How psychodermatology works and the importance of the mind-skin link

In his book, Skin Deep, psychologist Dr Ted Grossbart writes: “Shut anger or sadness or frustration out the door and it comes through in the window, or often enough, through the body. Your heart ‘attacks’. Your asthma ‘gasps’. Your eczema ‘weeps’.”

If we’re unable to process stress or emotion, it can show up in the form of acne, eczema, psoriasis, rosacea or even disorders such as dermatillomania, which manifests as repetitive and compulsive skin picking. This can affect our emotions and self-esteem. In fact, a study published in the British Journal of Dermatology found that those who suffered with acne were 63% more likely to develop depression in the first year of being diagnosed.

How does psychodermatology work?

“The link between mind and skin has been known for centuries, dating back as far as Hippocrates,” says Dr Alia Ahmed, a consultant dermatologist who runs a psychodermatology service at Eudelo Skin Clinic in Vauxhall, London, and practises in the NHS. 

“Psychodermatology considers both the mind and the skin together when seeing a person with a skin problem.” And these patients who Dr Ahmed sees are often facing a breadth of skin problems and body dysmorphia disorder, coupled with emotional distress.

Neuroscientist Dr Claudia Aguirre, who specialises in the mind-skin link, explains that our negative thoughts can affect the skin far more than we may realise. A term in psychology called rumination, which is when someone has a recurring stream of negative thoughts, can wreak havoc on the skin.

“This can hinder our healing, since it can lead to depressive thoughts or feelings of defeat about a recurring condition,” she says. “So, we can get stuck in a negative thought pattern, which is a form of stress and anxiety, and can maintain the body in an inflammatory state – this can even trigger or worsen inflammatory skin conditions like eczema and acne.”

As a result, this stress can make the issue worse, and so the viscous cycle begins. “Feelings of emotional distress lead to the release of stress hormone cortisol, which is known to affect the immune system (making the skin less able to defend itself), drive allergic responses, delay healing and disrupt the skin’s natural barrier,” she says. “I believe addressing the interaction between the brain, skin and mind is key to achieving healthy skin.”

How do I incoporate psychodermatology into my treatment menu?

With the rising acknowledgement of psychodermatology and popularity of mindfulness, the emphasis on the mind-skin link is now trickling in to salon and spa treatments. One practitioner who is paving the way is Beata Aleksandrowicz, founder of the Aleksandrowicz System. Her treatment Face Cure addresses the connection to their client’s appearance and the emotions that can be held in the face.

“If there is a preponderance of negative emotions, the muscles will remain contracted, which will restrict the flow of oxygen and nutrients to each cell and will be manifested by a lack of radiance and tone,” says Aleksandrowicz.

Combined with mindfulness and massage, her treatment focuses on the client reconnecting with their facial appearance. “I see so many clients who are unhappy with their face. Many have had aesthetic treatments, so they don’t always know what they should look like anymore; in some cases they become disconnected with their face,” she says. “It is as much about inner work on the conscious and subconscious as outer work on the facial muscles and skin.”

The skin can be a barometer for what’s going on underneath, and tapping in to this mind-skin link is becoming increasingly important to deliver a tailored treatment. “More clients are coming in with stressed skin, whether that is redness, rosacea, eczema, psoriasis, or general extremes on the skin,” says Katie Light, a holistic wellness coach and facialist, who treats clients at her treatment rooms in Brighton and Knightsbridge, London.

Light often sees these skin issues going hand-in-hand with mental health problems. “If people are having anxiety, panic attacks or depression, which I see a lot more of now, it
affects the skin, and everyone is supressing it because they think it’s the norm; no one is dealing with it,” she explains.

“It’s not just about applying things topically, it’s about looking at everybody’s lifestyle and where the anxiousness is coming from to treat the stress as well as the skin.”

In her treatments, Light uses a range of techniques. “I do affirmations and visualisations that are personal to that client, so I would ask: ‘How do you want to look? What is your ideal?’ and we make that in to a storyboard or a visual board of something to aim for,” she says. 

Neurolinguistic programming (NLP) is another technique she uses to treat her clients holistically, and between sessions she will also set up homework for them so they have a toolbox of techniques to hand to keep both the skin and mind healthy.

Light says the initial consultation is vital to fully understand her clients’ needs. “It’s an essential part of what I do to treat the physical, mental and emotional; whether it’s anxiety or eczema, they all need to be treated from a whole wellbeing perspective,” she says.

Similarly, holistic practitioner Alexandra Soveral also addresses the mind-skin link in her facials and massages at her London clinic. “I’m a great believer in self-healing for many skin conditions, and this comes from how we feel about ourselves,” says Soveral. “So many people come to me distressed about their persistent acne, irritated eczema or reoccurring rosacea, but seldom have they considered its cause to be laced within the interconnections of the various body systems.”

Soveral says clients suffering with persistent acne and stress are a common example of this. “They find squeezing their spots a stress-release mechanism that’s hard to give up, even when I explain that until they stop the acne is unlikely to go away as they are spreading the acne-causing bacteria every time they do it,” she says. “After squeezing a spot, the skin is inflamed and red and people often feel guilty, which then adds more stress.”

What language should I use during a psychodermatology treatment?

When treating a client, it can often be difficult to get them to open up, says Soveral. “Many don’t admit to having emotional issues regarding their skin or appearance, and those that want to address it don’t have the resources, support or the knowledge of how to approach such a problem,” she says.

Therefore, creating an offering on your treatment menu to open up this dialogue is important, as is having the training to spot what the client may have going on. “Holistic practitioners like me, and psychodermatologists, know the difference and can offer much-needed help and reassurance,” she says.

Part of this is asking the right questions, says Light. “There could be severe redness in the client’s face and that may be due to cortisol levels, lack of sleep or what they’re putting on their skin topically, but until you start asking those questions and understanding what it is that’s going on for that person, you can’t get to the root of that.”

Encouraging clients to adopt self-care strategies is another way to improve the mind-skin link between treatments. “This can also be done by practising self-healing on a daily basis and essentially making sure to take good care of ourselves,” says Soveral. “Taking action triggers positivity and has a ‘domino’ effect on our emotions that eventually will benefit the skin.”

A new app paving the way for this is Beautification, which offers guided meditations designed to be used in conjunction with a daily skincare routine. “With the rising awareness of skin-mind connection, it’s been proven that only three to four minutes of meditation a day can help ease the tension and bring out physical beauty benefits,” says chief executive and co-founder Heyyoung Kim.

3 ways to implement the mind-skin link into your treatments

1. Treat holistically

“Having a relaxing massage with a choice of three oils is not necessarily holistic,” says Soveral. The treatment needs to be prescriptive to the client. “It’s important for salons and spas to understand that working with your client needs to go beyond the technical approach to the face and skin,” agrees Aleksandrowicz.

“Understand where the client’s concern comes from and address them equally on a physical and emotional level. Advice should go beyond practical skincare suggestions to address the lifestyle, the emotional condition of the client and their ability to accept who they are.”

2. Upskill with training

Many brands offer training to help tap into the mind-skin link. A part of SBC skincare training is its 5 Phase Concept, which involves an in-depth conversation that includes reading the client’s body language and employing methods to understand their emotional needs and establish trust.

Meanwhile, Sienna X skincare training includes Emotional Freedom Technique (EFT), a holistic healing method designed to treat both physical and emotional distress by tapping the face at specific pressure points. Energy alignment practices, such as Reiki, are another way to create a holistic offering for your clients.

3. Invest in consultations

“For a spa to incorporate psychodermatology, it needs to invest in further training of its therapists, change its booking system to accommodate more time for each client, and extend the consultation period,” says Soveral. Carving out time for these initial conversations is essential to truly understand the needs of the client.

“I generally have a consultation with somebody on the phone first to find out a little bit more detail and then I will book them in according to what I think they might need,” says Light. “There’s a lot of detail that needs to come out at that point before I even get to the face.”

Read about where to turn for mental health support and whether organic products are the best for your skincare.