Psychodermatology lives at the intersection of psychiatry and dermatology, studying how one’s mental and emotional health relates to their skin, and vice versa. With only a handful of established clinics across the U.S., psychodermatology is still a fairly new concept in American skin care, which makes sense: When most people have skin problems, they make an appointment with a dermatologist, and when they have mental health problems, they make an appointment with licensed mental health practitioner—it’s rare for the two to work together.
But over the past few years, as the conversation about mental health has moved to the forefront, so has our awareness of its impact on our complexions—and psychodermatology has emerged to help us keep them in the clear. Read on for what you need to know.
Unpacking the brain-skin connection
The connection between the brain and the skin begins before we are born. Our skin and central nervous system are created from the same cells in the womb and remain physically connected by nerves and blood vessels throughout our lives, explains Amy Wexler, MD, a psychiatrist and dermatologist and author of The connection between mind and beauty.
“We know that there is a very complex interaction between the skin and the neuroendocrine systems,” echoes Dr. Evan Reeder, a dermatologist and psychiatrist based in New York City. “But we’re still working out the details of all that.”
Although there is still much to learn about how these systems work together, one of the most well-studied areas of psychodermatology to date concerns stress, which is known to exacerbate certain skin conditions. When you’re stressed, it pushes your body into fight-or-flight mode and triggers a burst of cortisol (known as the stress hormone), which sharpens your mind and boosts your energy so you can better navigate a stressful situation. While a quick spike in cortisol is fine, chronic stress can throw your baseline levels out of whack. When this happens and your cortisol is elevated for long periods of time, it can cause a whole host of stress-related skin problems.
“The same hormones that prepare our bodies for stressful situations are also known to stimulate our sebaceous glands. This leads to an increase in sebum production and inflammation, which translates to stress,” says Joshua Zeichner, MD, a dermatologist based in New York. “We know that stress has a significant impact on the skin, it damages the skin. barrier function, slowing wound healing and worsening various skin conditions, including acne and rosacea. Stress can also lead to facial redness and rosacea, burns along with worsening atopic dermatitis, including red, scaly, rashy 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, are linked to increased cases of anxiety and depression), which in turn creates more stress. “For better or worse, your skin can affect the way you feel about yourself and how you’re willing to appear in the world,” says Jeshana Avent-Johnson, MD, licensed psychologist and consultant for Selfmade, Psychodermatology. based skin care brand. “Not wanting to be seen physically can result in not wanting to be seen emotionally.”
Where psychodermatology comes in
Psychodermatological conditions usually fall into one of three categories: psychophysiological, primary psychiatric, and secondary psychiatric. Psychophysiological disorders are skin conditions that are exacerbated by stress (like eczema or acne, which react to that cortisol spike mentioned above). Primary psychiatric disorders are skin conditions that are fundamentally psychological but have skin manifestations such as trichotillomania, a hair-pulling disorder that falls under the obsessive compulsive umbrella. And secondary psychiatric disorders are skin conditions that start with the skin but have 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 psychodermatologist isn’t a requirement for having a particularly severe skin condition—even something as common as acne can benefit from this type of specialized treatment.
So what does this “specialized treatment” look like in practice? Because skin and mental health are so closely related, psychodermatology takes a two-pronged approach to address both for optimal results. Unlike a visit to a traditional dermatologist, a psychodermatology appointment will likely include an in-depth line of questioning about your lifestyle in addition to a skin exam.
“If you come to see me about a rash, I’m not just going to ask about your skin,” says Dr. Wexler. With each new patient, she attends to their sleep schedule, mood, relationships and more.
Making an appointment with a psychodermatologist doesn’t require you to have a particularly severe skin condition—even something as common as acne can benefit from this type of specialized approach.
As for treatments, Dr. Robert Tausk, a board-certified dermatologist who specializes in psychodermatology and serves as an advisor to LOUM Beauty, describes the process as threefold. The first pillar includes comprehensive dermatological medical treatment, the second is about stress reduction and lifestyle changes, and the third focuses on topical treatments to address the effects of stress on the skin. This means that standard care may include a mix of traditional dermatological practices, 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 psychodermatologist?
“If you’re at a point where you’ve exhausted all medical options and your skin is still burning, or maybe you have depression related to your skin condition and it’s affecting your quality of life, it’s time to think about what else is going on out there and look at alternative treatments,” says Dr. Reeder.
For many patients, addressing skin conditions with a psychodermatology approach can be life-changing. “Patients who have a psychological component to their skin condition respond more quickly, more robustly, and more sustainably to a combination of dermatologic treatment along with psychotherapy and possibly whole-person psychiatric medications,” says Josie Howard, MD. a psychiatrist from San Francisco with expertise in psychodermatology,
However, for the average patient, seeking psychodermatological care can be challenging. With only a few providers in the US, along with insurance difficulties, getting this type of treatment is time-consuming and expensive.
“There are very few practitioners and limited training opportunities for doctors who are interested in this area,” said Dr. Howard. “Not to mention, there’s also a lot of stigma around seeking mental health care.”
Moreover, “many insurance companies do not pay for this type of treatment,” says Dr. Reeder, “It can be billed as a psychiatry or dermatology visit, but with the amount of work required, many people do. do not accept insurance in this area. If they did, they couldn’t afford to keep their business open.”
In the future, as the line between skin and mental health becomes more central to the beauty conversation, there is the potential for psychodermatological treatments to become more accessible. “[Hopefully] there will be more mental health care providers working in dermatology offices for easy access to patients and better coordination of care between providers,” says Dr. Howard.
Until then, brands like Selfmade and Loum—which were founded with psychodermatology principles at their core—are doing their part to give people the products and resources they need to tackle their stressful skin concerns at home. While a serum or moisturizer can’t replace an appointment with a professional, for those who don’t have access to psychodermatological care, they can. can help alleviate some of the impact of stress on the skin. Self-care practices that reduce stress levels can also help improve the condition of your complexion.
All to say, if you are dealing with any of the above, know that you are not alone and out there everything resources out there that can help.