Published in Les Nouvelles Esthétiques, June 2015

Emotions play a big role in skin diseases. Approximately 50% of people with acne report an emotional trigger to their breakouts. At least 80% of those with atopic dermatitis (eczema) state psychological stress aggravates or brings about their itch. More than 90% of those with rosacea say stress triggers a flare-up, making their skin hypersensitive. And about 100% of those with excessive sweating, hyperhidrosis, say emotions trigger their reaction. Recurrent flares of psoriasis have been attributed to stress in up to 80% of individuals. What’s more, in psoriasis patients with associated depression, 9.7% acknowledged a “wish to be dead,” and 5.5% reported active suicidal ideation.

Emotions, in particular stress and anxiety, are not to be dismissed when it comes to treating the skin. Not only can they trigger or exacerbate skin conditions, but they can actually affect a person so deeply that they are scarred for life, or worse yet, make them want to take their own life. As estheticians, you use your tools to help people with their skin concerns, but in reality, you have the power to help improve the quality of life for every client you touch. In understanding the intimate relationship between the mind and skin, you will be better equipped to manage a client’s expectations and deliver your very best results.

A mind­-body approach

The notion that there is a definitive mind-body relationship is not new. From the ancient Greeks, to Shakespeare, to 19th century dermatologists ­ the mind­-body connection has been a topic discussed for centuries. Eastern healing practices, such as traditional Chinese medicine and Ayurvedic medicine also highlighted the interdependence between the mind and the body. Somewhere along the lines in Western medicine, we lost this connection, focusing instead on philosophies that treated the body as a separate entity from the mind. It’s only been in the past several decades that we’ve seen the resurgence of mind-­body awareness in medicine — And only in the past decade or so have we seen an emphasis on understanding the interaction between the mind and skin diseases with modern neuroscience techniques.


Psychodermatology is a new medical subspecialty that merges two major medical specialties: psychiatry and dermatology. Psychiatry treats mental processes manifested internally, while dermatology treats skin diseases manifested externally. In medicine, there are four main categories within psychodermatology.

1) Psychophysiological disorders; 2) Primary psychiatric disorders; 3) Secondary psychiatric disorders and 4) miscellaneous conditions like neuroses.

  1. Psychophysiologic disorders include skin disorders such as eczema and acne, that are triggered or worsened by emotional stress. This is the category you are most likely to encounter in the treatment room.

  2. Primary psychiatric disorders refer to problems that arise in the mind, but result on the skin. For example, a habit frequently seen in clients is skin picking, where the picking makes the acne lesion worse, causing even more distress. But the picking, scratching or pulling (as in the hair­pulling disorder, trichotillomania) is anxiety­-driven, and is ultimately a compulsive behavior that is ideally corrected with psychiatric intervention.

  3. Secondary psychiatric disorders are diseases of the skin that cause so much distress, they can trigger a significant psychological problems such as clinical depression and anxiety. The very visible skin disorders, such as psoriasis and vitiligo are particularly stressful for an individual, and rates of depression and anxiety are higher among them. Despite being ‘skin diseases,’ psychiatric intervention with anti­-anxiety or anti-­depressant medications may be prescribed in a medical setting.

  4. Finally, there are miscellaneous conditions that include neuroses, suchas feeling ‘bugs’ crawling on the skin. These are primarily treated in a psychiatric setting.

These subcategories are not mutually exclusive. For example, stress can trigger a breakout but acne can also cause social anxiety and depression due to visible scarring. While the medical world is beginning to integrate these two fields to better treat their patients, this is still a relatively new field, leaving many without the option for integrative treatment. Perhaps more importantly, they may not be getting adequate solutions from their healthcare providers, with specific medicine prescribed to treat their symptoms, rather than unveil the root cause, which may very well come from the mind. Now think of your typical client. A skin treatment center will likely see clients with inflammatory skin diseases like acne, eczema, and rosacea. Even the destination spa will see overworked, stressed individuals wanting a respite from their day­to­day. In all cases ­ from stress to acne to eczema ­ you’re dealing with chronic inflammation, and this poses a major threat to the health and wellbeing of your clients. Now think of the many people that quietly suffer from these conditions ­ the overworked mother will likely get a facial or massage to deal with her stress levels rather than see a physician. The teenage acne client may use OTC products, but finds they are not ‘working.’ We live in a world where stress is pervasive in society, lurking behind every traffic jam and argument as fuel to the fire of inflammation in our bodies. Estheticians are uniquely qualified to provide relief from the symptoms associated with stress­related skin diseases. From the aromatherapy inhalation techniques, to pressure point massage add­ons, to the act of gently massaging the face --­ these are truly mind­-body strategies that ultimately reduce the levels of stress hormones in the body, allowing for better balance between the immune, nervous and cutaneous systems.

The Power of Touch

Today’s society is correctly described as touch­-deprived. Estheticians and massage therapists represent two professions where practitioners can touch the skin of clients --­ a rarity in this day and age. With touch, we induce hormonal signals carried via the skin to our brain’s cognitive and emotional centers, resulting in positive behavioral changes. Recent neuroscientific research has unveiled the mysteries of touch. Our skin, the largest organ, is highly innervated and connected to our brain. Our skin allows us to ‘feel,’ with some sensations calling for immediate response (like a burn) while others take some time to process, like the pleasure during a massage. The rate at which these different sensations reach our brain and create emotions arises from anatomical differences in the nerve fibers that live just beneath the surface of the skin. There are fast-­conducting fibers that are thick and highly insulated, that transmit electrical signals to our brain (ouch! or that burns!) much like a high-­speed internet connection allows you to download a movie quickly. Now if these fast­ conducting nerves are like ethernet cords, the slow-­acting nerves are more like having a dial-­up internet connection (remember those?). These slow­conducing nerve fibers are called “C-fibers” and are thin and uninsulated. And it is these very ‘slow’ nerves that are processed in the region of the human brain responsible for positive feelings, the insular cortex. To us, that means we feel pleasure from receiving a gentle caress.

When you give a facial massage, you are activating these very slow nerve fibers that result in positive feelings and ultimately reduce levels of the stress hormone, cortisol. One other mechanism by which your gentle touch reduces cortisol is by increasing it’s counterpart, oxytocin. Oxytocin, initially studied for its role in childbirth, is involved in a variety of social behaviors, including motherly care, aggression, bonding between couples, sexual behavior, social memory and trust. Oxytocin also reduces stress responses, including cortisol levels. Finally, it is hormone that’s linked to feelings of empathy.

In Your Hands

Empathy is something that is impaired in many aspects of today’s modern culture. As estheticians, you are in the business of ‘touch.’ If you were not empathic with your touch, you would likely choose a different profession. This should all make your work a little clearer ­ you are not simply breaking up knots in muscles, or cleaning and smoothing the skin ­ you are providing a mind­-body therapy that restores the cellular balance between the skin, nervous system and immune system. One treatment at a time, through touch you can help create a more connected and compassionate world, beyond the immediate effects of reducing individual stress.


  1. Levin, Ethan C., and John YM Koo. "Psychodermatology: An Overview." Semin Cutan Med Surg 32 (2013): 64­67.
  2. Löken L.S., Wessberg J., Morrison I., McGlone F. & Olausson H. (2009). Coding of pleasant touch by unmyelinated afferents in humans, Nature Neuroscience, 12 (5) 547­548.
  3. Senra, M. S., and A. Wollenberg. "Psychodermatological aspects of atopic dermatitis." British Journal of Dermatology 170.s1 (2014): 38­43.