Dermatological psychology lives at the intersection of psychiatry and dermatology, studying how a person’s mental and emotional health relates to their skin, and vice versa. With only a handful of clinics established across the United States, dermatological psychology is still a fairly new concept in skin care in the US, which makes sense: When most people have skin problems, they will make an appointment with a dermatologist, and when they have a mental health concern, they make an appointment with a licensed mental health practitioner—rarely the two work together.
But over the past few years, as the conversation around mental health has come to the fore, so has our awareness of its impact on our skin — and psychological dermatology. appeared to help us clarify them. Keep reading for what you need to know.
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Unpacking the connection between brain and skin
The brain-skin connection begins before we are born. Our skin and central nervous system are made of the same cells in the uterus and maintain a physical connection to nerves and blood vessels throughout our lives, says Amy Wechsler, MD, doctor board-certified psychiatrist and dermatologist and explanatory book author. The Mind-Beauty Connection.
“We know that there is a very complex interaction between the skin and the neuroendocrine systems,” says Evan Rieder, MD, a dermatologist and psychiatrist based in New York City. . However, we are still working out the details of all of that.
While much remains to be learned about how these systems work together, one of the most well-studied areas of dermatology to date involves stress, which is known to worsen depression. aggravate some skin conditions. When you’re stressed, it pushes your body into a fight-or-flight mode and triggers a burst of cortisol (also known as the stress hormone), which clears your mind and boosts your energy. can better navigate stressful situations. While a quick spike in cortisol is okay, chronic stress can cause your baseline levels to go off-limits. When this happens and your cortisol levels spike over the long term, it can cause a host of stress-related skin problems.
“The hormones that help our bodies prepare for stressful situations are also known to stimulate our oil glands. This leads to increased sebum production and inflammation, which leads to stress breakouts,” says Joshua Zeichner, MD, a board-certified dermatologist based in New York City. “We know that stress has a significant impact on the skin, weakening it. barrier function, slows wound healing, and aggravates many skin conditions, including acne and rosacea. Stress can also lead to facial flushing and rosacea, which flare up with worsening atopic dermatitis, including red, scaly, rash, and itchy skin.
From there, it becomes a vicious cycle. Your stress affects your skin, which affects your self-esteem (acne and eczema, for example, have been linked to increased cases of anxiety and depression), thereby creating more stress. “For better or worse, your skin can affect how you feel,” says Jeshana Avent-Johnson, Psy.D, psychologist and licensed consultant for Selfmade, a dermatological psychologist. about yourself and how you are ready to present to the world.” based on skin care brand. “Not wanting to be seen physically can also lead to not wanting to be seen emotionally.”
Where does psychology come from?
Psychodermatological conditions generally fall into one of three categories: psychophysiological, primary psychiatric, and secondary psychiatric. Psychosomatic disorders are skin conditions that are made worse by stress (such as eczema or acne, in response to the spike in cortisol mentioned above). Primary psychosis is a skin condition that is essentially psychological but has dermatological manifestations such as hysteria and obsessive-compulsive disorder. And secondary psychosis is a skin condition that starts with the skin, but has profound psychological effects (like cystic acne and vitiligo). While these conditions can vary in severity, it’s worth noting that making an appointment with a dermatologist doesn’t necessarily have to be a particularly intractable skin condition—even as common as acne can also benefit from this type of specialized treatment.
So how realistic is this “specialist”? Because skin and mental health are so closely linked, dermatology psychology uses a two-pronged approach to address both issues for optimal results. Unlike a traditional dermatologist, a dermatology appointment will likely include a series of in-depth questions about your lifestyle in addition to a skin exam.
“If you came to me about a rash, I wouldn’t just ask about your skin,” says Dr. Wechsler. With each new patient, she makes sure to ask about their sleep schedule, mood, relationships, etc.
Making an appointment with a dermatologist doesn’t necessarily mean that you have a particularly intractable skin condition—even a common condition like acne can benefit from this type of specialized approach.
As for the treatment, Robert Tausk, MD, a board-certified dermatologist who specializes in dermatological psychology and a consultant for LOUM Beauty, describes the three-part process. The first pillar includes comprehensive dermatological medical treatment, the second pillar is stress reduction and lifestyle changes, the third pillar focuses on topical treatments to address the effects of stress on the skin. This means that standard care may include a combination of traditional dermatological treatments, such as oral and topical medications, combined with psychological interventions, such as talk therapy. , meditation, support groups, and in some cases hypnosis.
Should you see a psychological dermatologist?
“If you are at a point where you have exhausted all medical options and your skin still flares up, or maybe you are suffering from depression related to your skin condition and it is affecting your quality quality of your life, it’s time to think about something else. Dr. Rieder said.
For many patients, addressing skin conditions with psychodermatology can be life-changing. Josie Howard, MD, says: “Patients who have a psychological factor to their skin condition respond faster, stronger, and more sustainably to a combination of dermatological and psychological treatments. therapy and possibly psychiatric drugs that treat the whole person,” says Josie Howard, MD. a psychiatrist in San Francisco with expertise in dermatological psychology,
However, for the average patient, finding psychodermatological care can be challenging. With only a few providers in the United States and difficulties with insurance, getting this type of treatment is time-consuming and expensive.
“There are very few trainees and limited training opportunities for physicians interested in this field,” said Dr. Howard. “Not to mention, there is so much stigma around seeking mental health care.”
Also, “a lot of insurance companies don’t pay for this type of treatment,” says Dr. Rieder, “It could be billed as a psychiatric or dermatological visit but given the amount of work it takes. Essentially, a lot of people do not accept insurance in this area. If they do, they cannot afford to keep their business running.”
In the future, as the line between skin and mental health becomes increasingly central to the beauty conversation, psychodermatological treatments have the potential to become more accessible. “[Hopefully] Dr. Howard said there will be more mental health providers working in dermatology offices for easier access to patients and better coordination of care between providers.
Until then, brands like Selfmade and Loum—founded on dermatological principles at their heart—are working to provide people with the products and resources they need to tackle the problem. stress skin problems at home. While serums or moisturizers can’t replace seeing a specialist, for those who don’t get psychological dermatology care, they maybe helps to minimize some of the effects of stress on the skin. Practicing self-care that lowers your stress levels can also help improve the condition of your skin.
It all means, if you are facing any of the above problems, know that you are not alone and there are to be resources out there that can help.
