Stressed out woman
Photo: Corbis
Being under pressure doesn't cause just the occasional blip of acne or fleeting rash—it can do a number on your skin's ability to heal and fight off real trouble. The good news: There's proof that mind-body treatments like hypnosis and biofeedback can work in your favor.
As I write this story, my deadline looms before me. Actually, to be accurate, behind me—it was yesterday. My phone just rang for the ninth time in an hour (my best friend—I'd better be on time for the party at 8). I wish I could reach into my computer screen and rip out that exclamation point flashing in the upper right-hand corner, a pulsating reminder of my rapidly filling in-box. And now I feel the ominous tingle of a rash in the making just above my left eyebrow. Coincidence? Maybe. But increasingly studies show that stress—even the run-of-the-mill, day-to-day variety—can trigger or heighten skin problems, from small breakouts and inflammations to more serious, chronic conditions like psoriasis and eczema.

As hard evidence of this link accumulates, a growing cadre of doctors—many identifying themselves as psychodermatologists—are combining traditional skin treatments with psychotherapy, hypnosis, and meditation. An acupuncturist and a biofeedback therapist are part of the Yardley, Pennsylvania, practice of Richard Fried, MD, PhD, a dermatologist and clinical psychologist. A massage therapist and a psychiatrist are on staff in the office of New York City dermatologist David Colbert, MD, who says he sees patients every day with stress-induced skin problems. In 2006 the University of Rochester Medical Center in New York opened a psychodermatology clinic that offers therapies including mindfulness meditation and hypnosis. There's even an Association for Psychocutaneous Medicine of North America, consisting of both dermatologists and psychologists, which had grown from five members to almost 100 from 1991 to 2006. "Some people are prescribed the latest cream, and their skin problem goes away," says Ted Grossbart, PhD, an assistant clinical professor of psychology at Harvard Medical School who specializes in skin disorders. "But sometimes that doesn't happen. Now we're recognizing this other set of resources you can tap from within—which is terrific news."
Stress sets off several physiological reactions in the body that can affect the skin. It causes the release of hormones like cortisol that thicken hair follicle cells and increase oil production—the perfect recipe for acne. Stress can also trigger neuropeptides, chemicals unleashed from nerve endings in the skin that leave it red or itchy, and encourage T cells (the skin's infection fighters) to overreact, making the skin turn over too quickly and flake or scale. Then there are the blood vessels: Under stress they become more reactive, either clamping shut (so skin looks pale or sallow) or opening too widely (causing the skin to flush).

When you're stressed, the skin's repair mechanisms are compromised as well. In one study, scientists at Weill Medical College of Cornell University gave volunteers tiny wounds on their skin by applying and then ripping off pieces of tape, and then exposed the volunteers to a stressful situation: fake job interviews. Their skin took longer than usual to heal. "What's really intriguing is that even relatively mild stress—in this study, the subjects knew the interviews were fake—can affect the way your skin functions," says Richard D. Granstein, MD, chief of dermatology at New York–Presbyterian Hospital/Weill Cornell.

There's also evidence that stress can speed the onset of skin cancer—at least in mice. In a study published in the Journal of the American Academy of Dermatology in December 2004, scientists at Johns Hopkins showed that mice exposed to the scent of fox urine (the rodent equivalent of having a fight with your boss and getting a speeding ticket in the same afternoon) and UV light developed skin cancers in less than half the time it took for nonstressed mice exposed to the light.

Though it can be a factor, inner turmoil is rarely the sole culprit behind misbehaving skin. "You can have all the stress in the world, and you won't get psoriasis if you don't have the genes for it," says Grossbart. "And some people are just physiologically more hardwired to have their emotions trigger skin problems. The flip side is that those people are also more likely to be able to use psychological techniques to improve their skin's condition."
Some of the treatments recommended by psychodermatologists, such as meditation, acupuncture, psychotherapy, and massage, soothe the skin by decreasing the stress response through relaxation. "Studies show that when people utilize stress-reduction techniques, their skin misbehaves less often and less dramatically," says Fried. In one study at the University of Massachusetts, psoriasis patients who listened to meditation tapes during their light therapy treatments reduced by half the amount of therapy needed to clear their symptoms.

Other treatments, like imaging, biofeedback, and hypnosis, not only relax patients but teach them to control physiological factors such as body temperature and skin moisture. "Our bodies are more plugged into the pictures we have in our heads than into reality," says Grossbart. "If you hear the screen door slam and imagine it's the wind, for example, you're calm. If you imagine someone breaking in, you're going to produce adrenaline. Since many skin conditions are sensitive to changes in temperature and moisture, you can learn to pick an image—swimming in an Olympic-size pool of cool yogurt, say—that moves the skin in the right direction." For the imagination to do its best work, patients must enter a state of focused concentration and repeat the exercise daily (a brief daydream or two won't induce serious physiological change).

None of these doctors suggests rejecting traditional skin treatments altogether. "If you have acne that's aggravated by stress, you will see improvement from stress-reduction techniques," says Colbert. "But you also have bacteria under your skin, which will be hard to get rid of without a topical antibiotic." Amy Wechsler, MD, one of only a handful of doctors in the country who is board certified in both dermatology and psychiatry, also recommends a combination of approaches. "You can't just think your way to clear skin," she says. "But when you're using a treatment that should be working and it's not, it sets off some bells: What else is going on here? In those cases, you can use these psychological techniques as adjunctive treatments."

As the mind-skin connection gains credence, beauty companies have seized on the new marketing opportunity, launching serums and balms that they say cater specifically to the effects of stress on the skin. Without any independent clinical trials to back up these product claims, dermatologists are skeptical about how effective they might be. But doctors do advocate paying extra attention to your skin during tumultuous times. "If you already use acne products, increase the frequency of application when you're entering a stressful period," says Fried. And because skin's immunity is impaired when you're under stress, making you more susceptible to sun damage, he says, it's even more important to apply (and reapply) sunscreen. A bonus: Taking special care with your daily beauty regimen may help soothe your spirits as well as your skin. Fried conducted a study in which 32 women used an alpha hydroxy acid lotion on their faces for 12 weeks. Their skin felt smoother in the end, but the participants also reported feeling happier in general. "As soon as these women saw an improvement in their skin, it fostered a wider-reaching sense of optimism," says Fried. "Their feelings of stress or depression also decreased because they felt more in control—over their skin, their bodies, their world."
As a reminder, always consult your doctor for medical advice and treatment before starting any program.


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