Have you ever seen your skin breaking out exactly before some important life events? Most of us have experienced skin issues during exams or some stressful life event. Skin problems, including itches and breakouts, are often seen as a result of climate change, poor dietary habits, poor sleep schedules or some medical conditions. But one factor we sometimes fail to notice is the emotional turmoil and psychological factors. Not only do our skincare and lifestyle impact our skin, but also psychological factors have become a huge determinant of our skin health. This article will reflect on the intersection between psychology and dermatology.
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Skin: Reflector of Emotional State
Skin is the largest organ of our body. It not only detects and responds to heat, cold, pressure and texture but also reflects the functioning of our inner organs. It responds to hormones and neurotransmitters. Emotions like fear, stress, anxiety and even pleasure determine how our skin behaves. For example study by Gupta and Gupta (2001) reveals that patients with dermatological diseases show high rates of Depression, Obsessive Compulsive Disorders, and even Post Traumatic Stress Disorder.
Skin, apart from being a protector, plays the role of reflecting our inner world. Negative emotions can impact our skin’s radiance, glow, texture and can even cause itching. Similarly, emotions like joy and relaxation have a positive impact on our skin. This suggests a complex relationship between our mind and skin. A study by Zachariae(2001) shows that negative emotions like sadness have a significant impact on skin flare reaction as compared to happiness and anger. Hence, skin health is not only shaped by our biological mechanisms but also by psychological States.
Read More: Can Skin Conditions Indicate Higher Mental Health Risks? New Research
Psychodermatology: Where Psychology meets Dermatology
Psychodermatology is the point of interaction between mind and skin. While Psychiatry focuses on internal conditions and psychological state, dermatology focuses on external visible conditions (Mohammad Jafferany, 2007). This complex relationship is an interplay of the neuroendocrine and immune system. The focus area of Psychodermatology is psychocutaneous disorders. These are disorders that have both dermatological and psychological characteristics Brownet al., 2015). For example, Picardi, Abeni, Melchi, Puddu, and Pasquini (2000) showed that the prevalence of emotional disorders was even 25.2% in about 2500 outpatients of a dermatological clinic. Hence Psychodermatology deals with the relationship between our skin and psyche.
Because healthy skin plays an important role in our physical and mental well-being, the field of Psychodermatology has gained a lot of popularity recently. It aims to cover every aspect of interpersonal as well as intrapersonal factors that trigger and get triggered by skin problems (Bewley et al.,2021). As skin is a complex system of blood vessels, nerves, muscle elements and glands, the autonomic nervous system plays an important role in determining skin health. The nervous system can be controlled by psychological stimuli; it is important to understand how hormones and neurotransmitters impact skin problems.
The Skin Brain Connection
There is a two-way communication between our skin and brain, both impacting each other. For example, during acute stress conditions, there is an increase in oxytocin levels that helps to buffer against stress. But chronic stress leads to reduced oxytocin and more cortisol ( Y Li, 2019). This affects emotional well-being, skin inflammation and even wound healing (SF Mehdi et al., 2022). These elevated levels of cortisol can then further impact melatonin and suppress its release, disrupting the circadian rhythm.
This increases stress response cognitively and leads to the production of greater pro-inflammatory mediators ( Yang, Zhao, et al, 2017). Not only this, but skin also impacts our mental well-being. Our skin carries symptoms from external stressors, including rashes. Emotionally, individuals with skin problems experience higher rates of Depression, anxiety and reduced life satisfaction. Not only this, it is highly associated with characteristics of the skin problems like chronicity, coping styles and personality ( C.E.E.E CHOI, 2022)
Common Condition And Their Impact
- Puberty: during Puberty, there is an increase in androgens, leading to skin issues like acne, along with other concerns like increased sweat gland activity.
- Menstrual cycle: hormonal fluctuations during the menstrual cycle can cause skin breakouts. Also, estrogen diminishes acne and reduces the size of oil glands, while progesterone can make skin oily and blocked.
- Menopause: during Menopause, a decrease in estrogen can cause skin to be drier, thinner, and less elastic, leading to wrinkles.
- Stress: high cortisol can cause inflammation, increased oil production and hence more breakouts.
Positive emotions like happiness, pleasure, joy, and relaxation trigger the release of happy hormones like dopamine, Serotonin, and oxytocin. These hormones improve blood circulation, decrease inflammation, and support collagen production. This leads to a natural glow and fewer breakouts. This may be the reason behind the glow of skin during a relaxation-filled vacation.
Itch Without a Rash
A condition related to Psychodermatology is psychogenic itch. It is an itch disorder where the main symptom is itching, but the psychological factors play an important role in triggers and their persistence (Misery et al., 2018). Psychogenic itch is also known as psychogenic pruritus, somatoform pruritus, functional itch disorder, or functional pruritus, but “psychogenic itch” is the most commonly used denomination. Psychiatrists report that most patients with psychogenic itch prefer to consult a dermatologist and avoid a psychiatrist.
Its symptoms may include inflammation in the skin, bumps, and dry skin. Psychological causes include Depression, anxiety, and compulsive skin picking. A similar condition is neuropathic itch. The difference between the two is that neuropathic itch is caused by damage to the nervous system. Damaged nerves send itch signals to the brain. It is accompanied by a numbness and tingling sensation.
Psychiatric Conditions With Skin Manifestation
There are various ways in which psychological distress is expressed through the skin. One of them includes the condition of skin-picking disorder. It is commonly called Dermatillomania. It is a mental health condition where people may compulsively engage in skin-picking behaviour. They may not realise that they’re doing it, and it is an automatic behaviour in some people.
This leads to injuries, infections and scars on the skin. It falls under the category of Obsessive Compulsive Disorders. It is found d to be more prevalent in women. They focus on areas that are rough and already have some kind of blemish or irregularity. For example, they may start picking at their pimples, dry patches or sometimes even scratches or wounds. A similar condition includes trichotillomania, which involves compulsively pulling out one’s own hair. This behaviour may lead to bald spots. All this severely impacts mental health and well-being.
Studies show that people with such conditions show deficits in cognitive abilities that are linked to frontal lobe cause problems such as motor impulsivity (Isobe et al., 2018). In b9th the conditions, negative emotions precede the hair or skin pulling episodes. Picking and pulling serve the function of avoiding aversive experiences and emotions.
Conclusion
Skin serves not only as a physical surface but also as a mirror to our emotions and mental health. The psychological distress and negative emotions may express themselves through our skin. Psychodermatology combines dermatological techniques with psychological interventions to treat the conditions of itch, eczema, etc. Management of Psychodermatological conditions include use of SSRIs along with Cognitive behavior therapy. Understanding the interplay of psychological and psychosocial factors of dermatological conditions is important for effective treatment. Self-awareness, Mindfulness and healthy coping mechanisms must be practised to regularly manage our emotions for a healthy mind and skin.
Reference +
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