Your skin and your mind

Stress hormones can increase oil in the skin, slow healing and make itch feel stronger. That is why many people notice breakouts or flares during hard times.

Stress usually doesn’t cause skin conditions on its own, but it can make existing ones worse.

Itch can disturb sleep, and visible changes can affect how people feel about themselves. NIAMS notes that vitiligo, for example, can lead to low self-esteem or a poor self-image that affects quality of life.

Psoriasis itself can also cause stress, which can then feed back into flares.

A flare causes stress, the stress makes the flare worse, and the cycle continues. Breaking the cycle at either point, by caring for your skin or calming your stress, can help both.

Stress can’t cause acne on its own, but it can worsen it. Stress hormones increase oil in the skin, which can clog pores and lead to breakouts.

Acne is not only a teen problem: adult acne affects up to 15% of women.

Stress does not cause eczema, but it may make it feel itchier. Because stress makes it harder for skin to heal, it can also make flares last longer.

Stress does not cause psoriasis, but it is a common trigger for flare-ups. Dermatologists suggest managing stress regularly, not only when things are bad.

Ideas the AAD suggests

• Meditation
• A deep breath, breathed out slowly, when stress starts
• Practising stress care even when you feel okay
• Support groups
• Yoga

Some people get hives (raised, itchy welts) when they are very stressed. Long-lasting hives can also affect mood and sleep.

A very stressful event can cause hair to shed. Stress can also bring urges to pull out hair. Alopecia areata, where hair falls out in patches, may also be linked to stress.

NIAMS notes that emotional stress or illness can bring on alopecia areata in people who are at risk, but in most cases there is no obvious trigger.

The AAD says stress can help cause gray hair by affecting the pigment (melanin) in hair follicles.

Habit reversal therapy helps people notice when and why they scratch, then swap in a different action. Research supports it for reducing the urge to scratch in atopic dermatitis, and guidelines in the UK and Europe include it.

A small study in people with long-term scratch-related skin thickening found that adding habit reversal to usual care led to better results for itch, scratching and quality of life.

• At bedtime or while falling asleep
• In front of a screen
• When stressed, worried or bored
• After a hot shower or in dry air

• Clench your fists for a minute until the urge passes
• Gently press or pat the itchy spot instead of scratching
• Hold something cool against the skin
• Keep your hands busy with a stress ball or fidget
• Keep nails short to limit damage

Ask your dermatologist which skin-care steps suit you, so you’re treating the itch as well as changing the habit.

Many people start avoiding situations where their skin might be seen. Avoidance can bring short-term relief, but over time it can shrink your life and deepen worry.

Small, gradual steps back toward the things you enjoy can rebuild confidence. A therapist can help you plan them.

Unwanted questions or advice can sting. Deciding ahead of time how much you want to share can make these moments easier.

You could say

• “It’s a skin condition. It’s not contagious.”
• “Thanks, I’m working with my doctor on it.”
• “I’d rather not talk about it right now.”

Some people spend a lot of time checking, covering or worrying about their skin. If this is taking up hours or stopping you from living your life, talk with your clinical provider or a therapist.

A review of 98 studies found that about 28% of people with psoriasis had symptoms of depression. In population studies, people with psoriasis were at least one and a half times as likely to have depression.

The AAD also lists depression among conditions linked with psoriasis.

A review found adults with atopic dermatitis had about twice the odds of depression and of anxiety. Children with it also had higher odds of depression.

The authors found that improving the skin condition appears to reduce these risks, which is one more reason to get good skin care.

1. Breathe in gently through your nose for a count of 4.
2. Breathe out slowly for a count of 6.
3. Repeat for a minute or two.
4. Notice your shoulders and jaw softening.

When you start to feel stressed, taking a deep breath, holding it and breathing out slowly is one of the stress tips the AAD suggests for psoriasis.

Meditation and visualization are among the mind-body practices dermatologists say can help reduce stress.

Start with just a few minutes a day. Many free guided recordings are available.

Yoga is one of the stress-reducing practices the AAD lists.

If sweat irritates your skin, try gentle movement in a cool place and rinse afterwards. Ask your dermatologist what works for your skin.

A steady bedtime routine helps your body and mind wind down. The AAD suggests one calming bedtime habit: writing down three things you’re grateful for before sleep.

The AAD suggests

• Connecting them with other kids who have eczema
• Helping them follow their treatment plan
• Teaching them ways to cope with stress

Simple calming tools for kids include belly breathing, a favourite song, or squeezing a soft toy when the itch strikes.

Even though acne is very common, it can affect a teen’s confidence, especially with photos and social media. Take their feelings seriously, and help them see a doctor or dermatologist if it’s bothering them.

Ways to support a teen

• Avoid comments about their skin unless they bring it up
• Remind them filters and edited photos aren’t real life
• Offer to help book an appointment
• Watch for signs of low mood or withdrawal

The National Eczema Association (nationaleczema.org) is a U.S. nonprofit with free webinars, personal stories, a podcast and resources for people who are newly diagnosed.

The National Psoriasis Foundation (psoriasis.org) is a U.S. nonprofit that shares information, personal stories and community events for people with psoriatic disease.

• Don’t offer unasked-for cures or product tips
• Treat flares as matter-of-factly as any other health issue
• Listen when they want to talk about how it feels
• Never joke about their skin