Stress & Skin, brought to you by The American Academy of Dermatology

How the Mind Matters to Your Skin

How we feel on the inside could be affecting how we look on the outside. In fact, studies link factors that impact our emotional well-being — such as stress, depression and anxiety — to an increase in skin, hair or nail problems. Dermatologist and clinical psychologist Richard G. Fried, MD, PhD, FAAD, of Yardley, Pa., explains the reciprocal relationship between feelings and appearance:

Psychodermatology Interventions

• Stress can manifest itself on one's appearance in many ways, but primarily by making the skin more sensitive and more reactive.
  • For example, stress can make psoriasis or rosacea worse, result in acne lesions that are more inflamed and more persistent, cause brittle nails and ridging of the nails, cause hair loss, cause or worsen hives, and cause excessive perspiration.
  • Stress also is a known trigger or can be a worsening factor for fever blisters, psoriasis, seborrheic dermatitis and has even been shown to impair skin barrier function and dehydrate the skin — allowing more irritants, allergens, and infectious agents to penetrate the skin and cause problems.
• Beyond the direct physiological effects of stress, patients under stress also tend to neglect or abuse their skin. For example, they often lack the energy and motivation to adhere to their skin care regimens, and there also might be signs of stress-related behaviors — such as scratching, pulling or rubbing — that can exacerbate problems.
• Traditional dermatologic therapies should be used in conjunction with appropriate stress management therapies to successfully treat stress-related dermatologic conditions.
  • When dermatologists treat both the skin and stress, the skin often clears more quickly and completely as the influences of stress are diminished. This, in turn, can help decrease a patient's overall anxiety level, and the patient may start to feel better about how they look and how they feel emotionally.
• On a microscopic level, stress reduction can decrease the release of pro-inflammatory stress hormones and chemicals. For example, release of neuropeptides (or stress chemicals released from the nerve endings) can be reduced with stress management techniques. This often results in skin that looks and functions better.
  • These interventions can reduce blood vessel over-activity, resulting in less blushing or flushing.
• With accurate diagnosis by a dermatologist, effective treatments improve the appearance and function of the skin. This alone can substantially reduce patients' stress and improve their skin, hair and nail conditions. However, if stress is clearly interfering with patients' overall well-being and ability to cope, simultaneous stress management interventions are warranted. In some instances, referral to a mental health professional may be necessary.

Cosmetic Interventions

• While skin rejuvenation procedures have been shown to significantly improve a person's outward appearance, studies suggest these types of cosmetic interventions also can have positive effects on how people feel and how they function.
  • When people feel more attractive and more confident in their appearance, they tend to perform better in other areas of their lives — in their work, family life, social life, and marriage or personal relationships.
  • Under the right circumstances, cosmetic procedures can be a powerful ally, but it's important for patients to understand that these procedures are not a panacea.
• In a 2008 study designed to measure the positive ripple effects of botulinum toxin injections on other aspects of patients' lives, Dr. Fried found that patients treated with botulinum toxin clearly experienced substantial benefits. His key findings include:
  • 29 percent reported feeling less anxious
  • 36 percent said they feel more relaxed
  • 49 percent were more optimistic
• A previous study conducted by Dr. Fried evaluating the clinical and psychological effects of the use of alpha hydroxy acids (AHAs) found that patients demonstrated significant improvements in facial skin tone and fine wrinkling, and reported satisfaction with their physical appearance and the quality of their interpersonal relationships.

For more information on the effects of stress on skin, hair and nails, visit the American Academy of Dermatology's website at www.aad.org.

November 2008