What do your skin and mental health have in common? More than you think. Here, we take a closer look and talk to the experts.

Living with a skin condition such as eczema, rosacea, psoriasis or acne can be difficult enough, but in recent years, studies have shown that people who have one of these skin disorders are also, in severe cases, more likely to suffer from, or are at a higher risk for developing, psychological issues. Understanding the connection between your skin and mental health is the first step toward relief, and luckily, there's a field of medicine that bridges the gap between psychology and dermatology.

Psychodermatology provides folks with solutions for their skin conditions while helping them through their own emotional stressors. Read on to learn about the practice and hear from the experts about what you can do to treat your skin and your mood.

How your brain affects your skin—and vice-versa

We've all been there: breaking out during our periods or when we're super stressed out. But for anyone who has ever had a chronic skin condition—acne, rosacea, eczema, dermatitis or vitiligo, for example—finding a treatment can be mentally and emotionally draining. A 2018 study in the British Journal of Dermatology shows that people with acne are more likely to develop depression, and a 2014 survey by the Illinois-based National Rosacea Society of 1,675 patients with rosacea (which causes facial redness and related symptoms) demonstrated that 90 percent of the respondents reported lowered self-esteem and self-confidence. While most skin conditions aren't contagious or life-threatening, many are visible—on the face, the chest or the arms, for instance—and socially stigmatizing.

Dr. Julie Powell, pediatrician-dermatologist at Centre hospitalier universitaire Sainte-Justine in Montreal and past-president of the Canadian Dermatology Association, notes that there are many aspects to skin conditions, including the impact of the disease itself on the psychology of the person and how the skin condition can or will interfere with the person's relationships, self-esteem, socialization or, in severe cases, attempts to find work. "All too often, skin diseases are perceived to be more benign because they're not necessarily life-threatening," says Dr. Powell, explaining that people may ignore taking care of them because they think the conditions are solely a cosmetic concern and don't consider the mental and emotional impacts. With more and more individuals coming forward with their stories, Dr. Powell hopes that people will get to know their choices, noting, "We now have many good treatment options for a lot of skin disorders." There are also rare instances when the skin disease is a result of an underlying psychological disorder or worsened by stress or trauma. In these situations, there's usually a clear association between the stress and the exacerbation of the disease. In cases of psoriasis, for example, patients often report feeling stress before the initial flare-up, then disturbances of body image attributed to the flare-up itself. It's a vicious cycle of stress causing a flare-up, which leads to stress and poor self-esteem, then more flare-ups.

The benefits of treating your skin by treating your brain

Psychodermatology explores the relationship between our skin and our mood. Dr. Benjamin Barankin, medical director and founder of the Toronto Dermatology Centre, notes that the field has been around for more than 25 years, although there are currently just five psychodermatologists found in the U.S. and none in Canada. (The practice is well established in Europe.) "Dermatologists want to treat people's skin issues seriously, promptly and with the right care because we know that not only can we improve their skin condition but we can also make them feel better," says Dr. Barankin.

The aim of psychodermatology is not to substitute psychotherapy for medicine but, rather, to recognize that emotional issues may also be involved, especially when a condition resists conventional treatment. While it's important to evaluate and treat a skin problem medically before looking into its psychological aspects, sometimes a drug or other medical approach that doesn't work on its own becomes more effective when combined with psychological strategies.

Psychodermatology practitioners treat skin the way a psychotherapist treats behaviour—by learning how it responds to emotional and environmental stressors and helping moderate those responses. Some treatment plans can include medication, therapy and/or stress-reduction techniques. Patients may also be introduced to cognitive behavioural therapy, meditation and hypnosis to help reduce stress and, in turn, improve their skin conditions. Each person's treatment plan is subjective based on his or her condition and the recommendations of the person's medical team. So although you may feel trapped by your skin disease, take a deep breath and know that there are solutions to manage the breakout and improve your mood, too.

3 psycho-dermatologic disorders to know about

1. Psychophysiological: Skin problems that are physiological in basis but can be exacerbated by stress and emotional factors: acne, eczema, dermatitis, psoriasis, rosacea, urticaria (hives).
2. Secondary Psychiatric: A cosmetically disfiguring or potentially socially stigmatizing skin disorder, which can produce feelings of shame, poor self-esteem, depression and anxiety: acne, vitiligo, psoriasis.
3. Primary Psychiatric: Symptoms of psychiatric disorder: trichotillomania (chronic hair pulling), body dysmorphia (distress about an imagined or minor defect), dermatitis artefacta (self-inflicted damage to skin).

How to manage psychodermatologic disorders

Although there's no one-size-fits-all treatment plan when it comes to skin conditions, there are a few things you can do to manage these disorders.

1.  Watch what you eat.
   The food we put into our bodies can make a big difference in our skin. Calgary-based registered dietitian Grace Wong explains that "dietary changes may help alleviate the symptom if a food intolerance is involved," noting that some skin conditions like eczema may be triggered by food intolerances. In some cases, drinking lots of water and eating a diet rich in anti-inflammatory foods will help maintain healthy skin.
2. Treat your skin with TLC.
   Some cosmetics, detergents or skin-care products may trigger a reaction, so determine if your skin is sensitive to specific ingredients by reading labels and patch-testing new products before applying to a larger area. Choose unscented products formulated for sensitive skin. Remember to gently pat your skin dry with a towel rather than rubbing or wiping. If you have sensitive skin, speak to a dermatologist about what products are best for you.
3. Minimize triggers.
   Protect yourself from the sun by using an SPF 30 or higher; don't scratch or pick at your skin or breakouts; wash your hands often; use a cool-mist humidifier at night to help remedy dryness; and stop smoking.
4. Try mindfulness.
   Stress-management techniques such as meditation and yoga, which help you focus on something, like your breathing, can help calm your mind and alter brain activity. In addition, recent studies have shown that meditation can suppress the response of inflammation-promoting genes. Sign us up!