This Is Why Your Skin & Mental Health Are So Connected

Consider this: Someone tells you that your zipper is unzipped in public and your face turns bright red with embarrassment. Or, you're feeling overwhelmed with mounting deadlines at work and your eczema is flaring; the itching is out of control. In those moments, you know that your skin can reflect what you're feeling inside, and what you're feeling inside can be reflected on your skin.

Although cause and effect can be challenging to nail down, there is no denying an intimate and intricate brain-skin connection. Aside from being derived from the same embryologic tissue, the ectoderm, the bond between the brain and skin is complex, fascinating, and is the focus of areas in both dermatology and medicine—known as psychodermatology and psychoneuroimmunology: the interplay between the mind, skin, and our immune system.

In plain English, this just means that what we think, feel, and see can play a significant role in what shows up on our skin.

As your largest organ, your skin protects you from the outside world, guards your internal organs, plays a large role in your immune system, and protects you from infection. It absorbs, secretes, and excretes to keep your skin hydrated, regulate your body temperature, detoxify waste and metabolites from your body, and, with its many nerve fibers, allows you to feel pain and pleasure. It not only produces hormones like vitamin D, it has a role to play in regulating hormones throughout your entire body.

The brain and the nervous system influence the skin's immune cells through various chemical messengers and receptors, which respond to stress. We all know that stress is an inevitable part of life and arises when we are under mental, physical, or emotional pressure that we perceive exceeds our ability to adapt to it. Our brain plays a major role in the stress response, which exerts its effect on the skin mainly through the hypothalamic-pituitary-adrenal (HPA) axis. When this response is activated, stress hormones such as corticotropin-releasing hormone (CRH), glucocorticoids, and epinephrine are released. This results in a wide range of physiologic and immune reactions that can trigger or exacerbate skin conditions.

But, here's where it gets interesting: Recent research1 has confirmed skin both as an immediate stress perceiver and as a target of stress responses. Because there is a fully functional peripheral HPA system within the skin, all of the stress hormones and their receptors are produced in skin cells—just like the HPA system originating in the brain. So what does this mean for you and me? It means that stress stimulates both the brain and the skin to signal the release of hormones that can trigger inflammation, impair wound healing, accelerate aging, and worsen skin conditions including acne, eczema, and psoriasis.

It makes sense then, that a two-way communication between the brain and skin can cause issues for both what shows up on skin and how we respond to it.

The field of psychodermatology breaks up disorders into three general and sometimes overlapping categories:

Skin conditions that have a physiological basis but are known to be affected by stress and other emotional factors like acne, alopecia areata (hair loss), psoriasis, urticaria (hives), rosacea, and hyperhidrosis (profuse sweating) fall into this category.

Conditions that are cosmetically disfiguring or potentially social stigmatizing like vitiligo, psoriasis, or severe acne can create feelings of humiliation and shame; cause anxiety and depression; and erode self-confidence and self-esteem. One study2, for example, found there was an increased number of hospital admissions secondary to primary mental health disorders with coexistent acne or rosacea.

Skin disorders like chronic hair-pulling (trichotillomania), self-inflicted damage to the skin (dermatitis artefacta), and a belief that the body is infested with organisms (delusions of parasitosis) are symptoms of an underlying psychiatric disorder. Management of these conditions requires a multidisciplinary approach including dermatologic and psychiatric care.

While not everyone will react the same way to having a skin problem, nor respond emotionally through their skin, data suggests that in some people, creating a treatment plan that addresses medical management of skin physiology as well as mental health, will optimize the outcome.

When feelings of anxiety and depression are taking over, here are some mind-body strategies to consider:

Various studies highlight that focused breathing, mindfulness meditation, and relaxation techniques have been used successfully in a variety of skin conditions3 including acne, alopecia areata, atopic dermatitis, and psoriasis.

Recent research4 indicates that movement—including aerobic exercise and yoga—can be beneficial in skin conditions with a psychological component, including trichotillomania and excoriation disorders (skin picking). 

Eating nutrient-dense whole foods that offer anti-inflammatory, antioxidant, and low glycemic benefits like wild caught fish, pasture raised eggs, dark leafy green vegetables and brightly colored fruits like apples, berries, and pomegranates can boost your mood and your skin.

The world of psychodermatology is still developing, and there's a lot we don't know, but knowing about the mind-skin connection can help us be more aware of how our mental and emotional health might be showing up on our skin—and vice versa!