Psychodermatology – Is There a Connection Between the Mind and Skin?

As mentioned in previous articles, there is a strong link between chronic stress and skin conditions, such as rosacea. There are many ways to reduce stress levels such as participating in regular exercise, meditation, yoga, or even a gentle walk out in nature. My personal preference is a morning walk before settling down to work; which I find sets the day off to a positive start. Other benefits include a boost in energy levels, a regular sleep pattern and being out in nature: a brisk morning walk is a grounding habit I have incorporated into my daily routine. 

Defining Psychodermatology

So, what does the field of psychodermatology entail? It is a relatively new discipline in medicine, which covers the interaction between the mind and skin, combining both dermatology and psychiatry. 

Under the umbrella of psychodermatology, there are several sub-types: 

1. Psychophysiologic Disorders – refers to a skin disorder which is exacerbated by emotional stress. 
2. Primary Psychiatric Disorders – where skin conditions are caused by oneself, for example, skin picking. 
3. Secondary Psychiatric Disorders – those who are deeply affected by their skin condition, resulting in depression, low self-esteem and anxiety. 

Rosacea specifically, falls under ‘psychophysiologic’ as it is exacerbated by stress. For further information on Psychodermatology and its subtypes, this article provides in-depth information. 

There is no doubt that chronic stress contributed to my rosacea, particularly as I had been working in a relatively hectic work environment, in a job that did not provide enjoyment or fulfilment. The greatest indicator was the sudden appearance of the Rosacea – I went to work with clear skin and after a busy shift, my face had changed drastically. Of course, this took a toll on my self-confidence, not to mention the uncomfortable sensations which took many years to improve. 

Can Chronic Stress Potentially Cause Rosacea?

As covered in previous posts, stress can lead to a rosacea flare-up but what is the mechanism behind stress and the onset of various skin conditions?

The effect of stress on the skin is through the hypothalamic-pituitary-adrenal (HPA) axis. When stress occurs, corticotropin-releasing hormone (CRH) is secreted via neurons, which then travels to the pituitary gland, binding to the corticotropin receptor type-1, where various hormones and chemicals are released. For further information, see this article on the US National Library of Medicine, National Institutes of Health. 

In the same medical journal, skin mast cells are mentioned concerning stress: they are considered one of the main factors in the skin/stress response. Each chemical stress pathway can impact the function of mast cells, for example, the activation and release of inflammatory mediators such as histamine. 

The Impact of Stress on Other Physiological Mechanisms

Stress can also negatively affect the skin barrier, which in rosacea, is already impaired due to the nature of the skin condition. As previously mentioned, the main goals of rosacea are not only to reduce symptoms and improve appearances but also to repair and strengthen the skin barrier, which in turn reduces the sensations of itching, burning and overall skin redness. 

Wrapping Up

The link between skin and the stress response is complex and multi-faceted via the HPA axis, nerve endings located subcutaneously and several cells, for example, mast and immune cells. Additionally, inflammatory cytokines and inflammation within the nerves themselves all contribute to inflammatory skin conditions, as a result of chronic stress. 

Although there are no effective medical treatments that can improve or treat stress-related skin conditions or those which are worsened as a result of stress, one can certainly adopt stress-relieving practices to help keep skin issues to a minimum. As chronic stress can lead to a vicious cycle of exacerbation of a skin condition, which causes the sufferer further stress as a result of deterioration in one’s appearance, this detrimental loop must be broken. For example, incorporating relaxation techniques into one’s daily routine or even radically changing lifestyle (if that is viable), such as leaving a stressful job.