Skin Deep

Katy Young investigates the new field of psychodermatology and the relationship between your skin and trauma 

They say that the eyes are windows to the soul, but what if you want to know how that soul is bearing up? Well, then take a good look at your skin say the dermatologists whose latest field of research acknowledges that our state of mind and complexion are rather more co-dependent that we originally thought.  

While it may be a concept that our instinct is familiar with, knowing all too well that we blush when shy, sweat when anxious and irritatingly get spots when stressed, ‘psychodermatology’ is a relatively new field of skin science. This niche school of dermatology explores a rather more thoughtful way to treat skin conditions over and above prescription cream. Believing that our mental heath and state of our skin are inextricably linked, these doctors are more likely to prescribe spoken therapy over steroids. 

And it makes sense. Over a third of all psychological issues will show themselves in our skin, those common niggles including dryness, acne and eczema often nothing more than an emotional hangover. Skin diseases you see are not just a cosmetic issue, but also often a reminder than our nervous system, immune system and skin are constantly talking. It’s a theory that both Chinese and Ayurvedic medicine have long held true, but Western medicine is now eager to join the conversation. And here’s why.  

Skin, our largest organ, is constantly sensing and responding to endogenous and exogenous stimuli – experiences and changes that are happening both in and out of our skin. A complex organ, it adjusts to environmental cues, and then communicates those to the outside world… sadly for some, for all to see. 

Take trauma and stress for example which threaten the hormonal balance in our skin.  A surge in the stress hormone cortisol triggers the skin to whip into action and take on this challenging balancing act. This often causes exhaustion and inflammation, ergo skin barrier impairment and dermatitis, and by the way a rapid loss of collagen.  Interestingly, studies also confirm that over 80 per cent of psoriasis flare-ups are a direct response to a bout of stress.  

And then, when you take into account the added panic that a poorly timed breakout can add to someone’s existing stress levels, you start to see how working with a therapist might run deeper than a cream. (As if those flare-ups needed more heat, those aforementioned psoriasis sufferers also tend to experience an impairment of social functioning and negative body image – not something a face cream can smooth over). 

Psychodermatologists, often with a dual degree in dermatology and psychiatry, will classically use a three-pronged approach to healing your skin with medication, dermatology, and therapy. While often prescribed in conjunction with an atopic cream to treat the symptom, therapy is more clearly able to treat the cause. Reassuringly, researchers discovered that those who underwent six weeks of cognitive behavioral therapy for psoriasis experienced a far greater response than those on medication alone, while stress-induced itching has been relieved by mindfulness and relaxation say experts. 

With mental health now firmly on the agenda, it seems timely that modern medicine is no longer glossing over our skin health.  Beauty may well be skin deep, but so is our emotional wellbeing apparently.

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