Image: Lady in mirror
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When you feel good, you look good. But when you're stressed out, your skin is often the first place to show it.
By
msnbc.com contributor
updated 2/12/2007 8:47:27 AM ET 2007-02-12T13:47:27

The hives started as soon as Lorelei Russ moved in with her boyfriend.

“At first, I thought it was the latex paint or the cats or something environmental,” says Russ, 32, of Brooklyn, N.Y. “So I went to a doctor who told me to take antihistamines.”

The drugs didn’t help, but after nine months of breakouts, Russ discovered something that did: a breakup.

“I slowly figured out that my hives only happened when I was with my boyfriend,” says Russ. “It became my stress reaction. As soon as I left the relationship, my skin stopped freaking out.”

While Russ didn’t realize it, she’d stumbled onto the powerful mind-body connection that is at the heart of an emerging field known as psychodermatology. Focusing on the boundary between psychiatry and dermatology, psychodermatologists (or “skin shrinks”) care for the skin and the soul, dovetailing traditional treatments like antibiotics or topical medications with alternative methods such as relaxation, biofeedback, self-hypnosis or psychotherapy. 

“An estimated 30 to 60 percent of people who come to a doctor for help with skin problems also have emotional issues that are churning as well,” says Dr. Ted Grossbart, an assistant clinical professor of psychology at Harvard Medical School and author of "Skin Deep: A New Mind/Body Program for Healthy Skin."

“These emotional stressors can keep the best skin medicine in the world from working," he says. "You’ve got to address what’s going on in the heart as well as on the skin.”

A perfect storm for skin trouble
Stephanie Gasper, 32, of Kirkland, Wash., would agree. Since childhood, she’s suffered from psoriasis, a scaly skin condition exacerbated by stress. Two years ago, Gasper found herself amid a perfect storm of stress when she had to organize a move from England to the United States, plan her wedding and have her wisdom teeth out — all at the same time.

“My psoriasis just got worse and worse,” she says. “I remember trying on wedding dresses and being so embarrassed because you could see all of this red, scaly skin. But as soon as everything was settled and I was on the plane for the States, it completely disappeared.”

Now that Gasper has given birth to a new — and colicky — baby, though, her psoriasis is back, and she’s shopping for a psychodermatologist. “My doctors would always tell me to take a bath with candlelight or try to listen to music to calm down, but they’d never actually prescribe any alternative treatments,” says Gasper. “I’m definitely ready to go for that now.”

One of the first names on her list is Dr. Bernard Goffe, founder of Dermatology Associates of Seattle.

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“Whenever my old patients come in with a flare-up of eczema or acne or psoriasis, the first thing we do is ask, ‘What’s going on with your life?’” says Goffe. “And often they’ll be in the middle of a fight with their boss or going through a divorce. I had one patient where you could almost draw a curve correlating his hair loss with the ups and downs of the lumber market. I find a very frequent relationship with these things.”

Goffe — who says he’s recommended psychiatrists, antidepressants and biofeedback to his patients, with good results — is not the only one who’s spotted this mind-skin connection.

In August 2006, the Journal of the American Academy of Dermatology published a study that found 57 percent of patients suffering from alopecia (or hair loss) had total or partial hair regrowth after undergoing hypnosis. And a series of small studies conducted at Carleton University in Canada found half of patients lost their warts after undergoing hypnosis.

Relaxation tapes, meanwhile, have been shown to help those suffering from psoriasis; researchers at the University of Massachusetts Medical School discovered that patients who listened to meditation tapes while receiving UV light treatments saw their skin clear up nearly four times faster than those who got the light treatment alone. And in a case report published in the journal Applied Psychophysiology and Biofeedback, a 56-year-old woman who suffered from severe psoriasis lesions on her arms for seven years despite trying all the standard medical treatments was cured after 13 weeks of biofeedback therapy.

None of this surprises Kristen Salvestrini of Beverly, Mass., one bit.

The 27-year-old spent a year in and out of doctor’s offices, trying everything from steroid creams to a strawberry-free diet to rid herself of a pervasive eczemalike rash; she finally turned to Grossbart, who used guided imagery and psychotherapy.

“It came out that I’d been through a pretty devastating breakup which corresponded to the time when my skin started having problems,” says Salvestrini, who is rash-free these days. “One of my big things is not expressing my emotions, especially anger. But those emotions have of way of coming up one way or another.”

Hypnosis for hives
Psychodermatology can cover everything from a “ring finger” rash suffered by a someone in an unhappy marriage to psychiatric disorders that result in self-inflicted skin damage to the isolation felt by those living with highly visible skin disorders such as psoriasis, alopecia or vitiligo (patches of de-pigmented skin).

“We have groups that provide education, but they also provide psychological support, like group therapy,” says Dr. Bernard Cohen, a pediatric dermatologist at John Hopkins School of Medicine in Baltimore. “They’ve absolutely helped.”

And while some might raise an eyebrow at treating hives with hypnosis, or eczema with antidepressants, Salvestrini says the bottom line for her is that psychodermatology offers people an alternative.

“A lot of times when I was going from allergist to dermatologist to nurse practitioner, I’d start to feel really hopeless because it wasn’t getting better,” she says. “It’s just great to know there’s something else out there that may work.”

Diane Mapes is a Seattle freelance writer and author of the recently released "How to Date in a Post-Dating World."

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