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Anxiety's Favorite Canvas for Expressing Itself: Your Face

Negative emotions can trigger or worsen a wide range of conditions like acne​, hair-thinning, and psoriasis.
young man applying acne cream to his face
Bruce Ayres/Getty Images

Anxiety may originally arise in your brain, but the consequences can play out all over your face. And we don’t just mean a clenched jaw or a furrowed brow. Stress, anxiety, and similar emotional states can trigger or worsen a wide range of skin conditions, from acne to hair-thinning alopecia, to scaly psoriasis, research shows.

For instance, in one study of 101 people with psoriasis—an autoimmune condition that causes excess skin cells to build up in itchy, painful patches—about half reported that their first brush with the disease came during a particularly trying time in their lives. And about two-thirds said their symptoms worsened when they felt pressured.


Researchers also found that for about three-fourths of patients, stressful events had occurred within six months prior to developing a condition called alopecia areata, in which patches of hair fall out without warning. In another study, female medical students with higher stress levels also reported worse acne.

Modern medicine tends to slice the body into specialty domains, with psychiatrists attending to your mind while dermatologists soothe your skin. But practically speaking, physiology isn’t so neatly divided, says dermatologist Francisco Tausk, a professor at the University of Rochester Medical Center and head of the nation's only Center for Integrated Dermatology.

When you encounter a stressor—from a potential predator to a delayed Uber driver—your body’s immediate reaction is to pump out a compound called norepinephrine, along with other catecholamines. That’s what starts your heart pounding and primes your muscles to fight or flee. But catecholamines also induce the production of inflammatory compounds called cytokines—including tumor necrosis factor, a molecule that drives psoriasis, Tausk says.

Normally, the hormone cortisol works to bring the stress response to a halt, as well as to reduce inflammation, says dermatologist Suzanne Friedler of Advanced Dermatology PC in New York. In fact, drugs called corticosteroids, used to treat inflammation, are synthetic versions of this hormone.


People with psoriasis and similar conditions often have lower levels of cortisol to begin with—so as cortisol metabolism increases in stressful situations, production can’t keep up. The inflammatory cells rush to your pituitary, triggering the release of compounds that tell your body to produce even more norepinephrine. “Basically, it’s like a circle,” Tausk says. Inflammation runs amok, and your disease flares. Other hormones involved in the stress response—including corticotropin-releasing hormone—stimulate the sebaceous glands in your skin to produce extra oils. The end result? More acne.

Another aspect of the mind-body connection comes through your actions. Overwhelming anxiety can manifest in so-called “body focused repetitive behaviors,” including skin-picking and hair-pulling, says Marla Deibler, a licensed clinical psychologist and executive director of The Center for Emotional Health of Greater Philadelphia. Other negative emotional states, including anger, frustration, or boredom, can also trigger these ticks.

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While minor picking or pulling may count as a quirk or bad habit, these moves can have severe consequences, from swollen skin to bleeding to infections. “These are self-grooming behaviors; everybody grooms, just to different extents,” she says. “Some people do it in excess, to the extent that it takes up a lot of time and causes unintentional damage to the body. That’s when it starts to become clinical or problematic.


This self-destructive relationship can work both ways, with dermatologic problems exacerbating mood disorders. Teens with acne struggle with self-image; adults with psoriasis worry others will never want to touch them. “Because skin is visible and our largest organ, any skin condition, mild or severe, can produce these psychological effects,” Friedler says.

People who pick their skin so badly they have scars may then avoid social situations. “That, of course, then feeds into more negative feelings and more negative thoughts about themselves, which is one of the things that perhaps drove the behavior in the first place,” Dribbler says.

One in 10 people with an official dermatologic diagnosis—including psoriasis, skin infections, eczema, and acne—were clinically depressed, compared to 4 percent of controls without a skin problem, found a 2015 study in the Journal of Investigative Dermatology. Around 17 percent had anxiety, compared with 11 percent of controls. And psoriasis was even associated with suicidal thoughts.

Researchers reported similar findings in a meta-analysis earlier this fall, which linked atopic dermatitus or eczema—a chronic condition that leaves skin red and itchy, often in response to allergens—with depression in adults and children, and suicidal thoughts in adults.

These links also have a biological basis: The same inflammatory cytokines that trigger breakouts and psoriasis flares can also cross the blood-brain barrier, Tausk says. There, they can trigger or worsen depression.


Some treatments for skin conditions also affect your neurobiology. Isotretinoin—the acne treatment sold under the brand name Accutane—has received scrutiny for contributing to depression and even suicidal thoughts and behaviors. Other drugs in the same class, called retinoids, are used to treat psoriasis—and also count depression as a side effect. When patients are prescribed these drugs, dermatolgoists may ask mental-health questions as part of follow-up, Friedler says.

While stress and skin problems can worsen together, addressing one or the other can help you break the cycle. To start:

Be mindful
Staying in the present moment can mitigate the effects of stress on the body. Tausk often recommends practices like yoga or meditation to his patients. You might try a technique called mindfulness-based stress reduction, or MBSR; look for classes at mental health clinics or medical centers. In fact, Jon Kabat-Zinn—a forefather of mindfulness, who created the MBSR program—conducted a study on psoriasis in the 1990s, in which he found the technique increased the effectiveness of other treatments.

Track—and block—skin-harming behaviors
Awareness marks the first step in addressing excessive skin-picking or hair-pulling, Deibler says. Pay attention to your nervous ticks and note when and why they occur. From there, set up physical barriers. For instance, if you tend to pull your hair while waiting in traffic, wear a hat in the car; keep some clay or Silly Putty at your desk if you’re tempted to pick your skin while you’re freaking out about a deadline.

Treat your mind and your body
If your emotions are playing out on your skin, especially in ways you can’t control, consider seeing a dermatologist for relief. Conversely, if negative thoughts about your skin or appearance interfere with your daily life or linger even after your symptoms clear, involve a mental health professional in your skin-care regimen. That person can spot signs of more serious conditions—including severe depression or body dysmorphic disorder, in which you can’t stop thinking about real or perceived flaws in your appearance—that would benefit from treatments like cognitive behavioral therapy, Friedler says. Plus, they can provide additional strategies for managing your mood that just might clear your skin up, too.

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