Exploring the mind-skin connection

We've heard of the effect of stress on our physiological health, but experts say that it affects not only our internal organs, but also our skin. We spoke to Dr Anagha Kumar, an international fellow at the American Academy of Dermatology to understand the connection between our mind and skin. 

What exactly is the connection between the brain and the skin?

There is a strong physical connection between the brain and the skin. It can be traced to the first few days of our life, when the embryo is developing. The brain and the skin are essentially formed from the same group of cells—the ectoderm layer, thus establishing a fundamental physiological connection between the skin and the brain.

Does the skin reflect what the mind feels?

The fact that we blush when we are embarrassed is in itself a sign that the skin reflects what the mind feels. Similarly, the skin responds to mental stress also.

Scientifically speaking, what's the effect of stress on skin?

Scientific research points to the fact that chronic stress can interfere with the immune system, thus affecting the skin's ability to heal. Also, the skin's immune cells are influenced by the brain and nervous system through receptors and chemical messengers called neuropeptides. Scientists are studying these and other substances in the skin and how they respond to psychological stress. There's growing evidence that chronic stress can aggravate certain skin conditions.

Which means that mental health issues can cause the skin to react?

Dermatological diseases can have psychiatric symptoms and some psychiatric conditions can have skin manifestations. At the same time, some skin conditions like acne and psoriasis can actually get aggravated by mental stress. So there's a lot of skin-mind interaction in that sense. These are called psychodermatologic disorders.

Can you briefly tell us about psychodermatologic disorders?

Yes, psychodermatologic disorders are those conditions that involve an interaction between the mind and the skin. They can be grouped into three categories:

1. Psychophysiologic disorders: These are skin problems that have a physiological basis but can be aggravated by stress and other emotional factors. Example: Eczema and psoriasis

2. Psychiatric disorders with dermatological symptoms: Example: Trichotillomania : Chronic hair-pulling Delusions of parasistosis: Where the person feels that he's manifested with worms and parasites although he's not Body dysmorphia: Where the person is preoccupied with an imagined body defect

3. Dermatological disorders with psychological symptoms: Where emotional problems manifest as a result of having certain skin conditions. Stigma is often the cause of stress in these situations. Example: vitiligo, psoriasis, albinism, eczema:

4. Miscelllaneous: Medication-related adverse effects of both psychiatric and dermatological medications fall under this category.

Do you sometimes feel that people tend to be anxious about even common, harmless skin conditions?

A lot of adolescents are stressed about acne. They want to get rid of it as soon as possible. They are concerned about scarring and about how fast they could be pimple-free. Not knowing what's happening can in-turn cause unnecessary stress and anxiety. Actually, acne is one of the manifestations of changing hormones and most individuals experience it once in their lifetime. It will regress by the age of 25-30. And worrying too much about it and pricking lesions will only make it worse.

Do worries and anxieties about certain skin conditions in turn add to the stress, making it a vicious cycle?

Yes, many who come in with acne, grey hair, scars or vitiligo develop low self-esteem because of the change these conditions cause their external appearance. Some are saddened or angry when a diagnosis of certain skin conditions is made. They are concerned about how society would treat them. At such times, it is very important to spend time with them. It's the duty of the treating physician to educate them about the condition, the treatment options and the course of the disease. More importantly, the doctor needs to counsel them, educate them and refer them to support groups.

What would your advice be to people who are unduly worried?

Helping people understand these conditions would enable them to take better care of themselves. Also, it's important to explain to them and educate them about the disease or condition. For example, 90 per cent of the world's population experiences acne at least once in their lifetime. It's important to be aware of these facts and not feel stressed about it unnecessarily.