Are you suffering from skinxiety?

According to a recent survey, since the start of the pandemic, 9 out of 10 of us have admitted to being unhappy about our skin, with the term ‘skinxiety’ being coined to reflect this collective angst.

Not only is skin our largest organ, it’s also intrinsically linked to our psyche. Being forced to get up close and personal with our pores (thank you, HD Zoom), combined with stress, too much time on our hands for introspection and compulsory mask wearing, has created a veritable complexion crisis.

‘I’m seeing patients whose anxiety reached extremely high levels during the pandemic,’ says Dr Alia Ahmed, a consultant dermatologist (@the_psychodermatologist). ‘This group is spending a lot of time worrying about their skin and their response – or lack of response – to treatment/skincare. We know that stress caused by emotional distress can have an impact on the skin, with some specific effects including increased sebum (oil), inflammation, a poor immune response and delayed wound healing.’

‘Most people don’t realise that their psychological health affects their skin,’ says Dr Alia. ‘Psychodermatology empowers patients to recognise and manage this at the same time as treating their skin condition. Interest in psychodermatology is peaking, as more people are becoming aware of the link between mind and skin, and many want to seek adjunctive treatments for their skin.’

What exactly is psychodermatology in practical terms? ‘I have patients with chronic skin diseases such as acne, rosacea and vitiligo, all of which have a psychological effect – causing problems such as low self-esteem/body confidence, anxiety, and depression – and conditions that are affected by stress, such as eczema and psoriasis,’ says Dr Alia. ‘In addition, I see people whose skin problems are rooted in psychiatric or psychological distress, such as chronic itching, hair pulling, skin picking, nail-biting and body dysmorphia. So, someone with eczema, for example, might benefit from medical treatment and, in addition, can engage in habit-reversal therapy to help them break the itch-scratch cycle. Both facets are equally important.’

According to Dr Alia, the brain has a stress-activated pathway, which releases chemicals and hormones that drive inflammation both in the body and the skin. ‘Feelings of emotional distress lead to the release of a stress hormone called cortisol, which is known to affect the immune system, leaving the skin less able to defend itself, while driving allergic responses, delaying healing and disrupting its natural barrier,’ she says. ‘The effects can vary from a dry, scaly and itchy complexion to dullness and the formation of lines, wrinkles and pigmentation.’

Reducing your stress levels is important. Easier said than done, of course, but it’s worth acknowledging feelings of stress so you're able to focus on taking positive steps to minimise the effects. ‘I see several patients with skin conditions that are closely related to stress,’ says Dr Alia. She outlines the numerous effects stress can have on the skin:

• ‘Stress can cause a rise in glucocorticoids, which may alter the production and breakdown of collagen, proteoglycans and elastin, all of which are part of the skin’s building blocks,’ she explains. ‘Loss of these result in the loss of elasticity in the skin, which can lead to lines, wrinkles, increased pigmentation and dullness. It may also reduce the production of glycosaminoglycans (GAGs) such as hyaluronic acid, which can contribute to skin dehydration.’
• ‘Feeling stressed can affect sebum production, which may, in turn, cause or aggravate acne.’
• ‘Low mood and depression are often associated with sad facial expressions (such as deep, vertical frown lines, for example). When we feel stressed or sad for long periods and have certain associated expressions, it can cause physical changes to our face.’
• ‘Psychological stress results in the production of neurotransmitters, which alter the permeability of the gut and affect inflammatory pathways. Microbial imbalance is implicated in impaired skin function, illustrated in three common skin conditions: acne, atopic dermatitis/eczema and psoriasis.’
• ‘Stress hormone levels correlate with lack of sleep – and sleep deprivation activates the HPA axis. Long periods of poor sleep are associated with signs of premature ageing (fine lines, reduced elasticity, pigmentation changes), lack of hydration, larger pores, textural changes, and changes in blood flow to the skin. In addition, lack of quality shut-eye can disrupt the overnight skin-repair process.’ 

But there is some good news. Making lifestyle tweaks, such as getting enough sleep, adjusting your food choices and increasing your daily fluid intake and how much you move day-to-day, can have a positive impact on your stress levels – and, therefore, your skin.

‘People with skin conditions can be vulnerable,’ says Dr Alia. ‘Which is why it's important to practise holistic dermatology and incorporate skin positivity into your daily routine.’ She suggests several ways to feel more positive about your skin…

• Find the appropriate treatment for the condition: ‘Many people with dermatological conditions are being under-treated or believe there's no effective therapy,’ says Dr Alia. ‘In fact, there are some excellent treatment options.’
• Get educated about the diagnosis: ‘Knowing what your diagnosis means and how it can be managed is extremely empowering,’ she continues. ‘It allows you to make decisions about how you want to deal with your skin issue.’
• Develop a way to deal with unwarranted comments: ‘People with skin conditions are often on the receiving end of personal comments, some of which are well-meant but still hurtful,’ explains Dr Alia. ‘Learning how to respond to these is an important aspect of living with a chronic condition.’
• Learn to ignore the representations of skin in traditional and online media: ‘Incorporating “real” skin in media campaigns is highly important to “normalise” skin conditions by removing stigma. In fact, all skin is normal; it just behaves differently for different people.’