You’re going through a stressful week: multiple deadlines and back-to-back meetings are leaving you feeling anxious and completely burnt out. When you don’t think it could get any worse, a ripe pimple emerges on your cheek. If the trials of modern life are taking their toll not only on your psyche but also on your skin, you’re not alone. From acne breakouts to rosacea flushes to eczema flare-ups, physiological stress can trigger the inflammation causing or exacerbating skin conditions. The brain-skin connection is real. That’s why Sheperd Integrative Dermatology takes a holistic and integrative (hence our name) approach to treat the whole person (the body and the mind) rather than just zeroing in on one organ such as your skin.

The intricate relationship between the mind and body has been documented since ancient times from Greece to China. Somewhere along the way, we lost this connection in Western medicine. Only in the past several decades have we seen the resurgence of mind-body awareness—and only in the past twenty years or so have we seen an emphasis on understanding the brain-skin connection. Specifically, Psychodermatology is a new medical subspecialty emerging from the combination of psychiatry and dermatology—fascinating, right? In essence, psychodermatology is a holistic view of skin disease within the medical world.

Let’s rewind back a bit to the idea of physiological stress being the fuel to the fire of inflammation in our bodies. To break it down, your skin basically goes into “defense mode” at the first sign of physiological stress, which arises when people are under mental, physical, or emotional pressure that they perceive exceeds their adaptive power. This stress is perceived by the brain, which triggers a cascade of hormone release through the hypothalamic-pituitary-adrenal (HPA) axis, resulting in the secretion of cortisol or the body’s main stress hormone. In response, the body tries to adapt to the stress to bring the system back to baseline, but if the stress response is inadequate or excess, it can lead to chronic inflammation and disease. It has been shown that stress can trigger and/or exacerbate multiple conditions such as cardiovascular disease, migraine, multiple sclerosis, epileptic seizures, and neurodegeneration. More recently, clinical observations have also linked physiological stress to the aggravation of multiple skin diseases such as eczema, acne, and psoriasis.

That being said, the distress that these stress-related diseases cause is also very real, feeding a vicious cycle. Being an acne sufferer myself, to the point of going on Isotretinoin (Accutane) three separate times, I am aware of the psychological distress skin diseases can afflict on their victims. In fact, people with the most visible skin conditions (acne, vitiligo, psoriasis) have the greatest risk for developing anxiety, depression and even suicidal thoughts.

There is still much to uncover in the field of psychodermatology, but evidence points to a fully functional HPA system in the skin that is particularly sensitive to physiological stress. There’s also significant evidence supporting the brain-gut-skin connection that attributes psychological stress to altering the gut microbiome, leading to inflammatory skin diseases (Check out my other blog, “How a Healthy Gut Microbiome is Essential for Healthy Skin”). So if the problem stems in the mind, the creams, lotions, and potions you may be using aren’t addressing the root cause. Decreasing your cortisol levels could be the secret ingredient you’re missing.


Lucky for us, the solution is quite simple if we stick to it: meditate, eat whole foods, and ground in nature. Call us today to schedule an appointment with our Mt. Pleasant skin care professionals to help you get to the root of your skin concern(s). Come a few minutes early to walk the labyrinth in our peaceful garden to nourish the mind and the soul.