Emotions don't just rile up your brain—they can confound your skin. "Any emotion, particularly if it's not dealt with directly, can trigger skin disorders," says Ted Grossbart, an assistant clinical professor of psychology at Harvard Medical School. Here are new solutions for acne, rosacea, rashes, and more that go beyond the usual.
PROBLEM: SKIN PICKING
Picking usually starts as a fixation on a minor blemish "and spirals into hours of picking, plus scabbing and scarring, and feelings of guilt and regret," says Jenna Luu, a psychiatrist at Kaiser Permanente West Los Angeles Medical Center.
• When Heidi Waldorf, associate clinical professor of dermatology at Mount Sinai School of Medicine in New York City, encounters pickers, she writes "HANDS OFF!" on their chart, so she can remind them of this at every visit.
• Waldorf finds the Clarisonic face brush helpful for people who pick at any little flake or bump they feel. "By exfoliating with the brush, they're safely smoothing their skin and, at the same time, fulfilling their need to remove those unwanted elements," she says.
• If someone continues to pick, dermatologists often recommend counseling. "It's important that the patient try to understand what she's doing, why she's doing it, and where her distress is coming from," says Iona Ginsburg, an associate clinical professor of psychiatry in dermatology at Columbia University. In addition, therapists employ behavioral tricks like putting Band-Aids around a couple of key fingers, Grossbart says.
• Pickers also learn to occupy their hands with benign activities, like squeezing stress toys, knitting, or playing guitar, as part of their treatment.
• Hypnosis is another proven approach. Instructions given under hypnosis—like to visualize a stop sign and stop picking—can help emotional pickers resist temptation.
"Fear or embarrassment, usually in a social setting, activates our fight-or-flight response to release adrenaline, which dilates blood vessels in the face, causing a blush," says Luu.
• If you only redden at specific times, like when speaking in public, taking a beta blocker beforehand can help by stopping some of the adrenaline.
• You can also try holding ice in your mouth or putting a cold soda can over your jugular vein for a few minutes. "Cold can help block the impulse to the nerves that stimulate flushing, lessening the intensity of a blush," Waldorf says.
• A longer-term solution also exists for emotional blushers. "With biofeedback, you can learn to control your blood vessels," says Tausk. The technique involves machines that measure various physiological functions, like blood pressure. Over time, patients learn that certain thoughts or behaviors cause pressure to come down, reducing stress and preventing a flush, and eventually they no longer need the machines to get those results.
Rosacea is marked by persistent redness and often uncontrollable flushing that is exacerbated by various triggers, like stress, spicy foods, red wine, and temperature changes. That rush of blood from the condition brings with it inflammatory chemicals and bacteria, which feed the acne-like bumps that often come with rosacea.
• Managing stress and avoiding triggers are key to reducing rosacea symptoms, as is tackling bacteria and inflammation with oral antibiotics and prescription-strength lotions, such as Finacea (azelaic acid) or Metrogel (metronidazole).
• "Pulsed-dye lasers, like the Vbeam, work beautifully for rosacea patients with persistent redness," says Waldorf.
• "They decrease the number of superficial vessels in the face, thereby reducing blood flow to the area." (They aren't effective for purely emotional blushers without rosacea, however, because these people don't have an excess of vessels.) Rosacea sufferers usually see results after one to three sessions, at about $500 each.
Stress hormones ramp up oil production, leading to clogged pores. Add a dash of inflammatory neuropeptides, and angry zits follow.
• Finding ways to decompress can help keep skin clear. "Anything that reduces stress in your body—tai chi, running, sex, a warm bath—will make you have less acne, less often," says Richard Fried, a dermatologist and clinical psychologist and partner in a psychodermatology clinic in Yardley, Pennsylvania.
• Of course, even Zen masters have gotten pimples under pressure. When it happens, turn to an over-the-counter spot treatment containing pore-clearing salicylic acid or benzoyl peroxide. If that zit is a real monster, a dermatologist can shrink it within 24 hours with a cortisone injection.
• If blemishes are widespread, prescription-strength lotions and pills can knock out the bacteria and inflammation. "When someone comes to me under stress with lots of big, tender cysts, I might put her on a short course of oral antibiotics just to get her through the rough patch," says Jeannette Graf, assistant clinical professor of dermatology at Mount Sinai School of Medicine. She also prescribes lotions, like Ziana or EpiDuo, which combine plug-dissolving retinoids with antibacterial agents, delivering a potent double whammy.
When emotions run high, skin can behave like a petulant child. Neuropeptides, which make the skin feel sensitive and reactive, are partly to blame. Studies have also shown that stress increases trans-epidermal water loss in the skin. "As the upper layers of the skin become dehydrated, cells that were once plump and tightly pressed against one another shrivel and shrink," says Fried. The gaps that form between cells invite irritants. "Even people who normally have pretty hearty complexions may suddenly find that their regular creams are making them burn and itch," says Amy Wechsler, a dermatologist and psychiatrist and the author of The Mind-Beauty Connection (Free Press). "But it's usually just temporary."
• And consider taking supplements like omega fatty acids (in fish, flaxseed, and evening primrose oils) and vitamin D³, which is "crucial for skin repair," says Graf.
• Avoid things that overstimulate the skin, like retinoids, acids, harsh scrubs, and heavily fragranced products. Use only mild, hydrating cleansers with soothing ingredients, like feverfew, bisabolol, and green tea extract.
• Moisturize often with formulas containing dimethicone, ceramides, and humectants (such as hyaluronic acid)—ingredients that repair the skin's barrier and help it function better.
Those red welts don't only plague allergy sufferers. Emotional overload can also elicit hives by raising body temperature and, subsequently, prompting an adrenaline rush that triggers the release of hive-causing histamine in predisposed people. Anxiety, anger, even hard laughter—any feeling that generates heat—can bring on the itchy bumps, which appear suddenly and last for an hour or so, sometimes coming and going repeatedly over weeks or months.
Quelling the itch and the instigating emotion is the crucial first step to treating this type of hives, and antihistamines are the most effective way to do it. "In addition to stabilizing the cells that store and release histamine, most antihistamines have sedating properties that can have an antianxiety effect," Fried says. (That's why they often make you sleepy.) Relaxation techniques can work, too—for certain people. If yoga and deep breathing aren't your thing, try retreating to a cool, dark room and soothing yourself with music and two Claritins.
It's possible to break out in a rash even if you haven't been within 100 miles of poison ivy. Emotions can bring on itching, bumps, and flakes. "Out of the blue, you might develop a minor rash or spontaneous itch due to the histamine release that comes with stress," Waldorf says.
It's random and can happen to anyone. But those with a history of eczema or psoriasis—genetic, immune-related rashes—get hit harder, because stress sets off T cells (white blood cells) and cytokines (proteins that regulate inflammation), exacerbating these conditions. In the case of psoriasis, "overactivated T cells, in harmony with the cells and chemicals they switch on, tell the skin to turn over more quickly than it should—roughly every 8 days instead of 28—causing cells to pile up, thicken, and flake," Fried says.
• Since anxiety is such a troublemaker for rash-prone people, some doctors prescribe psychological treatments along with dermatological ones. A low dose of antidepressants or antianxiety drugs can often ease the stress responsible for flare-ups.
• In a study of psoriasis patients, those who listened to meditation tapes during light-therapy sessions found that their skin cleared up 40 percent faster than those who got light alone.
• Hypnosis and a form of guided imagery may also alleviate symptoms. With the help of a psychologist who provides a narrative, patients think of images that can influence their physiology. For instance, one might imagine herself in a pool of warm yogurt to sate dry, itchy skin, or envision a soothing ray of light melting away the discomfort of psoriasis. "Stress is unavoidable, but learning to manage the skin's reaction to it better is something many patients find incredibly empowering," says Ranella Hirsch, a dermatologist in Boston.