I’m A Psychodermatologist & I Always Avoid These 5 Habits For Good Skin

Photographed by Beth Sacca.
I feel very fortunate to have access to both a dermatologist and a therapist. The former I see on an as-needed basis, like when I accidentally use a high-concentration vitamin C serum and it causes contact dermatitis. (I needed a prescription to bring down the swelling.) The former is a standing weekly appointment that focuses on my mental and emotional health and habits.
While we might see our mental health and skin health as completely separate things, there’s actually a lot of overlap, particularly in how our skin affects our mental health. Evan Rieder, MD, a board-certified psychiatrist and dermatologist says that skin conditions can affect the way that we function on a psychological level, in some cases, lowering our self-esteem, triggering depression and anxiety. They also affect the way that other people interact with us. That can be stressful, and stress can exacerbate skin conditions like acne, eczema, psoriasis, and even hair loss.
To make matters worse, many of us tend to compare our skin — which may be going through it — to people on TV, in movies, or on TikTok. That comparison mindset can cause us to experience "normative discontent," or negative feelings towards our own skin. It makes sense. Let's face it, how often are we seeing acne and eczema represented in mainstream media? We're getting better — with brands (like Starface) normalizing pimples and influencers raising awareness around the common experience of having a non-binary skin type, like dry and acne-prone skin. But we have a way to go considering that stress-related skin conditions, particularly acne, affect most people at some point in their life.
As a psychodermatologist, Dr. Rieder's job isn't just to treat the skin topically, but to share certain coping strategies and techniques in order to help his patients cultivate a more mindful and compassionate relationship with their skin. And what better time to implement this into our own routines than a brand new year? Ahead, Dr. Rieder shares his very best advice.

Not practicing "skin compassion"

There's psychological science to support that developing a compassionate relationship towards your skin is to its benefit. This is referred to as 'acceptance and commitment' therapy. "If you can accept what's happening to your body — so in the case of acne, accept that you have acne — it will help you understand that it doesn't define you," explains Dr. Rieder. Of course, this is easier said than done, and practice takes work; having to repeatedly remind yourself that acne is normal and not a part of your identity is exhausting. Plus, it might not resonate with you right away and that’s okay.
Similar to the nuance between body positivity and body neutrality, where the former is a belief that everything about your body is good and positive and the latter is a more neutral acceptance of what is, skin compassion, or skin neutrality, isn't about 'loving' your acne. Rather, not attaching to it. Skin compassion separates the skin condition from the person identifying with it. In the case of acne, Dr. Rieder says that it happens to everyone and is by no means a character flaw. If it’s something that continues to bother you, you can take action from there. This would look like visiting a board-certified dermatologist for treatment, which may include a topical treatment like tretinoin or oral medication.

Trying to “figure out” the root cause of acne

With all the resources out there (ahem, TikTok), it seems like everyone is a skin expert, and we're bombarded with advice every time we scroll. Sharing knowledge and experience is great, but it can quickly put us in a mode of diagnosing our skin issues (especially when it comes to acne) based on a stranger's description of theirs. "People come in all the time and have some sort of explanation for why their skin is flaring up," says Dr. Rieder. "I appreciate the detective work but I think people can go nuts trying to figure it out." 
For acne, it's not always helpful to dig deep for the cause because it's often hard to pinpoint. "People like to say, 'I have stress-related acne' or 'I have hormonal acne' or 'I have diet-related acne,'" says Dr. Rieder. "But for the most part, the treatments for acne are the same regardless of how you like to conceptualize your acne."
Instead, the best thing you can do is see a trusted dermatologist for a personalized skin assessment. If you can't get in with a dermatologist (consultations can be few and far between depending on where you live, not to mention expensive), you can follow Dr. Rieder's general acne guidance. He recommends treating acne with a retinoid or an over-the-counter benzoyl peroxide, which he says is the number one ingredient that kills acne-causing bacteria on the skin. Dr. Rieder recommends Avene Medicated Clearing Treatment with 5.5% micronized benzoyl peroxide because it's formulated to be tolerable for sensitive skin. The tricky thing about acne medications like benzoyl peroxide is that they can be harsh, so you might have to mitigate potential side effects like dryness and irritation. Dr. Rieder recommends using a gentle moisturizer over any acne treatment so that your skin remains hydrated.
"People have to be careful with their acne care and make sure they're doing a lot to repair the epidermal barrier," adds Dr. Rieder, which is the outermost layer of skin that keeps bad stuff out (like bacteria and pollution) and good stuff in (think moisture and ceramides). That means gentle cleansing twice a day. “I'll often have acne patients use a hydrating cleanser once a day and a salicylic acid cleanser the other,” offers Dr. Rieder. He recommends Allies of Skin Silk Amino Hydrating Cleanser as well as iS Clinical Cleansing Complex. Then, it’s important to be diligent with moisturizer. Dr. Rieder recommends Sente Dermal Repair Cream and Avene Cicalfate+ Restorative Protective Cream. The latter is an affordable option. "It's a favorable price point and there's lots of data supporting its use even after laser procedures that can be pretty harsh on the skin," says Dr. Rieder. 
Additionally, Dr. Rieder says adding thermal water in the form of a facial mist is a great addition to a winter skincare routine. "There's really good science behind thermal waters used to calm skin conditions that are inflammatory, like acne, eczema and psoriasis," says Dr. Rieder. "It can also help buffer those negative aspects of being on something like benzoyl peroxide."

Overlooking the sensory part of skincare

Fragranced products are controversial. On one hand, there are various sensory benefits. The smell of roses in a product might be soothing to some people, for example. On the other hand, others report allergies and reactions to perfume in products. If that's you, it pays to steer clear, but there is some nuance.
"Some people respond well to smells in skincare," Dr. Rieder explains. "They don't have to be pleasant smells, they just have to be smells that elicit some sort of stimulus in the brain that they're being effective. It's one of the reasons that people like Biologique Recherche P50 or SkinCeuticals CE Ferulic Serum." The latter famously smells like hot dog water, but its diehard fans won't let that put them off. In fact, a lot of people associate the potent smell of the ingredients with efficacy, reports Dr. Rieder.
Similarly, consider the color and texture of your skincare products. "Some products may elicit a tingling sensation or it may have a color that you respond to that's really soothing, like a light blue," offers Dr. Rieder. He uses the popular Kiehl's Facial Fuel as an example of a product that tingles and has a color to it. "It's sort of a mindfulness experience of being in the moment because you're hitting a lot of different [sensory] angles," Dr. Rieder explains. 
Most of the data we have on the sensory aspects of skincare and how we respond to them are anecdotal, but according to Dr. Rieder, there's a lot of potential for additional development in that area.

Not having a mindfulness practice

The idea of skincare as self-care has been commercialized and sold to us in so many ways. But there is evidence to support the idea that skincare can be a mindfulness practice — and you don't have to spend any money on it. “Just the act of touching your skin, or massaging in skincare, is enough to clear the mind of the stresses of the day,” suggests Dr Rieder. Recent studies have shown that daily self-massage is beneficial for addressing visible signs of stress and improving emotional well being.
It would be wrong to compare applying your skincare products to ancient traditions like deep breathing and mindfulness meditation. However, many people respond to the routine and tactile element of doing their skincare. 

Sacrificing “set point” sleep 

I asked Dr. Rieder about the biggest lifestyle factor that impacts our skin and he said it's very clear: sleep. "Poor sleep disrupts the stress axis in your body and it can really dis-regulate every single organ in your body; your skin is no exception," explains Dr. Rieder. He recommends exploring your genetic sleep set point, or the number of hours of shut-eye you need. "Everyone has a different set point for how much sleep they require," he explains. Most people will fall somewhere between six to eight hours, but it’s helpful to know exactly where you land on the spectrum so you can optimize for it on a regular basis. 
Dr. Rieder acknowledges that this is easier said than done (if you have kids, you get it). “It's easy to say, ‘Oh you're just stressed and you have to decrease your stress levels,’ but it's really hard to do and practice,” offers Dr. Rieder. The best advice might sound trite but, just do the best you can. “Whatever [mindfulness practice] that feels good for you can be helpful to reduce anxiety, stress and insomnia,” says Dr. Rieder. “With repeated practice it will help general wellbeing and decrease the inflammation in your stress axis in your body.”
Mindfulness experts have a lot of helpful, non-tedious tips for reclaiming sleep when you’re stressed. Some recommend connecting with something or someone you love in the evening (like calling a friend on your walk home from work), developing a bedtime routine you look forward to (like writing in your Five Minute Journal), or listening to white noise while you sleep (maybe it’s time to try the Hatch alarm clock). Remember, be gentle with yourself, with your skin, your sleep, or your stress levels — it’s okay if things are a little off sometimes. Self-compassion is a huge first step.
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