Before the teeth, the fingers, and the toes that make us human, there is but the humble embryo. Within that single embryo are three layers: the endoderm, mesoderm, and ectoderm, where our story begins. From that germ-rich goodness eventually comes the stuff of the nervous system, skin, and brain cells. Even once separated by muscle, bones, and other bodily goo, the brain-skin bond remains for life.
After all, the skin is quite literally the protective barrier between our internal being and the outside world; more poetically, the skin is the keeper of the soul. In many ways, the opposite is also true.
The mind-skin connection has been studied since the 17th century, when The Anatomy of Melancholy noted an association between depression and the urge to itch. The field of psychodermatology is growing fast and furiously, according to psychodermatologist Dr. Mohammad Jafferany, a professor at Central Michigan University and the president of the Association for Psychocutaneous Medicine of North America. Its findings increasingly prove that the skin is particularly sensitive to stress and anxiety. Like a merry-go-round straight out of hell, the relationship between stress and the skin is a vicious cycle of doom.
The beauty industry is taking notice: A Clinique study last June explored the link between skin and emotional wellness, and a crop of new brands are focusing on the skin-mind connection. Formulas packed with adaptogens, plant neuroactives, and essential oils aim to “reduce the emotional toll of time on our facial features,” as Neuraé, a new skin-care brand from Sisley Paris, puts it. Is the cure to stress as simple as an ashwagandha-laced serum?
It all comes down to that pesky hormone cortisol, which is released in the body during times of emotional distress. “With higher levels of cortisol in your bloodstream, which your skin is going to feed off of, you can start to see changes in the skin,” explains Dr. Teresa Song, a board-certified dermatologist in New York. This, in turn, can disrupt the skin’s barrier function and impact the healing process—which isn’t great for anyone but can be particularly problematic for those with chronic skin conditions such as rosacea, eczema, acne, and psoriasis. A spike in cortisol increases inflammation in the skin, spurring more frequent, longer-lasting flare-ups with more severe symptoms.
The National Institutes of Health estimates that these inflammatory skin conditions may affect as many as one in three Americans at any given time. Whether fleeting (like contact dermatitis) or forever (psoriasis, rosacea), they come with baggage.
“Dermatology is special because you have to wear your disease,” says Dr. Corey L. Hartman, a board-certified dermatologist in Alabama. “You don’t necessarily wear your heart disease or your diabetes, but your skin disease is there for everybody to see. That can be emotional.”
While stress and anxiety can cause or exacerbate trouble, those very skin conditions can cause stress and anxiety—which then can further provoke issues. The dreaded merry-go-round begins. And we haven’t even touched on psychological disorders with very real dermatologic symptoms, such as trichotillomania (a hair-pulling disorder) or skin picking.
When dealing with such disorders, psychodermatology really shines. “These conditions are treatable,” Dr. Jafferany assures. “But the focus should be on a holistic approach.” This could be as simple as bridging the gap between dermatologists and psychologists, or as complex as a panel of skin and brain doctors. Dr. Jafferany is also a fan of support groups, including the TLC Foundation for Body-Focused Repetitive Behaviors and the National Psoriasis Foundation.
But our merry-go-round doesn’t stop just there. Stress, along with the associated inflammation and barrier disruption, impacts everyone—not just those with skin conditions. According to research from the Sisley Group Laboratories, stress can result in weakened muscle tone in the face, tension in the brow and jaw, and visible frown and worry lines. Meanwhile, sadness can actually lead to a dull complexion.
There are also longer-term effects to consider. “Cortisol speeds up the breakdown of collagen and elastin, which are great support structures in your skin,” Dr. Song says. “Overall, you can see a more accelerated aging process with more wrinkles developing.” If hate makes you ugly, stress may well make you old.
Perhaps the early signs of aging in skin cause you to become more anxious about that very thing. That anxiety, in turn, spews cortisol into the bloodstream; the hormone eventually reaches the skin cells, where it slowly breaks down the skin barrier and eats away at your precious, depleting collagen. The damn merry-go-round spins on.
An anxious thought does not beget a wrinkle—it’s a process, like any other, influenced by God knows how many other factors. But the message is clear: stress is not good for the skin.
For the superficially inclined, the beauty industry, in all its infinite glory, is famous for turning insecurities into profits. Skin-care favorite Youth to the People offers an Adaptogen Deep Moisture Cream that utilizes a blend of plant and mushroom extracts beloved by functional-medicine doctors for their ability to relieve stress in the body. I’ve finished several jars of the cream myself, and while it keeps my skin plump through a cold winter day, I can’t say I’ve noticed much else.
Meanwhile, personal-care brand Selfmade fuses psychology and skin care into all its offerings, with creams that claim to combat the cycle of stress and a balm that boasts of reducing muscle tension and inflammation. If it were only that easy.
“Putting a cream on, it’s not going to stop the stress,” Dr. Hartman explains. “It might calm down the inflammation that came from the stress, but I tell patients they need to get control of the emotions that are causing it.”
Plenty of studies extol the calming benefits of aromatherapy as well as adaptogens. Menthol, found in Selfmade’s Rumination Recovery Balm, can induce vasodilation, which in turn can lower blood pressure and, according to Dr. Jafferany, induce a feeling of relaxation. “Now, the thing is with applying a cream, how much?” he says. “What is the actual strength? How many milligrams are you giving to the skin? All these things, they still need a lot of research.”
For now, I’ll be sticking to Lexapro for my anxiety, dapsone gel for acne, and an L.E.D.-light mask for inflammation. I like to think of them as my own form of psychodermatology, a private, soothing, and remarkably effective support group.
Danielle Cohen is a New York–based beauty writer whose work has appeared in Elle, Allure, Glamour, and Cosmopolitan, among other publications
