As Above, So Below || Mind
Our As Above, So Below Series has highlighted the many ways our skin plays essential roles in our bodies – it provides a first line of defense against environmental stressors, connects with our immune system to ward off infection, regulates our temperature, and it acts as a sensory organ to perceive touch, to name just a few.
The relationship between our brain and our skin is clearly exemplified in how our skin cells work with our nerve cells to differentiate between a “good touch,” e.g. a head massage, and a “bad touch,” e.g. a burn. Our skin reacts to negative sensation faster than positive, so that we get our hand away from the oven ASAP, while it takes our brain a little bit longer to identify the calming touch of a gentle caress. These slower nerves are processed in the area of our brain that perceives pleasure and positive feelings.
Our skin-brain connection does not only work in one direction, however. Have you ever felt the hair on your arm or the back of your neck stand up? This isn’t just your skin reacting to the sensation of cold – it’s our bodies response to adrenaline in moments of high alert. Darwin suggested that this response stems from a time when we were covered head to toe in long hair. When we entered fight/flight/faun mode, all the hair on our body would perk up to intimidate our opponent. This process of our skin and brain talking to each other is called bi-directional communication.
Bi-directional communication between our skin and brain is incredibly significant, as more and more research is showing what we have suspected since ancient times to be true: how we feel inside can affect the appearance of our skin outside, and vice versa. Society unfortunately places significance on physical appearance and if our perception of self falls short of the prevailing societal norms it can have a detrimental effect on our self-esteem. In this way we can certainly attest that our physical appearance is linked to our mental perception of self. The growing acknowledgement of the link between the mind and the skin has led to a surge in research in the area known as psychodermatology.
Psychodermatology discusses three main categories of disorders (1):
Psychophysiologic disorders are skin conditions that are triggered or worsened by stressful emotions.
Primary psychiatric disorders are issues that arise internally but result in affecting the skin.
Secondary Psychiatric Disorders are disorders that arise in the skin and cause so much stress that they can trigger psychological issues such as depression and anxiety.
The above conditions may overlap sometimes. Examples include psoriasis, acne and alopecia which may present as both psychophysiologic and secondary psychiatric disorders. Conditions such as skin picking and body dysmorphic disorder are categorised among primary psychiatric disorders. If you’d like to learn more about psychodermatology, the UK based consultant dermatologist Dr Alia Ahmed has a wealth of resources here.
The study of the brain-skin connection is being taken very seriously in research, however it is taking society and medical systems some time to catch up. There is a tight correlation between how we feel and how our skin presents, and the insistence that our skin’s appearance is trivial or purely cosmetic can affect the quality of care patients receive, and socially leave us feeling isolated. It was determined by the All Parliamentary Group on Skin in 2020 that patients experiencing certain skin diseases should be treated with both physical and psychological interventions (2). It is now considered in many circles, good practice to include cognitive-behavioural therapy for psoriasis patients to manage stress levels, or habit reversal therapy for eczema patients to break the itch-scratch cycle.
The same group published a report in 2013 that found that many skin diseases, including acne, psoriasis and eczema can result in disability levels that are equivalent to the experience of non-dermatological patients (3). It was found that patients who experience skin issues on their face, hands and genital areas experience more distress than those with issues on other areas of their bodies, as these are not easily covered, and/or can cause or result in relationship issues. The stigma felt by patients associated with visible skin disorders, can be incredibly distressing.
If you have any doubt as to whether this bi-directional communication between our skin and brain exists – we can all sympathise with the experience of the build up to a much anticipated event, and waking up the morning of to a break out that almost makes us want to skip the event altogether. It is undeniable that stress can trigger skin issues. You’ll find that most people who work in skin, myself included, have had a personal skin journey that has spurred them on to better understand the skin and spread the knowledge to our community.
Of course, there is no one size fits all solution when it comes to our mental and skin health, however the more we learn about how our brain interacts with our skin, the better we will be able to manage skin conditions in a holistic manner. For now, if you are feeling extreme psychological or emotional distress due to a skin condition, we would advise to seek advice from your GP to see what options are available to you.
As we have learned throughout this series, acts of self-care benefit your body for many reasons and the skin appears to be an additional benefactor of these practices. Make sure to treat yourself kindly and we recommend trying to introduce practices such as mindfulness and meditation for your overall health and wellbeing. We love the Headspace and Open apps that provide accessible ways to practice calming the mind. We want to remind the beautiful Le Formulaire community that no one is alone in their skin struggles, we all have “bad skin days” and to us, you are perfect.
(1) Leon A, Levin EC, Koo JY. Psychodermatology: an overview. Semin Cutan Med Surg. 2013 Jun;32(2):64-7. doi: 10.12788/j.sder.0002. PMID: 24049961.
(2) All-Party Parliamentary Group on Skin. Mental Health and Skin Disease. London 2020
(3) All-Party Parliamentary Group on Skin. The Psychological and Social Impact of Skin Diseases on People’s Lives. London 2013