Despite a popular embrace of self-care and the growing awareness of trauma-like symptoms stemming from COVID, one facet of mental health remains widely overlooked: the way our emotional state affects our skin.

Although most of us don’t think about it regularly, our mental state impacts our bodies from head to toe, and the skin—the largest, most visible organ of the human body—is not an exception.

Over the last two decades, numerous studies have linked emotional stress, depression, and anxiety to many dermatological conditions. Repeated exposure to psychological or environmental stressors can have lasting effects on the skin. Stress may cause the release of hormones such as cortisol and adrenaline into the body, which can cause inflammation and make the skin more reactive. With the coronavirus pandemic elevating stress levels globally, more people than ever may be experiencing challenging skin conditions.

Another way the mind is connected to the skin is through the sensory nerves that reach the very superficial surface of the skin. These nerves release neuropeptides, chemical messengers that direct the body how to act, and which can cause pro-inflammatory effects and play a role in numerous skin diseases.

The connection between the skin and the mind has been recognized at least since about 400 B.C. when Hippocrates, the father of modern medicine, wrote about cases of people who tore their hair out in response to emotional stress.

While the exact prevalence of psychological factors in skin disease is unknown, a group of Italian dermatologists estimated that approximately 30 percent of patients seeking dermatological treatment have an underlying psychiatric or a psychological problem that either exacerbates or triggers their skin disorder. When it comes to psoriasis, the prevalence of a psychiatric condition may be as high as 90 percent, according to a study performed by Portuguese authors.

One only needs to look through the Diagnostic and Statistical Manual of Mental Disorders (DSM) to see the myriad of psychiatric issues that manifest in hair pulling, skin picking, nail-biting, and delusions of parasitosis, a disease in which the patient falsely believes that parasites or other organisms infest their skin.

As scientists continue to study and document the connections between emotions and epidermis, the area of study has grown into a medical subspecialty known as psychodermatology, or psychocutaneous medicine. While psychodermatology is more developed in Europe than in the United States, and there are not yet any American teaching hospitals offering formal residencies for specialists-in-training, there are several American clinics with subspecialists on staff. Additionally, a growing number of dermatologists, psychiatrists, and psychologists have begun working together to assist patients with dermatological disorders that have a psychological component. This community now makes up the psychodermatology specialty.

I see firsthand how difficult it can be for patients without access to this speciality, and often find myself treating patients who had to travel long distances to get the care they need. I treat my patients with many conventional dermatology treatments, of course, but add complementary therapies that are personalized for each patient—such as cognitive behavioral therapy, recommendations for meditation, exercise, sleep hygiene, and sometimes psychiatric medications.

Another reason psychodermatologists can help is that stigma surrounding mental illness often prevents patients from seeking the mental health care they need, delaying care and prolonging suffering. Fear, embarrassment, and impaired quality of life are a reality for many patients suffering from skin disorders like severe cases of psoriasis, hair loss, or acne. In these cases, assistance from a dermatologist who bridges both specialties might be better accepted by patients and can help them find relief for their skin and mind more quickly.

When it comes to helping the millions of Americans suffering from skin issues, whether a flare-up or the management of a chronic condition, exploring both the physical and emotional causes of disease is key to a successful treatment. Neglecting how our emotional lives affect the largest organ of the human body is a mistake, and thankfully, psychodermatological treatments are now available to complement conventional therapies.

Katlein França is a dermatologist.

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