Skin problems and anxiety often go hand in hand. A mental health condition which affects many of us, anxiety is a sense of impending danger or panic, which often manifests itself in shortness of breath, increased heart rate, insomnia and being unable to focus on anything but the present worry. Feeling self-conscious about your skin can easily trigger these kinds of reactions, which if left unchecked, can spiral out of control. While we tend to focus on the physical side of skin conditions, the emotional repercussions, like anxiety, are just as much of an issue — and often even more debilitating.
I had terrible acne on my back throughout my teens, which came back with a vengeance later on in adulthood. My back was suddenly covered in large red cysts, some the size of golf balls. People would tell me I was 'lucky' that it hadn't spread to my face but it felt like I was hiding a dirty secret. New relationships were tough; I didn't want to get undressed in front of anyone. I stopped going to my usual spin classes after catching a woman staring at my back in the changing rooms. It eventually cleared up but I'll occasionally still scrutinise my back in the bathroom mirror, terrified the acne will return like a sequel to a horror film.
Skin anxiety can affect pretty much anyone, including R29’s own beauty editor Jacqueline Kilikita. "I’ve had hormonal acne since age 11 but it has only made me anxious quite recently," she says. "As I work in beauty, I'm often worried that any skin experts or makeup artists I meet will judge my spots and scars or try to give me advice, and I've tried most things, including medication." It’s even had an impact on her working life. "I've cancelled events and meetings because the thought of people seeing me on a 'bad skin day' can often fill me with panic and dread. In reality, the majority don't really say anything but I find it difficult not to feel this way. After all, the link between skin and mental health is very real."
For some, it can be a vicious cycle. PR Lauren MacAskill found herself with a condition called pompholyx eczema: blisters that appear on your hands and feet. "I couldn’t sleep because my skin was on fire, I'd lie in bed in tears," she recalls. "Because I knew it was as a result of stress, this in itself led to additional stress about how it was affecting me." When fitness entrepreneur Lucy Arnold began to suffer from adult acne, her anxiety was so bad that she couldn't leave the house — she even missed a friend's wedding. Despite winning awards for her activewear brand Lucy Locket Loves, she shunned the ceremonies and didn't collect any of her awards in person. "In the fitness industry, there's a lot of pressure to look perfect," she says. "I used to wear makeup all the time — even to work out. Some clients asked if my skin was sore but others were less polite. One woman asked how I live with skin like mine."
For chef Priscilla Casey, who suffers from rosacea, her anxiety stems from her skin condition potentially flaring up at any time. "People may think I am blushing and may point out that it's 'cute' while not realising that I am actually in the early stages of a rosacea flare-up and experiencing a painful tingling sensation," she explains. Like Lauren, Priscilla has also dealt with sleep disruptions. "I used to get nightmares numerous times, especially when I had an important event coming up. I get nervous that I will have a severe flare-up, as has happened multiple times in the past."
A quick search on Reddit shows how many people's love lives have been stalled by skin anxiety. One user wrote: "I’ve never had a [girlfriend]. I think the main reason of my social anxiety is my bad skin." Another says: "I’m so utterly crippled by how much I hate my skin that I'm now a 29-year-old woman who's never been on a date, never been kissed, who refuses to entertain the hope of finding someone who might be actually attracted to me once they got a close-up good look."
Despite skin anxiety being so widespread, getting treatment isn't always easy. Skin positivity activist Amy How felt that her anxiety was less of a priority when she sought treatment on the NHS for severe acne. "I would spend hours obsessively analysing my skin in the mirror, covering it with makeup again and again," she recalls. "I was in a really bad place." Yet the doctors she saw were mainly concerned with treating the acne itself and failed to notice her growing anxiety. "I did ask to be referred to a dermatologist who might better understand what I was going through but my GP talked me out of it, saying, 'They'll just put you on [acne drug] Roaccutane — that's all they’ll do.'"
Many feel that the severity of skin anxiety is being overlooked. A recent survey by the British Skin Foundation found that nine in 10 dermatologists agree that the psychological effects of skin conditions are not taken seriously enough. "This survey demonstrates that dermatologists recognise some patients experience psychological distress associated with their skin condition," comments clinical psychologist Professor Andrew Thompson on the foundation's website. "It also indicates that whilst dermatology is making great advances in treating the medical aspects of skin disease, perhaps not enough is being done to address the accompanying psychological effects. Clearly, we need more research that looks to develop effective psychological treatments or support for both children and adults living with skin conditions."
Thankfully, the tide is slowly changing, with several dermatologists treating skin conditions in the wider context of mental health. British Skin Foundation spokesperson Dr Alia Ahmed is one of them. "A psychodermatologist is a medically qualified doctor with expertise in dermatology, who can also manage mental health issues," she explains. "In psychodermatology, we treat not just the skin condition but its psychological impact. For example, someone with acne may be feeling anxious about being in a social environment because of their skin. So in addition to treating their acne, I will discuss techniques they can use to overcome these feelings," she adds. Is psychodermatology easy to access on the NHS? "Yes, although the wait time before you are seen is unpredictable. Your GP or dermatologist can refer you to the nearest psychodermatology clinic, but this may be outside of your immediate area," continues Dr Ahmed.
Being vocal about your skin anxiety is also important as a patient. "It's helpful to discuss with your GP or dermatologist how you are feeling so that these issues can be recognised early on. Not all symptoms of low mood need medicine; talking therapies can also help. Your GP can refer you for counselling, or sometimes you can self-refer."
Many individuals tend to put their anxiety problems on hold until their skin clears up, but is this the best way forward? "This depends on why the anxiety exists in the first place," Dr Ahmed says. "Stalling treatment of mental health issues is not ideal, as they can be part of the skin problem and negatively affect treatment outcomes. The best way forward is to treat both the mind and skin together."
Caroline Sims, skin expert and CEO of Botanycl agrees. Her severe acne drove her to research herbal remedies yet despite clearing up her acne, the anxiety didn't disappear. "I've struggled with anxiety for years and years, particularly after a difficult past relationship, where I endured a lot of bullying in regard to my appearance. That had a huge impact on my confidence. So when I developed acne, it just got worse." For Caroline, the best approach was to deal with both at the same time. "If you just focus on your skin, you don't know if the anxiety can move on to another issue. I needed to tackle the symptoms of body dysmorphia that stemmed from that abusive relationship and found CBT really helped. Now I'm having weekly counselling to help with the anxiety in general."
Alternative or holistic therapies are another option. Award-winning facialist Vaishaly Patel offers holistic treatments for clients with underlying anxiety. "I offer craniosacral sessions, which is a very powerful treatment that rebalances the body emotionally and physically," she tells me. "This really helps to release mental and emotional blockages. I also advise to see Dr Tran who's an incredible acupuncturist and Buddhist mentor of mine. You cannot just treat the skin condition. You have to treat the anxiety that is causing it in the first place."
In Amy’s case, big changes such as a new job and lifestyle tweaks really helped, but social media was also a powerful tool. "I started following people on Instagram who were having the same struggles as me. Seeing people going through a similar thing made me accept that it's okay and that I'm normal. It taught me how important it is to be kind to myself. At the time, I really wasn't."