The role of mental health in skin treatments

Psychological disorders like stress, anxiety and depression often manifest as physical symptoms like acne, rosacea or eczema

The general belief is that once the hormonally charged teenage years are over, one can happily bid adieu to acne. However, many women and men in their late 20s and early 30s who have never had any major skin problem during their teens are witnessing episodes of mild to severe acne.

While pollution could trigger skin irritation and pimples, even those with low levels of outdoor exposure complain of acne and dark patches.

Many studies in the relatively new field of psychodermatology have linked acne and other skin problems to psychological disorders and factors. Stress, depression, anxiety and other psychological conditions can contribute to skin diseases like acne, rosacea, eczema, psoriasis, alopecia, telogen effluvium (hair fall) and vitiligo.

Experts believe that a cluster of skin diseases could be the somatization (the tendency to experience psychological distress as physical or organic symptoms) of disorders like low self-esteem, feeling of shame and lack of interest.

When it comes to skin diseases caused due to the clogging of pores, stress takes the lead as a causal factor. Studies have found that when the body is stressed, it tends to generate more skin sebum.

The skin sebum is an oily discharge that causes clogged pores. Some studies also point to a causal link between stress and cold sores caused by the herpes simplex virus on and around the lips.

The link between skin diseases and mental health has long been ignored.

Dermatologists often prescribe hormone treatment for acne. This is because increased levels of testosterone in women can cause painful and stubborn acne problems. Some studies have shown the relationship between depression in women suffering from low and high levels of testosterone secretion.

Similarly, there are studies to back the hypothesis that stress is a major cause of skin problems. One of the most valid and reliable findings of biological psychiatry is the activation of the hypothalamic-pituitary-adrenal (HPA) axis, in a subtype of patients with major depressive disorders.

Activation of the body’s flight and fight mode leads to the secretion of cortisol. Under normal circumstances, cortisol is important for coping with stress. However, activation of the HPA axis for longer periods and its excessive secretion have a damaging impact on the health of our skin and hair. People who work in stressful situations may experience more acne breakouts. The skin’s sebaceous glands generate more sebum (oil) under stressful conditions.

Not just acne, stress hormones can also exacerbate eczema, psoriasis or rosacea and even accelerate the ageing process, visible through symptoms like wrinkles, dark circles, patches and skin dullness.

Often the hormonal disbalance-depression/stress-skin problem cycle is a self-sustaining loop. While mood disorders can trigger skin problems, the latter can negatively impact one’s self-esteem aggravating anxiety, stress and depression.

For instance, recently, a friend suffered a severe acne attack when she was going through a difficult financial situation. She went to a dermatologist and was put on birth control pills (hormone therapy). While it cleared the acne, she got mood swings, lethargy and gained weight. Once she stopped taking the pills, the pimples reappeared.

Her breakouts started reducing when she started meditating every day, gained emotional stability and became less anxious. She ate healthily, exercised and lost weight. Her skin healed as she recovered emotionally and physically.

That’s why skin treatment is not just about medicines but also home remedies, mindful living, therapy, and, most importantly, maintaining inner peace and joy.

(Dr Deepali Bhardwaj is one of Delhi's renowned practising dermatologists)