Sometimes, it feels like nothing in life is more stressful than a poorly timed breakout. So, it seems plausible that the reverse can also be true — your emotions may also affect your skin.

And the connection between the mind and body is becoming clearer with new studies in psychodermatology.

The mind-skin connection

Rob Novak has had eczema since he was a child. Throughout high school and college, the eczema had taken over his hands to the point where he couldn’t shake people’s hands, handle raw vegetables, or wash dishes because his skin was so inflamed.

Dermatologists couldn’t identify a cause. They prescribed him corticosteroids that relieved the itching for a short time but ultimately thinned his skin, leaving it prone to further cracking and infection. He also had anxiety and depression, which ran throughout his family.

Jess Vine has also lived with eczema throughout her life. The steroid and cortisol creams her doctors prescribed would temporarily ease her symptoms, but eventually the rash would pop up elsewhere.

“The tipping point,” she says, “was when my whole body broke out in a terrible rash. My eyes were swollen shut. It was all over my face.”

At that time, she was dealing with a lot of anxiety, which caused a feedback loop. “Anxiety about my skin made my skin worse, and when my skin got worse, my anxiety worsened,” she says. “It was out of control. I had to figure it out.”

In his mid-20s, Novak took an integrative approach. He eliminated as many potentially inflammatory foods from his diet as he could, including nightshades, wheat, corn, eggs, and dairy. This succeeded in reducing the severity of his eczema, but it still bothered him.

Acupuncture helped a little.

He only experienced real relief when he started doing somatic psychotherapy and “tapping into deeply suppressed emotions and expressing emotions,” he says. As he did this, the eczema completely cleared for the first time in his life.

His anxiety and depression also improved with the psychotherapies and emotional release.

Years later in graduate school, with chronic stress and deprioritization of his emotional life to manage a heavy workload, the eczema reappeared.

“I’ve noticed a strong connection between how much of my emotions I’m suppressing, stress, and eczema,” Novak says.

Vine educated herself about eczema, addressed digestive issues, and received therapeutic emotional support to ease her anxiety. Her skin responded. Now her eczema is mostly controlled, but does flare during stressful times.

Connecting mental health with physical conditions can be tricky. If health issues are diagnosed as “psychological,” a doctor may fail to identify and treat a very real physical condition.

Yes, some skin conditions are purely physical in nature and respond well to physical treatment. In those cases, one need look no further.

But for many with treatment-resistant eczema, acne, psoriasis, and other conditions that flare up with stress, anxiety, and depression, psychodermatology can hold an important key to healing.

What is psychodermatology?

Psychodermatology is a discipline combining the mind (psychiatry and psychology) and the skin (dermatology).

It exists at the intersection of the neuro-immuno-cutaneous system. This is the interaction between the nervous system, skin, and immune system.

Nerve, immune, and skin cells share an “embryological origin.” Embryonically, they’re all derived from the ectoderm. They continue to communicate and affect one another throughout a person’s life.

Consider what happens to your skin when you feel humiliated or furious. Stress hormones increase and set into motion a series of events that ultimately cause blood vessels to dilate. Your skin reddens and sweats.

Emotions can cause very physical reactions. You can slather on all the dermatological creams you want, but if you speak in front of a group and have a fear of public speaking, your skin may still get red and hot (from the inside out) unless you address the emotional cause — by calming yourself down.

In fact, management of skin conditions requires psychiatric consultation in more than one-third of dermatology patients, reported a 2007 review.

In other words, as Josie Howard, MD, a psychiatrist with expertise in psychodermatology, explains: “At least 30 percent of patients that come into a dermatology office have co-existence of anxiety or depression, and that’s probably an underestimate.”

Harvard Medical School professor and clinical psychologist Ted Grossbart, PhD, estimates 60 percent of people who seek medical help for skin and hair problems also have significant life stress.

He believes a combination of medication, therapeutic interventions, and dermatological treatment are often necessary to gain control of skin conditions.

Psychodermatologic disorders are divided into three categories:

Psychophysiological disorders

Think eczema, psoriasis, acne, and hives. These are skin disorders that are worsened or, in some cases, brought on by emotional stress.

Certain emotional states can lead to increased inflammation in the body. In these cases, a combination of dermatological remedies, as well as relaxation and stress management techniques, can help manage the condition.

If the anxiety or emotional stress are severe, anti-anxiety medications, like selective serotonin reuptake inhibitors (SSRIs), may be very effective.

Primary psychiatric disorders

These involve psychiatric conditions that result in self-induced skin harm, such as trichotillomania (pulling out hair), and other mental health conditions that result in picking at or cutting away the skin.

In many cases, the best treatments for these disorders are medication combined with cognitive behavioral therapy.

Secondary psychiatric disorders

These are skin disorders that cause psychological problems. For example, some skin conditions are stigmatized. People can face discrimination, feel socially isolated, and have low self-esteem.

Skin conditions like cystic acne, psoriasis, vitiligo, and more can lead to depression and anxiety. While a doctor may not be able to cure the skin condition, working with a mental health professional can help overcome depression, social phobias, and anxiety related to it.

To treat any disorder, a holistic, whole-body approach is often best.

How do anxiety and depression affect the skin?

So, how do anxiety and depression, the two most common U.S. mental health conditions, affect the skin?

“There are three basic ways the skin and mind intersect,” Howard explains. “Anxiety and depression can cause an inflammatory response, which weakens the skin’s barrier function and more easily allows in irritants. Skin can also lose moisture and heal more slowly,” she says. Inflammatory conditions are triggered.

Secondly, health behaviors change when anxious or depressed. “Depressed people might neglect their skin care, not keeping up with hygiene or using topicals they need to for acne, eczema, or psoriasis. Anxious people might do too much — picking and using too many products. As their skin reacts, they start to do more and more in a viscous cycle,” Howard says.

Finally, anxiety and depression can alter one’s self-perception. “When you’re anxious or depressed,” Howard says, “your interpretation of your skin can change drastically. All of the sudden that zit becomes a very big deal, which may lead to not going out to work or social events, and the avoidance of social activities can make anxiety and depression much worse.”

Using a holistic approach

Most psychodermatologists utilize a three-pronged approach composed of therapy and self-care education, medication, and dermatology.

For example, Howard worked with a young woman who had mild acne, severe depression and anxiety, as well as skin picking and body dysmorphic disorder. The first step was to address her skin picking and get her dermatological treatment for her acne.

Next, Howard treated her anxiety and depression with an SSRI and began CBT to find better methods of self-soothing than picking and tweezing. As her patient’s habits and emotional state improved, Howard was able to address the deeper interpersonal dynamics in the young woman’s life, which were causing much of her distress.

While psychodermatology is a somewhat obscure practice, more evidence is pointing to its efficacy in treating both psychological and dermatological disorders.

One study found that those who received six weeks of CBT in addition to standard psoriasis medications experienced greater reduction in symptoms than those on medication alone.

The researchers also found emotional stress to be the most frequent trigger for psoriasis outbreaks, more than infections, diet, medication and the weather. About 75 percent of participants reported that stress is a trigger.

The takeaway

Thinking back to our sweaty, red-faced public speaker, it’s no surprise that our emotions and mental states affect our skin, just as they affect other parts of our health.

This doesn’t mean you can think away your acne or resolve psoriasis without medication. But it does suggest that if you have a stubborn skin issue that won’t respond to dermatological treatment alone, it might be helpful to seek out a psychodermatologist to help you live more comfortably in the skin you’re in.


Gila Lyons’ work has appeared in The New York Times, Cosmopolitan, Salon, Vox, and more. She’s at work on a memoir about seeking a natural cure for anxiety and panic disorder but falling prey to the underbelly of the alternative health movement. Links to published work can be found at www.gilalyons.com. Connect with her on Twitter, Instagram, and LinkedIn.