At age 16, Dawn Montefusco developed a serious case of psoriasis that covered 85 percent of her body in itchy, red scales. Her doctor dashed her hopes of an easy cure, telling her she’d most likely have the autoimmune disease the rest of her life. “I was a sophomore in high school, so this was devastating,” recalls Montefusco, now 40.
The summer after her sophomore year, Montefusco decided to take it easy. She spent the next few months relaxing, going to the beach, and hanging out with friends. Remarkably, by fall the psoriasis had cleared almost entirely. The condition flared up occasionally on her scalp, hands, and face as she grew older but never as badly as that first outbreak.
Everything changed at age 36 when Montefusco moved across the country, from sunny Florida to Portland, Oregon, to take a job working with at-risk youth. The dreary climate only exacerbated the stress she felt at her new job. Her psoriasis came back full force, covering her entire body just as it had 20 years earlier. This is when Montefusco finally made the connection: Her psoriasis had always flared up when she felt stressed or emotionally unbalanced. Even the smaller outbreaks in her 20s and early 30s, she says, occurred when she’d been sleeping less, partying more, and not taking care of her mental well-being. As further proof, her psoriasis would disappear altogether when she felt emotionally healthy and relaxed—like during that summer she’d spent at the beach.
More than skin deep
We all know intuitively that stress and skin problems go hand in hand, but the medical community has only just begun to really explore the connection—and tailor treatments for psoriasis, acne, eczema, and even warts accordingly. “Up until very recently, the American Academy of Dermatology was saying that stress was not a factor in acne,” says Ted Grossbart, PhD, a professor of psychology at Harvard Medical School and author of Skin Deep: A New Mind/Body Program for Healthy Skin, “even though everyone and their grandmother knew that you got the pimple before the big date.” Coincidence? Grossbart and others don’t think so.
A growing field of integrative medicine called psychodermatology probes this mind-skin connection. Practitioners sometimes have both medical and psychology degrees, but an increasing number of specialists—even those without dual degrees—are beginning to look at skin ailments more holistically, turning to psychological techniques like hypnosis, meditation, biofeedback, and counseling to solve their patients’ afflictions. And the University of Rochester Medical Center opened the Center for Integrative Dermatology in 2005, which treats patients by focusing on the mind-skin connection.
“Research has shown that 30 to 60 percent of people who seek medical care for skin conditions have some kind of emotional turmoil going on as well,” says Grossbart. “And those emotional issues can not only trigger skin disorders, they can keep the most medically advanced regimens from working.”
Balanced mind, balanced skin
When the stress-psoriasis connection finally became clear to Montefusco, she decided to make some major life changes. She quit her job to start her own life-coaching business and began meditating one hour each day, focusing her efforts specifically on her skin. She also practiced yoga and took long walks, in addition to undergoing a few traditional psoriasis remedies such as ultraviolet light treatment and cortisone injections. The result? Clear skin in less than six weeks. “My dermatologist was dumbfounded,” she recalls.
Montefusco’s experience echoes what research has shown and illustrates a basic physiological fact: Skin is intimately associated with the brain and the rest of the nervous system, which manages stress.
“The brain and skin have many interconnections—the skin has a vast neurologic and vascular network,” says Amy Wechsler, MD, a New York City–based dermatologist, psychiatrist, and author of The Mind-Beauty Connection. “[Therefore] chemicals made in the brain in response to stress travel to the skin.”
Whatever the emotional trigger—work pressure, relationship issues, life transitions, or depression—stress can cause these troublemaking chemicals, called neuropeptides, to flood your skin and wreak havoc. They can cause inflammation, widen blood vessels, increase skin permeability, and generate excessive moisture, all of which can exacerbate skin problems—particularly those that tend to flare up periodically.
“Acne, psoriasis, sensitive skin, wrinkles, dark circles, dry skin—all of these conditions are worsened during times of stress and sleep deprivation,” Wechsler says. “So addressing the stressors improves the skin faster than just treating the skin alone.”
Mind-body relaxation and calming activities like meditation, biofeedback, yoga, and t’ai chi reduce the flow of neuropeptides, leading to less reactive skin, explains Richard Fried, MD, PhD, a dermatologist, clinical psychologist, and director of the Acne and Rosacea Society. Decreasing stress, by whatever means, can also help your skin “better tolerate the numerous insults that occur throughout the day like exposure to irritants, allergens, friction, perspiration, and makeup,” he says. In short, even if you’re just worried about wrinkles and dryness and not necessarily a diagnosed skin disorder, your skin can still benefit from addressing and controlling the emotional stress in your life.
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Science supports mind-centered solutions to skin diseases. In 2007, researchers from Wake Forest University found that high school students were 23 percent more likely to break out in acne during times of heightened stress—even without an increase in sebum production, which is usually thought to be acne’s cause. A 2002 University of Manchester study showed psoriasis improved in patients who received cognitive-behavioral therapy. In another study, from the University of Massachusetts Medical School, psoriasis sufferers who listened to relaxation tapes while receiving UV-light therapy experienced quicker clearing of their scales than patients who had the light therapy but didn’t listen to the tapes.
If emotional turmoil can cause skin troubles, the inverse is also true: Problem skin can do a number on emotional well-being. A 2007 National Health Interview Survey showed that people who have skin disease are more likely to experience depression, anxiety, and psychosis, which can in turn exacerbate their conditions. So the benefit of mind-centered treatment is twofold, explains Fried: It helps control the stress trigger and reduces stress about the condition itself. In addition, he says, mind-centered techniques augment traditional therapies, often allowing them to work more quickly and effectively, with the added perk of creating a feeling of control that increases the patient’s likelihood of following the treatment regimen.
Charting your own course
Despite all the evidence supporting them, mind-centered treatments are no magic bullet. Unlike traditional topical and ingested remedies, the success of psychodermatology treatments depends as much on the individual as the disease. That is, hypnosis and counseling might work for one person, while more physical regimens like t’ai chi and yoga may work better for someone else. As anyone who has ever engaged in a mind-body practice can tell you, learning to manage your emotions and finding your groove with a relaxation technique takes time and effort. Therefore, Grossbart uses what he calls a “smorgasbord of techniques” to treat patients, and then he and each patient work together to see which ones are most effective.
“It’s hard work,” says Montefusco, describing her daily regimen. “You need to really reach inward and know that you control more than you think you do.” But there’s an added bonus to all her efforts: Her skin isn’t the only thing that improves when she focuses more on her mind and heart. “My psoriasis is my gauge to tell whether or not I’m taking care of myself emotionally,” she says. “And it’s the most intense kind of gauge, because you have to look at it in the mirror every morning, everywhere.”
By O’Rya Hyde-Keller