But long-term, chronic stress has more serious effects. 

“It results in the body entering a permanent ‘stress-response’ state, which can aggravate existing skin problems through a poor natural immune response and ongoing inflammation,” says Dr Ahmed. “There is also an increase in severity of existing skin conditions related to stress, like psoriasis and eczema.”

Depression rash: can a rash be psychological?

Have you ever heard of a ‘stress rash’ or ‘depression rash’? These are also examples of your mind directly impacting your skin. “The brain interprets emotional distress as stress, which can activate the stress axis to cause many issues,” explains Dr Ahmed. “There are also links between having depression and particular skin conditions, for example, psoriasis.” 

When should you consult a psychodermatologist?

If you think your skin concern is affected by stress or anxiety, it’s essential to seek advice from a healthcare professional and find out if you would benefit from a psychodermatological approach. 

“Please do not allow skin conditions to be trivialised,” Dr Ahmed emphasises. “Speak up and ask to be seen by an expert. The usual NHS pathway is to see your GP, who can refer you to a general dermatologist or psychodermatologist.”  

She adds: “Try to tell your GP how your skin condition affects your quality of life – this will help them to decide who to refer you to. Don’t suffer in silence! Psychological health is as important as physical health.”

How psychodermatology can help

A psychodermatological approach combines conventional dermatological treatments like medication and skincare with tools to manage psychosocial factors. 

“Adjunctive treatments include relaxation therapies, mindfulness, and other cognitive-behavioural therapies,” explains Dr Ahmed. “In some cases, I will treat this with mood or anxiety-managing medications when psychological distress is severe. In addition, lifestyle choices can impact skin health. So, it is important to consider the hours of sleep people get, their daily fluid intake, food choices, and amount of time spent exercising.”  

You can expect a psychodermatology appointment to be longer than a general dermatology appointment (45-60 mins). This allows enough time to assess the patient’s physical and psychological health and adequate time to discuss treatment options. 

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