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The Burgeoning Field of Psychodermatology Explores the Link Between Mental Health and Skin

If the mind can cause skin issues, can it heal them, too?
Photo: Imaxtree

Photo: Imaxtree

Dr. Amy Wechsler would rather you didn't call her a psychodermatologist, thanks. "My friends tease me; it's not a great term," she says with a sigh. Unfortunate double meaning aside, the portmanteau deftly describes Dr. Wechsler's line of work. "I'm a psychiatrist and a dermatologist. I think that stuff that goes on in the mind can make skin conditions worse — or better."

The double-board-certified doctor is part of the burgeoning, but still relatively small, field of psychodermatology. So small, the Association for Psychoneurocutaneous Medicine of North America lists only 10 practicing psychodermatologists — aka, physicians who "treat skin the way a psychotherapist treats behavior: by learning how it responds to emotional and environmental stressors and helping to moderate those responses," according to Psychology Today. Despite slow growth (studies on the mind-skin connection began in the 1930s) and a dearth of in-person practitioners (it takes two residencies and eight years, outside of medical school, to receive board certification in both specialties), psychodermatology seems primed to hit its stride in 2019.

If the ever-blurring line between self-care and skin-care is any indication, consumers are starting to suspect that skin health is more than skin deep. Sephora, Ulta and even Net-a-Porter boast "Wellness" sections now, stocked with supplements and sleep aids and smoothie mix-ins, all nestled into the overarching category of beauty — the thought being, the link between diet and skin is pretty much undeniable at this point. Psychodermatology aims to add the mind to that equation; and considering the recent popularity of products like crystal-carved facial tools and essential oil elixirs, it's a leap that beauty buffs are ready (and willing) to take.

"More people are understanding a mind-body connection, that what goes on in the psyche affects the body, including the skin," Dr. Wechsler tells Fashionista. "I think that it's just slower to catch on in the U.S. Here, doctors have not thought holistically like they do in other parts of the world."

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It's true: A mind, body and spirit approach to skin care has been front and center in Eastern cultures for centuries (think: healing modalities like Traditional Chinese Medicine and Ayurveda, the ancient Indian approach to health), which mainstream Western doctors have largely dismissed.

But to be clear, psychodermatology is not alternative medicine. Dr. Wechsler balks at my use of the word "energy" ("I don't believe in that kind of thinking," she says) and doesn't hesitate to pull out the prescription pad when necessary. On the contrary: Psychodermatology is rooted in clear-cut biology and peer-reviewed studies. Yes, there are scientific studies — a lot of them — that confirm the mind-skin connection.

"The skin and the brain are made from the same embryonic layer," Dr. Wechsler says. "Of course they have a connection — they're wired together, essentially." This is known as the Gut-Brain-Skin Axis, discovered in 1930 by dermatologists John H. Stokes and Donald M. Pillsbury at the University of Pennsylvania. In utero, all three organs start as the same mass of tissue and establish a lifelong connection. (This explains why ingestible probiotics are all the rage in skin-care right now: Gut health is inextricably tied to skin health.)

The easiest way to understand the brain-to-skin portion of that axis is by considering your sense of touch. Nerve endings on the skin are "hardwired" to the brain — and this connection flows both ways. Emotional responses can trigger skin responses: Anger precipitates a red face, shock drains your color.

And then there's the big one: stress. "If I had to give you one word that is the root of all evils today, at least when it comes to beauty, it's stress," Dr. Wechsler says. "Stress," admittedly, is a broad term; but while the evolved mind may have specific names for nuanced conditions — anxiety, depression, sadness, overwhelm — the primitive body processes them all in the same way: with a stress response. Hormones like adrenaline and cortisol surge when stress of any kind is detected, setting off a string of reactions throughout the body. Cortisol has been shown to negatively affect collagen production (the protein responsible for keeping skin plump and young-looking), ramp up oil production (so, more pimples) and increase overall inflammation (the source of nearly all skin issues).

"During periods of stress, the skin kind of 'leaks' water, which is called trans-epidermal water loss," the psychodermatologist adds. "The barrier function of the skin doesn't work as well, and it lets things in — for example, sensitizers like fragrances and bacteria — and doesn't keep the bad stuff out." One scientific paper goes so far as to call this barrier damage a "nervous breakdown in the skin."

These kinds of reactions, or lack thereof, are determined by genetics, too. "If someone has a predisposition towards acne, if they're anxious or depressed or sleep-deprived or stressed, they'll break out," Dr. Wechsler says. "But if someone's never had a pimple in their life, or it doesn't run in their family, it's unlikely for the skin to react in that way."

That being said, it's hard not to correlate the recent rise in overall stress with the rise in chronic skin issues. A 2018 poll from the American Psychiatric Association showed that anxiety levels are up 40% year on year, while a recent poll from BodyLogicMD found that 60% of millennials and 37% of Gen Xers still struggle with acne, well into adulthood. According to the American Academy of Dermatology, the total treatment cost for chronic skin issues including dermatitis, psoriasis and rosacea — all of which can be triggered by stress — top $60 billion per year. It’s a phenomenon Dr. Howard Murad, the founder of Murad Skincare, calls "cultural stress."

"I noticed my patients weren't so happy," he told the crowd at a panel about the connection between sleep and skin-care earlier this year, hosted by Lunya in Los Angeles. "They weren't smiling, they were downtrodden, saying, 'There's traffic, work is hard, so much is expected of me, things are more difficult than they used to be.'" In these cases, he noted that stressful lifestyles often translated to wrinkles, sagging and dullness — classic signs of premature aging.

The relationship between stress and aging is one that's well-documented; in order to visualize how one affects the other, Dr. Wechsler suggests Googling pictures of George W. Bush and Barack Obama. "Think of how [they] looked before they entered the Oval Office, compared with their appearances near the end of their terms," she writes in her book The Mind-Beauty Connection; stating the stress of the presidency "gave them… white hair, deep creases and blotchy complexions." Even if you aren't, you know, running an entire country, stress still impacts your appearance. "It can age you three to six years or more," she says.

So if the mind can cause skin issues, can it heal them, too? That's the question at the heart of psychodermatology — and there's evidence to suggest the answer is yes.

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According to Dr. Wechsler, mindfulness alone can make a significant difference. "Just noting that stress may be causing your skin issues, being mindful of that, is so helpful," she tells me. "If someone can figure out that that’s what's going with them, half the battle is won — most people aren't aware."

It's a sentiment echoed by Dr. Murad, who packages written "affirmations" — or repeated positive statements — with his skin-care products. "Dance even though you can't hear the music," advises one. "Forgive yourself. Love yourself," reads another. The doctor even has an app that customers can download for daily positive reinforcement. "If you look at them twice a day and journal, we've done studies, the results are spectacular — transformations happen," he told panel attendees.

Affirmations are not exactly protocol for psychodermatology, but deep breathing and meditation, somewhat surprisingly, are. Slow, deep breaths have been shown to help heal the skin on multiple levels: For one, this kind of breathing activates the parasympathetic nervous system and thus, "the relaxation response," a term coined by Dr. Herbert Benson at Harvard Medical School in 1975. The body is then flooded with tension-relieving hormones, blood circulation is boosted and skin cells are oxygenated. The result, to be somewhat reductive, is less stress and better skin.

From a scientific standpoint, meditation takes this a step further. A 2005 study showed that those who frequently meditate (or "focus the mind for a period of time") have a thicker cerebral cortex than those who don't. Since aging causes the cortex to thin, it stands to reason that meditation can slow or even reverse the physical signs of aging. What's more, a 2017 study proved the practice of meditation essentially "turns on" anti-inflammatory genes — a definite plus for inflammation-based conditions like acne, eczema, rosacea and psoriasis, among others.

Dr. Wechsler encourages daily meditation for her patients, but pairs it with more concrete methods for decreasing stress hormones and increasing skin health, too; including orgasm (yep, it lowers cortisol), exercise (which has the same effect, albeit in a less-fun way) and, most of all, sleep.

"It's the rare person that's stressed and is sleeping well," Dr. Wechsler explains. "You need seven and a half to eight hours of sleep a night, there's no getting around that. Sleep is when we're bathing all our organs in anti-inflammatory molecules. It’s healing the brain, the mind, the skin, all the organs — it affects everything."

To this end, Dr. Murad has an interesting suggestion: "Apply products on your skin that encourage that sleep." No, he's not touting some trendy new transdermal sleep aid — he's talking about the rise of aromatherapeutic skin-care, or products infused with stress-reducing and sleep-promoting essential oils.

"For some people, aromatherapy is excellent," Dr. Wechsler agrees. "But I don't think there’s one blanket aromatherapy ingredient — it’s very individualized." Luckily, beauty brands are heeding the psychodermatology call (even if they don't know that "psychodermatology" is a thing yet), and the options are endless.

Essential Rose Life is one such brand that promotes "mental health and healthy skin" via the use of essential oils. Its founder, Jennifer Rose Goldman, tells Fashionista, "In studying aromatherapy, I recognized that we can use these essential oils for mental health, emotional health and emotional regulation." Like Dr. Wechsler, Goldman is quick to note that her products — for example, the mood-balancing facial toning mists — are not about being "zen" or pushing an agenda of enlightenment. They're about results.

"An example is lavender essential oil," she says. "When inhaled, it's shown to act as a sedative, to slow down the breath and heart rate and promote relaxation and stress relief — tangible, scientific, researched benefits for the mind and emotions." While those features alone could help assuage any brain-skin stress, the plant extract has topical benefits, too. "Applied topically, lavender is also is great for toning the skin, cleansing and soothing inflammation — so in this one oil, you have the capacity for a really holistic healing experience," Goldman explains.

Many other essential oils exhibit similar dual-action behaviors, like chamomile (a calming agent on every level), frankincense (which promotes sleep and fights signs of aging) and rose (it relaxes the mind and the skin); all of which feature heavily in a new crop of stress-busting beauty products.

These mind- and skin-balancing tools are intriguing, for sure — not to mention, actually proven to have mood-regulating benefits — but at the end of the day, they're just that: tools. "Do they prevent [depression and anxiety]? No," says Goldman. "With a condition like that, there are a number of factors going into it." In other words: If you suspect stress may be at the center of your skin issues, you can’t just slather on all the essential oils and expect to get better. Which is exactly why Dr. Wechsler hopes the practice of psychodermatology will soon become more accessible.

"What I do is I spend more time with patients," she explains. "I sit with patients, I don't stand over them and I ask a lot of open-ended questions." She'll touch on things that dermatologists generally don't — like relationships, work, sleep and sex life — in order to get to the root of the problem. "I think that in doing that, I'm a better diagnostician and I'm a better doctor and I can choose the best treatments for someone," she says.

Sometimes, that means prescription topical creams and oral antibiotics. Sometimes, the answer is therapy. And sometimes, a daily dose of meditation and a spritz of a mood-balancing facial mist is just what the doctor ordered.

In the gallery below, a selection of products that contain ingredients beneficial to mental wellbeing as well as skin health.

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