Psychological and Emotional Aspects of Skin Conditions

If you are anything like most people who suffer from skin problems, your skin is often on your mind. Your first thought as you wake up might be, “Is my skin better or worse than it was yesterday?”

It may feel nearly impossible to walk by the bathroom mirror or take a shower without thoroughly investigating your skin. Whether you spend five minutes or 100 minutes in front of the mirror, if you decide your skin looks terrible, chances are it’s the start of a challenging day. You are not alone.

Skin conditions affect many people and can isolate them both physically and emotionally. They often create intense feelings of shame and guilt that slowly diminish self-esteem, building a negative emotional snowball that gradually grows until it limits people's lives.

This emotional snowball is not based on your specific skin condition. I work with clients suffering from acne, alopecia, body dysmorphic disorder, eczema, hives, pain and burning, psoriasis, rosacea, skin picking (excoriation/dermatillomania), hair pulling (trichotillomania), warts, and undiagnosed conditions. Although each condition presents different physical symptoms on the outside, inside, the emotional suffering tends to be similar.

The following train of thought may look familiar to you. You may think, “My skin is awful. What’s wrong with me?” This can turn into: “My skin is awful. No one will love me,” or “My skin is awful. I hate myself,” or “My skin is awful. My life is hopeless,” or “My skin is awful. I hate the world.” If you have experienced any of these thoughts or similar ones, you know firsthand how stressful it is.

The snowball isn’t just emotional, either. According to dermatologist Dr. Flor A. Mayoral (American Academy of Dermatology, 2007), “In treating hundreds of patients over the years with skin conditions such as eczema, rosacea, acne, psoriasis, I have seen firsthand how stress can aggravate the skin and trigger unexpected flare-ups that, in effect, create more stress for patients. Learning how to manage the effects of stress on your skin can help alleviate some of the anxiety and symptoms.”

Intense emotions, such as stress, anger, fear, or pressure, can trigger acne and rosacea or cause eczema or psoriasis flare-up. This is thought to be, at least in some conditions, a result of an inflammatory stress response induced by the activation of the sympathetic nervous system. For example, studies by Stohl et al. have shown that sympathetic neurotransmitters such as norepinephrine can cause the release of inflammatory signaling molecules that may, in turn, activate inflammatory pathways in the skin.

After working with many people who experience a wide variety of skin conditions, I can assure you that you are not alone, physically or emotionally. In this blog, my goal is to increase your awareness of the link between the mind and body and help you learn psychological techniques that will let you manage the emotional impact of a skin condition—and often reduce physical symptoms as well.​