As a physician who has studied the interactions of the skin and mind and treated many patients who experience a profound emotional burden from their skin conditions, I’m often asked how the skin and mind interact, why psychodermatology matters, and how we can use this knowledge to improve mental health and skin health. In explaining these questions, I find it helpful to start from the very beginning. Most people don’t realize that our skin and nervous system are actually formed from the same embryonic layers. During weeks 3-8 after conception (when sperm and egg come together), the ball of cells called the gastrula divides into three layers. One of these layers, the ectoderm, eventually gives rise to the skin, brain, and nerve cells. I find this helpful in setting the stage for a lifelong connection between these systems, many of which we are just beginning to appreciate. Continuing to think about this from a biological standpoint, it’s important to remember that the skin is not only the largest, but also the most visible, organ in the body. It therefore makes sense that skin conditions, partly due to their highly visible nature, take such a heavy psychological toll. The skin plays a central role in how we present ourselves to the world, how we perceive ourselves and how we are perceived, and is literally our sensing organ – the boundary between ourselves and the world.
The skin is an exquisite reactor to stress and emotion. The phenomenon of blushing is a great example of an emotional reaction that shows itself on the skin in an almost immediate timeframe. Many other skin conditions are known to be worsened by worry, anxiety, and low mood, including psoriasis, eczema, cold sores, and acne. In general, we know that increased psychological distress can result in a weakened skin barrier as well as delayed wound healing.
Importantly, our mental states affect both how we perceive our skin as well as how we treat it. When people are depressed or anxious, they often perceive their skin as being worse, leading to a vicious cycle of negative perception of their skin which leads to more stress which in turn worsens their skin. Additionally, I see patients who begin to either over treat their skin because of anxiety and worry or neglect their skin because of depression and low mood. In both cases, these habits worsen skin health.
Given the profound interconnection of the mind and skin, it is no surprise that optimism is a key tool in promoting mental and physical health. Optimism is, in fact, known to be a protective factor in patients who are medically ill. Holding a sense of hope, it turns out, is good medicine. Optimism is defined as the expectation of a positive outcome, is bolstered by strong social supports, and is a key to cultivating resilience. A sense of optimism leads to greater commitment to healthy behaviors as well as to a healthy focus on self-care.
Research tells us that the power of positive thoughts, like optimism and gratitude, have the ability to offset the effects of negative thoughts. We also know that because our brains are evolutionarily hardwired, and often socially trained, to put more weight on the negative than the positive, training our brains to focus on optimism takes extra effort and intentionality. As the neuroscientist, Dr. Rick Hanson explains in his theory of “negativity bias”, it takes more positive thoughts, emotions, and experiences to outweigh negative one (3:1 from the research) because our brains are Teflon for the positive and Velcro for the negative thanks to our biology’s survival mechanism. The good news is that our brains can be trained to selectively focus attention on the positive, thereby cultivating a sense of hope, and bolstering optimistic expectations for the future.
-- Intentionally incorporate expectations for positive outcomes into your self-care routine. Good times for this might be while brushing your teeth, applying skincare, or just after getting in bed at times. Make it the same time every day and link it to a specific activity that is already part of your routine. Use this opportunity to visualize positive outcomes in your day, week, and month. This opens a space for subtle but powerfully positive changes in how you interact with yourself and the world. Remember that the brain is “plastic” and you can influence it by choosing where to focus your attention. Focus on what you can control (i.e., wearing sunscreen, getting physical activity) and not what you cannot control (other people’s reactions, global warming).
-- Look for opportunities to openly express gratitude.
-- Focus on relationships as social support is a key factor in maintaining an optimistic lens.
-- Embrace opportunities to be in nature, to see beauty, and to gain perspective.
As we take time to remind ourselves of our mind’s powerful role in skin health and the beauty in capitalizing on optimism as a tool for a better life, it is important to remember that knowledge of the mind-skin connection does not mean that one can simply meditate ones way to perfect skin. Prioritizing habits that promote healthy mental, emotional, and physical health is another tool in the practice of building a meaningful life, a full present moment, and a hopeful future. Capitalize on this knowledge to prioritize practices that promote physical and mental wellbeing and make sure to expect the best.
 Carver CS, Scheier MF, Segerstrom SC. Optimism. Clin Psychol Rev. 2010 Nov;30(7):879-89. doi: 10.1016/j.cpr.2010.01.006. Epub 2010 Feb 1. PMID: 20170998; PMCID: PMC4161121.
 Coneo AMC, Thompson AR, Lavda A. The influence of optimism, social support and anxiety on aggression in a sample of dermatology patients: an analysis of cross-sectional data. Br J Dermatol. 2017 May;176(5):1187-1194. doi: 10.1111/bjd.15115. Epub 2017 Mar 14. PMID: 27726126.
 Erthal F, Bastos A, Vilete L, Oliveira L, Pereira M, Mendlowicz M, Volchan E, Figueira I. Unveiling the neural underpinnings of optimism: a systematic review. Cogn Affect Behav Neurosci. 2021 Oct;21(5):895-916. doi: 10.3758/s13415-021-00931-8. Epub 2021 Aug 2. PMID: 34341967.
 Rick Hanson, Shauna Shapiro, Emma Hutton-Thamm, Michael R. Hagerty & Kevin P. Sullivan (2023) Learning to learn from positive experiences, The Journal of Positive Psychology, 18:1, 142-153, DOI: 10.1080/17439760.2021.2006759
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