How your skin, acne and psoriasis reflects your mental health state

The skin is the body’s largest organ and recent research has confirmed that the skin acts as both an immediate stress perceiver, as well as a target of stress responses. That is, your skin not only detects stress, but is often the first thing to reflect that stress outwardly, typically with an inflammatory response.

Although cause and effect can be difficult to pin down, considerable data suggests that in some people at least, stress and other psychological factors can activate or worsen certain skin conditions.

The link between psychological stress and the onset or aggravation of multiple skin diseases, has led to the investigation of how the brain and skin communicate with each other. The brain-skin connection, similar to the gut-skin axis, looks at how the skin reacts to stress by activating the endocrine and immune systems, and the negative impact of chronic stress on skin health.

Our skin contains sweat glands, blood vessels, nerve endings and cells controlled by our immune and nervous systems, which in turn are easily triggered by our mental health.

More often than not stress is the main culprit. When we experience stress or anxiety, our body releases cortisol. This is a natural hormone that helps the body deal with stress, but if our body is exposed to persistent high levels of cortisol, it can wreak havoc on your skin.

Stress, anxiety, depression, and other psychological conditions may be an underlying reason for common skin issues hyperhidrosis, acne and psoriasis.


Hyperhidrosis is the name given to excessive or uncontrollable sweating, unrelated to body temperature or exercise. An estimated 7.8 million individuals, or 2.8% of the population, have hyperhidrosis. Of these, 50.8% (4 million) have axillary hyperhidrosis, or excessive sweating of the underarms. In fact, seven out of 10 people with hyperhidrosis report having to change clothes two or more times per day.

Hyperhidrosis can have a serious impact on a person’s physical, social, and mental health. Research published earlier this year confirms the link between hyperhidrosis and depression. Results from the study found that people with hyperhidrosis, especially severe forms, have higher rates of depression than those without the condition.


Acne vulgaris (or simply acne) is a very common skin condition affecting a majority of the population at some point in their life. It occurs when the hair follicle and its associated oil (sebaceous) gland become blocked and inflamed. Whiteheads, blackheads and inflamed pus-filled spots develop on the face, neck, back and chest because this is where oil glands are largest and most active.

Stress and anxiety cause chronic inflammation in the body which cause cortisol spikes and encourage our sebaceous glands to produce more thick and sticky oil, which dead skin sticks to and in turn blocks pores. Stress can also encourage bad bacteria growth making it the perfect environment for breakouts.


There are an estimated 19,000 Australian men and women living with severe chronic plaque psoriasis. Most people develop the disease before 45 years of age, which often appears as patches of thick, red, scaly skin, known as ‘plaques’. These can become itchy and painful, with the potential to crack and bleed.

In people living with psoriasis, the immune system reacts abnormally to certain environmental conditions. The inflammatory response results in an excess of skin production, with the excess skin accumulating on the skin surface as ‘plaques’. Stress is both a consequence of living with psoriasis, and a cause for psoriasis flare-ups. As such, psoriasis is associated with clinical depression, anxiety, social exclusion and discrimination.

Dermatologists are specialists in the diagnosis, treatment and prevention of skin diseases and cancers. Discuss any skin, hair or nail concerns with your GP and they will advise whether you need a referral to a dermatologist for specialist advice, and to find your best treatment plan.

The Australasian College of Dermatologists (ACD) is Australia’s leading authority for dermatology. For more information or to find a dermatologist who can help you to manage your skin, hair or nail condition visit

Dr Adrian Lim is a Fellow of the Australasian College of Dermatologists and has extensive international dermatology research and experience, being considered among Australia’s leading dermatologists. Dr Lim is currently a Dermatology Staff Specialist at The Royal North Shore Hospital, Clinical Trials Director at Central Sydney Dermatology, and Consultant Dermatologist at uRepublic Cosmetic Dermatology & Veins.