Explainer / What is psychodermatology? The emerging wellness trend explores how emotions and stress affect hormones, immune responses and physiological processes – and it all shows on our skin

Stress affects not only our minds but also manifests on our skin in various forms like acne, eczema and psoriasis. The proverb “more than skin deep” finds literal meaning here, opening the door for an often-overlooked frontier at the intersection of psychology and dermatology: psychodermatology, an emerging field that explores the complex relationship between our emotions, stress levels, mental well-being and the health of our skin.

The connection between our emotions and skin condition is deeply rooted in the complex interplay of hormones, immune responses and physiological processes. “A simple way to explain it is to understand that the skin reflects everything happening inside and outside us,” says Angelica Figueroa, cosmetologist and founder of the website Geek & Chic. When we encounter stress, our body responds by activating the hypothalamic-pituitary-adrenal (HPA) axis, releasing cortisol, known as the “stress hormone”. This surge is part of the body’s fight-or-flight response, which is crucial for survival.

However, in our modern world – where stress more often takes the form of near-constant psychological pressure – this response can negatively affect our skin. Elevated cortisol levels disrupt the skin’s barrier function, leading to increased sensitivity, a reduced ability to retain moisture and a slower healing process. “Just as external changes, such as those caused by exposure to UV rays and pollution, can pigmentate or dry out your skin over prolonged periods, internally, the skin processes what’s happening, using nutrients, oxygen and water to regenerate and maintain its functions,” Figueroa explains. “Your emotions can disrupt these functions, as they can modify the messages the cells receive.”

Under stress, our body produces more androgens – hormones that stimulate the skin’s oil glands and hair follicles, leading to clogged pores and acne outbreaks. This is why periods of high stress can often lead to a noticeable increase in acne flare-ups, creating a frustrating cycle where stress about the skin’s appearance can further aggravate the condition.

Likewise, eczema – characterised by dry, itchy, inflamed skin – can flare up under emotional distress, leading to more severe outbreaks and disruption of the skin’s protective barrier, and making it more susceptible to irritants and allergens. The itching and discomfort caused by eczema, in turn, can lead to increased stress and anxiety, perpetuating a distressing cycle of skin irritation and emotional unrest.

In practice, psychodermatology doesn’t replace conventional dermatological treatments but rather complements them, addressing the psychological factors that may be contributing to skin issues. “One of the key psychological strategies employed in psychodermatology is cognitive behavioural therapy [CBT], a form of talk therapy that helps patients identify and modify negative thought patterns and behaviours that may be making their skin conditions worse,” says Dr Penny Lee, a dermatologist at Sydney’s Eastern Suburbs Dermatology. For instance, in cases of acne or eczema, CBT can equip patients with the tools to manage their stress more effectively, breaking the cycle of skin flare-ups leading to anxiety, leading to exacerbated flare-ups.