The Best Way to Heal Acne from Anxiety and Depression

Sometimes, it feels like nothing in life is more stressful than a poorly timed breakout.

So, it seems plausible that the reverse can also be true. Your emotions may also affect your skin.

The mind-skin connection

To better understand let's take Rob Novak who had eczema since he was a child. Throughout high school and college, eczema had taken over his hands to the point where he couldn’t shake people’s hands, handle raw vegetables, or wash dishes because his skin was so inflamed.

Dermatologists couldn’t identify a cause. They prescribed him corticosteroids that relieved the itching for a short time but ultimately thinned his skin, leaving it prone to further cracking and infection. He also had anxiety and depression, which ran throughout his family.

Jess Vine has also lived with eczema throughout her life. The steroid and cortisol cream her doctors prescribed would temporarily ease her symptoms, but eventually, the rash would pop up elsewhere.

“The tipping point,” she says, “was when my whole body broke out in a terrible rash. My eyes were swollen shut. It was all over my face.”

At that time, she was dealing with a lot of anxiety, which caused a feedback loop. “Anxiety about my skin made my skin worse, and when my skin got worse, my anxiety worsened,” she says. “It was out of control. I had to figure it out.”

Connecting mental health with physical conditions can be tricky. If health issues are diagnosed as “psychological,” a doctor may fail to identify and treat a very real physical condition.

Yes, some skin conditions are purely physical in nature and respond well to physical treatment. In those cases, one needs to look no further.

But for many with treatment-resistant eczema, acne, psoriasis, and other conditions that flare up with stress, anxiety, and depression, psychodermatology can hold an important key to healing.

How do anxiety and depression affect the skin?

So, how do anxiety and depression, the two most common U.S. mental health conditions, affect the skin?

“There are three basic ways the skin and mind intersect,” Howard explains. “Anxiety and depression can cause an inflammatory response, which weakens the skin’s barrier function and more easily allows in irritants. Skin can also lose moisture and heal more slowly,” she says. Inflammatory conditions are triggered.

Secondly, health behaviors change when anxious or depressed. “Depressed people might neglect their skincare, not keeping up with hygiene or using topicals they need to for acne, eczema, or psoriasis. Anxious people might do too much — picking and using too many products. As their skin reacts, they start to do more and more in a vicious cycle,” Howard says.

Finally, anxiety and depression can alter one’s self-perception. “When you’re anxious or depressed,” Howard says, “your interpretation of your skin can change drastically. All of a sudden that zit becomes a very big deal, which may lead to not going out to work or social events and the avoidance of social activities can make anxiety and depression much worse.”

Using a Holistic Approach

Most psychodermatologists utilize a three-pronged approach composed of therapy and self-care education, medication, and dermatology.

For example, Howard worked with a young woman who had mild acne, severe depression and anxiety, as well as skin picking and body dysmorphic disorder. The first step was to address her skin picking and get her dermatological treatment for her acne.

Next, Howard treated her anxiety and depression with an SSRI and began CBT to find better methods of self-soothing than picking and tweezing. As her patient’s habits and emotional state improved, Howard was able to address the deeper interpersonal dynamics in the young woman’s life, which were causing much of her distress.

While psychodermatology is a somewhat obscure practice, more evidence is pointing to its efficacy in treating both psychological and dermatological disorders.

One study found that those who received six weeks of CBT in addition to standard psoriasis medications experienced a greater reduction in symptoms than those on medication alone.

The researchers also found emotional stress to be the most frequent trigger for psoriasis outbreaks, more than infections, diet, medication, and the weather. About 75 percent of participants reported that stress is a trigger.

The Takeaway

Thinking back to our sweaty, red-faced public speaker, it’s no surprise that our emotions and mental states affect our skin, just as they affect other parts of our health.

This doesn’t mean you can think away your acne or resolve psoriasis without medication. But it suggests that if you have a stubborn skin issue that won’t respond to dermatological treatment alone, it might be helpful to seek out a psychodermatologist to help you live more comfortably in your skin.