The skin shrink will see you now
A revolutionary new therapy that reveals how much your mood controls your complexion
Back in the spring and summer, my normally contentedly medicated depression took a turn for the worse. My life felt stuck: grieving my recently dead parents, living somewhere I could no longer bear to be, yet too incapacitated to act.
Everything ground to a halt until I felt detached, underwater, at arm’s length even from my own existence.
all the old signs were there, but it was only when my skin erupted into eczema, my mouth into ulcers, and a patch of psoriasis took up residence on my chest that I finally realised what a state I’d let myself fall into. While my mind remained closed, my skin was the canary in the mine, broadcasting my psychological state.
It’s a situation that trailblazing psychodermatologist Dr alia ahmed encounters all the time. ‘The relationship between what is going on in the mind and what is going on with the skin is profound and intimate,’ she tells me at her clinic in Vauxhall, London. ‘It can be explained at a biochemical level via the hypothalamic-pituitaryadrenal axis [our central stress response system].
‘Stress prompts the neuroendocrine system [our chemical messenger system], which then activates cellular processes that cause skin disease.
‘at the same time, 85 per cent of dermatology patients are troubled by the psychosocial aspects of their condition. Put simply: stress causes skin problems and skin problems cause stress, meaning it becomes the ultimate chicken-and-egg scenario. This is where psychodermatology comes in.’
If the term sounds like fashionable mumbo-jumbo to you — a friend enquired whether I was going for a ‘psychic facial’ — think again. This medical speciality is being pioneered by doctors, creating a cutting-edge field with an annual global conference and its own Uk-based society.
It may have taken flight in only the 21st century, but the connection between skin complaints and mental disruption was recognised as far back as ancient times. aristotle elaborated upon the mind/body relationship, while Hippocrates described people pulling out their hair when anxious — behaviour that also appears in the Bible and in Shakespeare’s plays.
For millennia, the areas covered by psychodermatology — the skin on one’s face and body, in one’s mouth and ‘down below’, plus one’s hair and nails — have acted as early warning systems for mental disquiet; banners on which psychological symptoms may be writ large.
Even my late father, a psychiatrist, invariably compared notes with my mother, a former nurse specialising in dermatology, about the cases he had seen in which states of mind were reflected by states of skin.
(amusingly, many of his young female patients would ask to go on the contraceptive pill ‘for their skin’, returning weeks later with their mental health improved, clearly not only because of the effect on their spots.)
Meanwhile, my siblings suffered myriad skin conditions, including terrible eczema, psoriasis, and lifethreatening angioneurotic edema (in which skin swelling can cause the throat to close), meaning we grew up knowing all too well the link between stress and skin crises.
AS THE firstborn, who often escapes inherited conditions, I managed to avoid such horrors. However, this summer, my resurfacing depression made my previously calm skin unrecognisably reactive.
Hence my visit to Dr alia, as she is known, whom I meet at Eudelo, an award-winning private skin clinic to which clients can self-refer.
Dr alia earned a BSc in clinical psychology before her medical degree, latterly working at the Royal London Hospital’s psychodermatology clinic, a groundbreaking service that started in 2002.
at this NHS clinic, she and her colleagues see patients from all over the country. Similar services are available at her other NHS clinic, at king Edward VII Hospital in Windsor, and at the Royal Free Hospital in North London and Solihull Hospital in Birmingham.
The lion’s share of her patients — 70 per cent — are women, generally thirtysomethings, or middle-aged war horses such as myself. ‘I see a lot of young professionals who didn’t have skin problems when they were younger,’ she says. ‘Then they hit their 30s, when they’re juggling stressful careers and/or parenthood, and suddenly their hair is thinning and they have acne or rosacea.’
Or they might be my age, late 40s, facing the muddle of middle age with the skin to show for it — ageing, inflamed, aggravated by challenges such as hormonal sleep deprivation.
For all these women, 37-year-old Dr alia acts as her own advertisement: she is radiantly peachy-skinned. a glance in her direction and one vows to follow her advice to the letter.
FOR the first 20 minutes, Dr alia makes enquiries about lifestyle factors such as stress, sleep, mood, appetite and social networks; ‘building a story’, as she puts it.
Tweaks are suggested. Most people cannot become stress-free, but they can introduce more exercise, keep water on their desk, or score more rest and relaxation. I get a gold star for my new pet dog and obsessive vitamin and mineral intake.
Then it’s a thorough skin examination. Mine is deemed very good, although I do have a few horriblesounding lumps and bumps that could be ironed out with one of Eudelo’s Dermatology Grade Facials.
This would involve a gentle peel and advanced microdermabrasion to support skin renewal. Blackheads, whiteheads and milia (small bumps under the skin) would be extracted, while any sebaceous hyperplasias (overgrowing oil glands) and small plane warts (a sort of face verruca!) could be removed with a very precise form of electrocautery.
Dr alia also gives me tips for wimpy middle-aged hair — gentle handling, the supplement Viviscal (from £29.99,
boots.com) and bone broth. Just in case the symptoms that have been the bane of your life vanish the day you visit a psychodermatologist, Dr alia recommends taking dated pictures and keeping a diary. Some people will realise what is happening only from secondary factors, such as finding blood on their sheets, or poor-quality sleep from the misery of the itch/scratch cycle.
I am told to launch a comprehensive daily skincare regime running to 11 products. However, Dr alia recognises that this may sound like too much, so she asterisks the key components: cleanser, antioxidant serum for day, sun protection, and an age-busting retinol cream for the night.
Retinol is an antioxidant derivative of vitamin a, which speeds up cell renewal, reducing wrinkles.
There’s a Jan Marini Bioglycolic Facial cleanser and SPF30 moisturiser — not a brand I know, but apparently first rate — while the nightly retinol she favours is by Skinceuticals, as is my daily antioxidant layer.
a lot of patients over-moisturise. Not me, though I balk at her tip that I should remove my make-up and launch my skincare ritual the moment I arrive home. Having just moved in
with my boyfriend, I’m quite keen not to frighten him off.
There may be treatments Dr Alia can prescribe to allay physical symptoms, such as ointments for eczema or phototherapy (light therapy) for vitiligo, a condition where pigment is lost from areas of the skin in patches.
Then, she may prescribe antidepressants or anti-anxiety pills, often SSRIs (selective serotonin reuptake inhibitors): drugs that increase levels of mood-regulating serotonin in the brain.
Dr Alia divides her clients into three main categories. ‘There will be those with chronic skin conditions such as eczema, psoriasis, acne and rosacea, who have developed emotional problems because of them. This stress impacts on their skin creating an excruciating, vicious circle.
‘Then there are those whose primary psychiatric problems are generating their dermatological issues, say, body dysmorphia, or OCD, and what I refer to as the “pickers, pullers, and pokers”.
‘Finally, there are psychiatric patients whose skin situations may or may not be related to their mental state, such as people with bipolar disorder for whom being treated with lithium is causing psoriasis.’
Dr Alia can then explore talking therapies, including habit-reversal techniques that call on cognitive behavioural therapy, say, in the case of pickers; mindfulness, for psoriasis sufferers; or acceptance and commitment therapy to calm eczematous insomniacs.
‘Psoriasis sufferers tend to be stoical,’ she says. ‘You’ll ask how things are and they’ll say: “Fine.” Then they take off their clothes and are covered in it. People with eczema often have issues with social anxiety and touch.’
I think of my poor sister, who, so plagued by eczema that other children wouldn’t hold hands with her in case they ‘caught’ it, felt she had to learn how to touch and hold her children. ‘The situations can be very sad,’ agrees Dr Alia. ‘There are no miracle cures, but I look at normalising things, symptom management and patient empowerment. People can learn to recognise their triggers and handle flare-ups.’
REGARDING the demand for her services, she thinks society may be suffering from a collective dysmorphia. ‘We’re chasing an idea of perfection, but not everybody can look like a celebrity.’
I ponder occasions when my skin and brain fell apart in unison. Once, heartbroken and getting over pneumonia, I bruised merely by leaning my chin on my hand. Nine months after my parents’ deaths, I broke out in florid eczema. Now I know to whom I can turn.
Dr Alia is on sabbatical until Christmas, so you can’t get an appointment until January. But here is a woman worth the wait.
eudelo.com; £550 for a onehour consultation; £300 for a 30-minute follow-up. Dr Alia also runs NHS clinics at the Royal London Hospital and King Edward VII Hospital in Windsor.