Psychological and Emotional Aspects of Skin Conditions

The skin is the largest organ in the body and an important barrier between the internal and external environment. The experience of a skin condition is subjective, not objective. Three different people with the same skin condition may well report three completely different experiences. The clients I work with have vastly different experiences with their skin conditions depending on their temperaments and behavior.

If you are anything like most people that suffer from skin problems, you will notice that your skin is often on your mind. Typically, as you wake up in the morning your initial thought will be about how your skin looks. You’ll spend minutes or hours staring into a mirror to determine whether your skin is better or worse than the day before. You are not alone.

It is vitally important to know that you are not alone. Skin conditions isolate people. Spending too much time alone, either physically, by isolating yourself, or mentally, by hiding shameful thoughts, is physiologically and emotionally unhealthy. The result is often an emotional snowball that gradually builds until it starts to limit your life.

This emotional snowball does not discriminate based on your specific skin condition. I work with clients suffering from acne, alopecia, body dysmorphic disorder, eczema, hives, pain and burning, psoriasis, rosacea, skin picking (excoriation/dermatillomania), hair pulling (trichotillomania), and warts. Although each condition presents different physical symptoms on the outside, inside, the emotional suffering tends to be similar.

A common train of thought I see when working with my clients illustrates the experience well. “My skin is awful. I’m so alone,” can turn into “My skin is awful. No one will love me” or “My skin is awful. I hate myself” or “My skin is awful. My life is hopeless” or “My skin is awful. I hate the world.” If you have experienced any of these thoughts or similar ones, you know firsthand how stressful it is.

The snowball often doesn’t end there. According to dermatologist Dr. Flor A. Mayoral (American Academy of Dermatology, 2007), “In treating hundreds of patients over the years with skin conditions such as eczema, rosacea, acne, psoriasis, I have seen firsthand how stress can aggravate the skin and trigger unexpected flare-ups that, in effect, create more stress for patients. Learning how to manage the effects of stress on your skin can help alleviate some of the anxiety and symptoms.”

Intense emotions such as stress, anger, fear, or pressure can trigger rosacea, increase acne, or cause an eczema flare-up or outbreak of psoriasis. This is thought to be, at least in some conditions, a result of an inflammatory stress response induced by activation of the sympathetic nervous system. For example, studies have shown that sympathetic neurotransmitters, such as norepinephrine, can cause the release of inflammatory signaling molecules that may activate inflammatory pathways in the skin.

After working with many people who experience a wide variety of skin conditions, I can assure you that you are not alone. My hope is that I can increase your awareness of the links between the mind and body and help you learn psychological techniques that will let you manage the emotional impact of a skin condition and hopefully reduce symptoms.


Matt Traube, MFT
Child and Adult Psychotherapy
License #84815

Phone: (805) 324-4684 and (781) 223-8629
Skype: matt.traube1


Comments 4

  1. I loved popping other people pimples, I started chewing the inside of my cheeks at sixteen years old. Then I switched to split end pulling. It felt more satisfying to see the hairs. I learned how to warm up my skin and get the dry blackheads out without damaging my face.
    Now its my callouses on my fingers and toes, which I have plenty of material to work with. The nail trimming became excessive. I don’t want the dirt. The split ends were painless.
    I see now that all these are self injurious and done in private. Except that I carry or go out and buy nail clippers if I have to so I can get the callouses off immediately. I’m a pretty hardy person, working outside. I have no confidence in my life really, introverted, obscure, narrowed down, and completely at odds with the world. When I lived in Santa Barbara I walked past your office, not knowing you specialized. Lynn was my therapist. Then Susan F. Now I’ve managed to extricate myself, after raising my daughter. I always said I’d move if I found some place better. Now i don’t know what that means.
    I’m going to see my psychiatrist, Michael Mc P in Septemeber for refills. Nobody will touch me in Stanislaus County. I’m glad I know whatdisorder I have, its name. I’m not hurting myself too badly, just enough regularly to know I have a problem. Don’t know what I’d do with out.

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      Thank you for sharing your experiences, I know many people can relate. Ultimately, most of these body-focused repetitive behaviors like skin picking, hair pulling, and cheek chewing are used for pain control. They allow people to feel temporarily relief from uncomfortable feelings, I say temporary because many feel a sense of shame or guilt right afterwards. You bring up an important point about what life would be like without them. I don’t think you’ll ever experience the exact same feeling you get from skin picking, hair pulling, and cheek chewing, but I often notice that when people learn how to manage the behaviors, it’s a big relief and they are generally happy to see them go. Thanks again for your thoughts.

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