DOES stress cause your acne or rosacea to flare up? Do you chew your nails to a bloody end? Experts say the state of your skin lies in the state of your mind. Whenever Mira feels nervous, she breaks out in a horrific bout of zits. Sarika suffers from eczema and often shuts herself in her room during bad flare ups. The only way that Shweta can stop her obsessive thoughts is by pulling out her hair.

"Our skin is always telling a story. Whether you're fit and happy or disturbed and anxious," says dermatologist Dr Jamuna Pai. You name it: Acne, eczema, hives, rosacea, psoriasis, alopecia (hair loss), vitilgo (white spots), trichotillomania (hair pulling), self-mutilation disorders and many skin disorders are a direct reflection of the state of your mind. The fancy term for it is 'psychodermatology.'

Heady Trouble

"Psychodermatology addresses the impact of an individual's emotion as it relates to the skin," says Dr Sandhya Shetty, a dermatologist. "In dermatology today, we take in so many different aspects of a patient's life that influence her skin and health. It's time we integrate different treatments eg use anti-depressants, relaxation therapy, or counselling that can alleviate the mood problems that result from or cause skin problems," says Dr Shetty, who recently moved from London where she was practising this approach. "The mind and skin are connected on many different levels," she points out. "A lot of nerve endings are connected to the skin, which wrap around the organs, so as emotions are played out neurologically, they can be expressed through the skin just as stress can be expressed through gastro-intestinal symptoms, increased anxiety, or hypertension," she explains.

Take acne, for example. When you are tense, your body releases stress hormones including cortisol, which may increase the skin's oil production, making you prone to zits. "Stress suppresses the production of oestrogen which leads to skin disorders," adds Dr Pai.

Freaking Out

In some cases, people have truly psychiatric diseases that present as dermatological ones, including nail biting, hair pulling, some nervous tics, and delusional parasitosis (a belief that one is being infested by parasites such as lice, fleas, worms, etc). "It's the target organ theory, and people have different target organs that channel stress," says Dr Ritika Gidwani. "In some people, stress can trigger ulcers, migraines, asthma attacks, the same way, others break out in rashes. The skin is the target organ for them," she says. Often, Dr Jamuna Pai encourages her patients to do yoga, deep breathing exercises or take a plant extract known as St John's Wort to calm their minds. "A lot of my patients are going through mid-life crises, suffer from weight gain, hair loss, dark circles and pigmentation. I also tell them to consult a good dietician," says Dr Pai.

Quit Fingering

Another potential solution is habit-reversal training. "I've noticed a lot of women touch their face constantly. I find ways for my patients to give up such habits. If you pick at your acne, you scar and are actually making it worse, you need to be aware where your hands are," she says. "Being more self-aware of what your hands are doing and having alternative behaviour take its place, helps."

For example, every time your hand reaches above your neck, grab a pencil and write a sentence, or drink a glass of water.

The bottom line is that "If the dermatologist and patient are both aware that the stressors exist, then they are better suited to deal with the problem, but if no one talks about it, it can't be addressed," says Dr Shetty. At Dr Jamuna Pai's clinic, most patients talk to her about everything - from troubles at home, relationships, affairs, work place issues, etc. "Some of my patients are young men and women who work really long hours, are either too tried to have a sex life or suffer from performance anxiety; as a result, it shows on their skin and hair health. I tell them that they have to calm their mind," she points out. The secret to great skin lies less in jars and injections and more in a calm and happy mind. And of course, make-up looks best on good skin!