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Most everyone has heard of the gut-brain connection, in which the gut and brain communicate back and forth with each other. In fact, the gut-brain connection has been well established in multiple studies for decades. But what about the mind-skin connection?
Could psychodermatology be the key to understanding the intricate interplay between emotions and the epidermis? What is psychodermatology, and how may this emerging field be a game changer regarding skin health?
Psychodermatology is an emerging field that intersects with the study of the skin and the mind. It incorporates dermatology, which involves understanding and treating skin conditions, such as vitiligo, acne, and rosacea, with psychology and psychiatry, which seek to comprehend the mind and its disorders, such as depression, anxiety, and schizophrenia, among many others.
Despite the view that psychodermatology is a new and rising discipline of medicine, it was first eluded to in ancient Greece during the time of Hippocrates. In his written works, Hippocrates acknowledged the connection between stress and the skin. He even mentioned cases in which people would tear out their hair specifically due to emotional stress.
In more recent times, the book Diseases of the Skin, written by William James Eramus Wilson in the 1850s, introduced a more in-depth look into psychodermatology to the world. Wilson wrote about “skin neurosis.” Skin neurosis is technically defined as a condition affecting the skin caused by a mental disorder with no organic cause.
Wilson noted that mental disorders were linked to such skin diseases as skin lesions that were lighter in color than the surrounding skin of the area; alopecia areata or patches of hair loss resulting in baldness; and even delusions of parasites in the skin, causing itching. He even linked hyperhidrosis, a condition in which there is excess sweating, to such mental disorders as anxiety, fears and phobias, and depression.
In modern times, psychodermatology has been linked to another emerging field, psychoneuroimmunology, which studies how emotional and mental disorders, such as stress, can affect the immune system and the skin.
Many researchers and clinicians divide psychodermatological disorders into three categories: psychophysiological disorders, primary psychiatric disorders, and secondary psychiatric disorders.
Psychophysiological disorders are skin disorders that react to emotional conditions such as stress. Skin conditions that would fall under this category include eczema and psoriasis.
Primary psychiatric disorders are conditions of the mind that result in self-afflicted skin disorders. This would include conditions such as trichotillomania. Trichotillomania is a condition that involves pulling hair out of various parts of the body, such as the scalp or the eyelashes, due to extreme stress or other mental disorders.
Secondary psychiatric disorders involve skin disorders that cause disfigurement and result in social phobias and low self-esteem.
Clearly, there is a well-documented history of psychiatric and psychological disorders manifesting in the skin and the other way around. This suggests a distinct connection exists between the mind and the skin.
While the gut-brain connection has been studied extensively and received a lot of interest in recent years, there has been less buzz about the mind-skin connection. In fact, the belief that the body is interconnected has only started gaining acceptance in modern medicine.
Interconnectedness means that no part of the body acts or suffers in isolation to another. If one part of the body is out of balance, then another part of the body may be affected as well. This means that an imbalance in the gut microbiome can affect the health of the brain, and a mental disorder such as anxiety can affect the integrity and health of the skin.
But why a connection between the mind and the skin? Psychodermatology gives us some insight into this question.
Psychodermatology recognizes that both the skin and the nervous system, which includes the brain, come from the same origin. During the embryonic, or early stage, of human development, the layer of the embryo called the ectoderm eventually gives rise to both the skin and the nervous system. This common link between both the origin of the skin and nervous system helps to explain the connectedness of the mind and skin.
Research also indicates that the physiological connection between the mind and the skin may arise from a special type of cell called Merkel cells. Merkel cells are specialized cells located below the outer layer, or epidermis, of the skin called. These cells are responsible for the sensation of touch, and they are closely linked to nerves that relay the sensation of touch to the brain.
Merkel cells may also be involved in releasing neurotransmitters, or chemical messengers, into the body. One in vitro, or test tube, study found that the size of the Merkel cells in the skin increased with inflammatory skin conditions.
Psychodermatology also gives more insight into the mind-skin connection by studying the effects of stress on the body. One study found that acute emotional stress may lead to an increase in activation and degranulation of mast cells. Mast cells are white blood cells that contain histamine. When they are activated, they release granules of histamine (degranulation) into the blood, causing increased itching and swelling in the skin.
Research continues to indicate that there is a very distinct mind-skin connection. In fact, research indicates that mental disorders are fairly common in those who suffer from skin conditions. For example, one study found that children with eczema had a significantly higher risk of developing attention-deficit/hyperactivity disorder than children without eczema.
Another study found that individuals with sensitive skin had a greater association with anxiety and increased skin reddening. Yet another study found that individuals suffering from major depression disorder were at a 64% increased risk of developing vitiligo, a skin condition that involves the loss of skin color in a patch-like pattern. Research has also linked vitiligo to anxiety. For instance, approximately 36% of individuals diagnosed with vitiligo also had anxiety.
Even acne has been linked to emotional stress in psychodermatology. Research suggests that an increase in stress can lead to more severe acne breakouts. One study following female medical students found that a greater perception of stress led to a more severe acne breakout.
Studies indicate that up to 40% of individuals who seek treatment for skin-based conditions also have an underlying psychiatric disorder that contributes to or worsens their skin condition. This is why psychodermatology focuses on addressing both the mind and skin to the benefit of the individual.
Studies in psychodermatology have focused on a number of different modalities to help improve both the skin and mental health condition of the individual. Some of the modalities studied include N-acetyl cysteine (NAC), inositol, stress reduction techniques, and vitamin B12.
For example, studies suggest that the administration of NAC may benefit repetitive behaviors like compulsively scratching the skin or pulling out the hair. One double-blind placebo-controlled study involving 50 individuals with trichotillomania found that NAC significantly decreased the severity of the hair pulling when compared to that of placebo.
N-acetyl cysteine (NAC) is a synthetic form of the amino acid cysteine, which is needed for making proteins like beta-keratin, which is found in hair and skin. A case study involving NAC use in a female with trichotillomania found that she was able to completely regrow her hair within 3 months of supplementation.
Another study involving skin excoriation, a disorder that causes individuals to excessively pick at their skin, found that inositol helped to reduce the severity of skin picking. Inositol is a type of sugar found throughout the body and brain that helps to influence the mood and brain function.
Studies also suggest that reducing anxiety may help to directly improve skin health. Research indicates that mind-body therapies, such as meditation and mindfulness-based stress reduction, helped to moderately improve the sensation of itchiness and the desire to scratch in adults with eczema and psoriasis compared to a placebo group.
Research also suggests that using vitamin B12 as a supplement topically or orally may play a beneficial role in the mind-skin connection. For example, one double-blind, placebo-controlled, randomized trial used topical vitamin B12 on eczema lesions in children. The study found that topical vitamin B12 was superior to placebo in improving eczema at a 4-week follow-up. Another case study found that B12 supplementation helped to improve eczema in an 18-year-old male who needed considerable amounts of topical steroid treatment due to the severity of his condition.
Interestingly, studies have linked B vitamins, especially vitamin B6 and B12, to a positive increase in overall mood and a decrease in the perception of stress.
Psychodermatology is an emerging science based on the interconnectedness of the mind and the skin. An approach to the mind-skin connection using psychodermatology may be the way of the future to promote healthy, youthful-looking skin and a sound mind. The study of psychodermatology may even promote longevity by focusing on skin manifestations of mental health as an early sign of the body’s response to stress.
By addressing the effects of the mind on the skin and vice versa, a psychodermatological approach may be the key to a complete anti-aging routine for both the mind and the skin.
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By Dr. Candace Mathers, N.D.
