The Brain Skin Connection | Sheperd Integrative Dermatology in Mount Pleasant, SC

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 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 excessive, 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 their victims. In fact, people with the most visible skin conditions (acne, vitiligo, psoriasis) have the greatest risk of 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 alter 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 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.

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Rebecca Repaire


Becky is a board- certified Physician Assistant and has practiced Dermatology for over 18 years. She graduated magna cum laude from her undergraduate degree at the University of Georgia, then completed her Physician Assistant studies at the Medical University of South Carolina. She now practices medical, surgical and cosmetic dermatology. She has done extensive training in the use of a dermatoscope and equally extensive training in surgical techniques for the removal of skin cancers. As her practice and skill have continued to grow, cosmetic dermatology has become a passion of hers and she devotes herself enthusiastically to continuing training to ensure she remains at the forefront of innovations with Botox, fillers, threads, and other techniques. She believes that our skin is a reflection of our overall emotional and physical well-being, and she delights in helping patients find their inner beauty.

Amy Jetter


Amy brings her whole heart to her role on the Sheperd cosmetic team.  A graduate of Elon College and the Medical College of Virginia, Amy has been a board-certified nurse for over 30 years.  Bringing her skills as an ICU nurse into her role in cosmetic patient care, Amy provides a warm, reassuring presence to all her clients, listening to their concerns and collaborating with them in a plan to bring forth and enhance their natural beauty.  A standing member of the American Association of Plastic Surgery Nurses and a past RN trainer in cosmetic and aesthetic procedures, Amy offers all types of laser treatments, botox and dermal filler injections, and chemical peels.

Melissa Mancuso

Body Contouring Specialist

Melissa has six years of experience in body contouring, beginning with her role as the CoolSculpting representative for Maryland, Virginia, and the District of Columbia. Since joining the Sheperd team, she has received additional training and now offers chemical peels, Vivace micro-needling, and Diamond Glow dermal infusion. She loves helping patients feel good about their bodies and teaching them about how the various cosmetic procedures can help them achieve the results they are seeking.

Margaret Gierhart


Margaret, a South Carolina native, is a Licensed Esthetician and makeup artist with over 20 years of experience in the beauty industry. She earned a BA in Psychology from the University of South Carolina. She began her career in beauty as the resident makeup artist for Bobbie Brown cosmetics at Saks Fifth Avenue in Charleston. In order to expand her knowledge, she earned her degree in esthetics from Trident Technical College, graduating with honors. She joined the Sheperd Integrative Dermatology staff in 2014 and is certified in a wide array of cosmetic procedures and skin care products. Her offerings include laser skin resurfacing, IPL, micro-needling, chemical peels, radio frequency, laser hair removal, and body contouring. Her background in both psychology and artistry gives her a deep capacity to care for patients and understand what makes them feel beautiful. A mother of two daughters, Margaret understands beauty as not only external appearance, but also as a manifestation of the inner qualities of kindness, generosity, and well-being.

Madeline Anderson


Maddie is a board-certified Physician Assistant and a Lowcountry native. She obtained her undergraduate degree from Clemson University and then went on to earn a Master of Science in Physician Assistant Studies from the Medical University of South Carolina, graduating with highest honors. While in PA school, Maddie served as a Student Representative for the SC Society of Dermatology Physician Assistants. After graduation, she completed a six-month advanced dermatology internship here at Sheperd Integrative Dermatology. She also completed the Diplomate Fellowship with the Society of Dermatology Physician Assistants. Maddie has a heart for medical missions and is passionate about patient education. Her free time is shared with her family, her friends, and her two fur babies!

AnnaKathryn Keiper


AnnaKathryn completed her Doctorate degree at the Medical University of South Carolina and has seven years of experience in dermatology. She has completed additional training in medical dermatology, cosmetic dermatology, and functional medicine. She provides skin cancer screenings, surgical removal of skin cancers, treatment of precancerous lesions, extractions of cysts, and the treatment of acne. In the cosmetic domain, she provides laser, filler, and neurotoxin treatments. Certified through the Institute of Functional Medicine, AnnaKathryn has a special focus on wellness, including weight loss and diet consulting. She uses her expertise in this field to create an individualized program to help each of her patients achieve optimal wellness supporting them in maintaining vibrancy and vitality throughout their lifespan.

Allyson Harrell-Garrison


Ally is a board-certified Physician Assistant and a Diplomate of the Society of Dermatology Physician Assistants, their highest rating. She is a graduate of Clemson University and earned her Master’s degree in Physicians Assistant studies at the University of Alabama; additionally, she completed a dermatology fellowship at Charlotte Dermatology in North Carolina. For more than ten years, her focus on both medical and surgical dermatology has included identifying and treating skin cancers as well as managing biologic medications for psoriasis and atopic dermatitis. Ally has a strong love of surgical dermatology and she performs surgeries every day in the clinic, including excisions of cysts and skin cancers. She also loves the challenge of a difficult case! On the cosmetic side, Ally is a skilled injector of both Botox and Dysport. She sees compassion and empathy as vital qualities that she brings to all her patient interactions. She is mindful that skin cancer screenings can be frightening or overwhelming; her warm, calm manner and her focus on patient education throughout each appointment make her an outstanding clinician.
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