While you may have heard of the familiar gut-skin link, there’s another lesser-known axis you should know about – the mind-skin link. Dr Zeenit Sheikh explores this fascinating phenomenon and the field of psychodermatology, highlighting the clear effects the skin and mind have on each other.
The skin is the largest organ of the human body. It provides a physical barrier, prevents loss of moisture, is crucial in temperature regulation, plays a role in the immune system, and assists with vitamin D production. Moreover, it is one of the most sophisticated and sensitive sensors of the human body, which allows one to navigate through life and all its challenges. Yet, that list only scratches the surface, so to say, of the depth of this remarkable organ.
A visual mirror of the mind
The mind-skin link is easy to see in everyday life phenomena. When going through an embarrassing situation, there is a flushing of the face; when angry, the skin turns red; when frightened, the skin becomes pale; when terrified, the hair on the body stands on end. These reactions, which anyone can see, are so undeniable that there are even emoji expressions commonly used to represent them in everyday communication.
An ancient idea
The field of psychodermatology may be fairly new, but the concept of a relationship between the skin and the mind goes back millennia. In his writings, Hippocrates (460-377 BC) mentioned the relationship between stress and its effects on the skin, citing cases of people who tore their hair out in response to emotional stress. Aristotle (384-322 BC) believed that the mind and body were not two separate entities but complementary and inseparable1.
In 1857, English dermatologist and surgeon William James Erasmus Wilson described the first so-called “skin neurosis” in his book entitled Diseases of the Skin, detailing topics such as delusional parasitosis, alopecia areata, pruritis, and hypopigmented lesions2. He also highlighted that the amount of sweat produced from the skin may be attributed not only to factors that affect the body physically, but also the nervous system. This clearly presented the hypothesis that a mental state (anxiety, depression, or fear) could be responsible for a dermatological problem (excessive sweating)3.
Embryonic origins
During development, in the earliest stages of an embryo, different tissues and organs develop from three different groups of human cells known as germ layers. By now, it should come as no surprise that the skin and the nervous system both originate from the same germ layer, providing further explanatory support for the intimate interactions that occur between the two systems. Likely as a result of their common embryological origins, the skin and central nervous system share a number of common neuromodulators, peptides, and biochemical systems of internal communication4.
For this reason, the skin is an organ that is strongly reactive to emotion. Eczema flare-ups before an exam, psoriasis lesions appearing before a big work project, and acne breakouts at the least opportune time when facing an important social appearance are all events revealing the impact mental stressors have on dermatological conditions.
A cyclical process
However, this is not only a one-way street. Severe acne, disfiguring hyperpigmentation, early onset hair loss, and a slew of other skin conditions can easily lead to anger, anxiety, depression, social isolation and stigmatisation, feelings of embarrassment or shame, and a loss of self-esteem.
A recent survey of 544 individuals with chronic skin conditions revealed that 98% of the participants experienced a significant negative impact on their emotional/psychological well-being5. This highlights the huge impact skin conditions have on mental health – and just how prevalent this phenomenon is!
No system in the human body works purely in isolation, and the mind and skin are no exception.
Lessons learnt: the skin affects the mind; and the mind affects the skin.
Take-home message
If you are struggling with a skin condition, be cognisant of your mental well-being and how it may be affected by your skin – and vice versa. Be open to the idea of being referred for further assessment and/or psychological support, and be sure to consult a trusted healthcare practitioner who considers and manages you in a holistic manner.
References:
- França K, Chacon A, Ledon J, Savas J, Nouri K. ‘Psychodermatology: a trip through history’. An Bras Dermatol. 2013;88(5):842-843. doi:10.1590/abd1806-4841.20132059
- Koo JY, Pham CT. ‘Psychodermatology. Practical guidelines on pharmacotherapy’. Arch Dermatol. 1992;128:381–388
- Wilson E. On diseases of the skin. 2nd ed. London: Ed John Churchill; 1847
- Jameson, C., Boulton, K.A., Silove, N. et al. ‘Ectodermal origins of the skin-brain axis: a novel model for the developing brain, inflammation, and neurodevelopmental conditions’. Mol Psychiatry28, 108–117 (2023). https://doi.org/10.1038/s41380-022-01829-8
- https://www.appgs.co.uk/publication/view/mental-health-and-skin-disease-2020/
MBBCh (Wits), Adv Dip Aesth Med (FPD), DMH (SA)
Dr Zeenit Sheikh qualified at the University of the Witwatersrand, practised in the field of Psychiatry for 4years, attained her Diploma in Mental Health, and thereafter found her calling in the field of Medical Aesthetics. After qualifying cum laude with a postgraduate diploma in Aesthetic Medicine (FPD, Pretoria), she co-founded the exclusive practice “The Aesthetic Doctors” in 2014. Charmed by this marriage of medicine, beauty and psychiatry, she regularly attends and presents at local and international conferences in her quest to further her own knowledge and skills, as well as to expand the borders of the field of aesthetic medicine. Hailing from and residing in Nelspruit, Mpumalanga, she treats a myriad of skin types, and a large proportion of patients with darker skin tones seek out her expertise.