Explainer / What is psychodermatology? The emerging wellness trend explores how emotions and stress affect hormones, immune responses and physiological processes – and it all shows on our skin

Apr 23 , 2024

Psychodermatology explores how emotions and stress levels affect the body’s hormones, immune responses and physiological processes – which in turn affect our skin. Photo: Getty Images

Stress affects not only our minds but also manifests on our skin in various forms like acne, eczema and psoriasis. The proverb “more than skin deep” finds literal meaning here, opening the door for an often-overlooked frontier at the intersection of psychology and dermatology: psychodermatology, an emerging field that explores the complex relationship between our emotions, stress levels, mental well-being and the health of our skin.

The connection between our emotions and skin condition is deeply rooted in the complex interplay of hormones, immune responses and physiological processes. “A simple way to explain it is to understand that the skin reflects everything happening inside and outside us,” says Angelica Figueroa, cosmetologist and founder of the website Geek & Chic. When we encounter stress, our body responds by activating the hypothalamic-pituitary-adrenal (HPA) axis, releasing cortisol, known as the “stress hormone”. This surge is part of the body’s fight-or-flight response, which is crucial for survival.

At the intersection of psychology and dermatology, psychodermatology explores the complex relationship between our emotions, stress levels, mental well-being and the health of our skin. Photo: Gallery Stock

However, in our modern world – where stress more often takes the form of near-constant psychological pressure – this response can negatively affect our skin. Elevated cortisol levels disrupt the skin’s barrier function, leading to increased sensitivity, a reduced ability to retain moisture and a slower healing process. “Just as external changes, such as those caused by exposure to UV rays and pollution, can pigmentate or dry out your skin over prolonged periods, internally, the skin processes what’s happening, using nutrients, oxygen and water to regenerate and maintain its functions,” Figueroa explains. “Your emotions can disrupt these functions, as they can modify the messages the cells receive.”

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Under stress, our body produces more androgens – hormones that stimulate the skin’s oil glands and hair follicles, leading to clogged pores and acne outbreaks. This is why periods of high stress can often lead to a noticeable increase in acne flare-ups, creating a frustrating cycle where stress about the skin’s appearance can further aggravate the condition.

Likewise, eczema – characterised by dry, itchy, inflamed skin – can flare up under emotional distress, leading to more severe outbreaks and disruption of the skin’s protective barrier, and making it more susceptible to irritants and allergens. The itching and discomfort caused by eczema, in turn, can lead to increased stress and anxiety, perpetuating a distressing cycle of skin irritation and emotional unrest.

The connection between our emotions and skin condition involves a complex interplay of hormones, immune responses and other physiological processes. Photo: Getty Images

In practice, psychodermatology doesn’t replace conventional dermatological treatments but rather complements them, addressing the psychological factors that may be contributing to skin issues. “One of the key psychological strategies employed in psychodermatology is cognitive behavioural therapy [CBT], a form of talk therapy that helps patients identify and modify negative thought patterns and behaviours that may be making their skin conditions worse,” says Dr Penny Lee, a dermatologist at Sydney’s Eastern Suburbs Dermatology. For instance, in cases of acne or eczema, CBT can equip patients with the tools to manage their stress more effectively, breaking the cycle of skin flare-ups leading to anxiety, leading to exacerbated flare-ups.

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“Educating patients about the connection between their mind and skin is vital, and it can empower them to take a more active role in managing their condition,” says Lee, adding, “Understanding the impact of stress and emotions on the skin can motivate patients to make healthier lifestyle choices and seek psychological support when needed.” From relaxation techniques like deep breathing exercises, progressive muscle relaxation and guided imagery to lifestyle changes like regular physical exercise, dietary modifications and adequate sleep, these choices can amplify the effectiveness of traditional skincare routines and medical formulas.

However, while psychodermatology presents a promising frontier in treating skin conditions, it’s not without its challenges and limitations. These hurdles stem from various factors, ranging from a lack of awareness to scepticism within the medical community, which plays a significant role in how the field is perceived.

Elevated cortisol levels disrupt the skin’s barrier function, leading to increased sensitivity, a reduced ability to retain moisture and a slower healing process. Photo: Gallery Stock

“Even with all the increasing evidence supporting a link, the fact that emotional and mental well-being can seriously impact skin conditions is not widely recognised. This lack of awareness can be found both among the general public and within certain segments of the medical community, and as a result, patients may not receive comprehensive care that addresses both the physical and psychological aspects of their condition,” Lee notes. This gap in understanding can lead to suboptimal treatment outcomes as the emotional or stress-related triggers of skin conditions go unaddressed.

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Scepticism within the medical community, particularly among traditional dermatologists, can pose a significant barrier. “While the integration of psychological aspects into dermatological treatment is gaining ground, there is still a degree of resistance,” says Lee, adding that some medical professionals remain sceptical about the efficacy of psychological interventions in treating skin conditions, “preferring to rely solely on conventional medical treatments”.

Despite these challenges, the field of psychodermatology holds great potential. However, the journey towards fully integrating its principles into mainstream skincare is still in its early stages. There is a pressing need for further research to validate the effectiveness of psychodermatological approaches and pave the way for their wider acceptance and implementation in medical and dermatological practice.

Wellness

Psychodermatology uses cognitive behavioural therapy to help patients identify and modify any negative thought patterns and behaviours that may be making their skin condition worse
Stress hormone cortisol disrupts the skin’s barrier function, leading to sensitivity, dryness and slower healing, while androgens stimulate oil glands, making the skin more prone to acne