HOW STRESS, SLEEP & RESILIENCE AFFECT SKIN

Consultant Psychodermatologist Dr. Ahmed on why she’s trying to rid us of ‘skin guilt’.

At the Body Shop, we’re in the business of creating skincare products that work. We’re certainly not in the business of stoking anyone’s fear of ageing. Getting older is a process, sometimes an emotional one. But we don’t think people need a time machine. We just need some good ideas on how to be kind to ourselves and the skin we’re in. It’s the only one we’ve got.

Enter Consultant Psychodermatologist Dr. Alia Ahmed who is here to help. She shares her insights on the powerful relationship between stress and skin, how we build our skin’s resilience and reduce what she calls ‘skin guilt’.

SO, WHAT EXACTLY IS PSYCHODERMATOLOGY?

Psychodermatology is the part of dermatology that considers the mind and skin together. I tend to focus a lot on a very holistic sort of approach. I never just say ‘here's your cream, here's your antibiotic.’ It's also about, ‘OK, so tell me about your work life balance. What do you eat? Are you hydrated? Who do you talk to? What are your relationships or your work like?’

As well as treating the condition you can see, it’s important to give people strategies for giving skin a fighting chance and improving resilience. Day to day, this could be simple changes in three ways:

1

Creating environments that build positivity using scents, music and colours.

2

Finding moments of joy in routines like a face massage, or working on more positive self-dialogue and fostering gratitude.

3

Incorporating realistic changes into their day that will improve their skin health. Restorative sleep routines, mindfulness, hydration - and things like gentle face massage that both improve circulation and relaxation.

“Stress can make skin more greasy because the stress hormone cortisol drives the production of oil in your skin, which is why I sometimes hear from patients that they get breakouts when they’re stressed.”

One of my specialist areas of interest is stress. Skin flares associated with stress are the most common complaints I see. Alongside treating the psychological, I also help patients manage their symptoms and offer easy ways that may help protect the future of their skin.

WHAT MADE YOU INTERESTED IN THE RELATIONSHIP BETWEEN MIND AND SKIN?

I have a history in my family of skin conditions. When my mum's dad died, she developed rosacea very suddenly. I always knew it was to do with stress. Later I did three years of a psychology degree. That was when I learnt so much more about stress and how it affects the whole body, not just the skin, but how it affects the heart, how it affects your liver, kidneys, everything. And I was like ‘wow, stress can literally kill you.’ I could see that there were a lot of psychological consequences of having skin conditions which weren't necessarily being dealt with so I chose dermatology.

WHAT’S THE SCIENCE BEHIND THE STRESS OUR SKIN IS UNDER?

Over time the natural building blocks of the skin can lose their resilience when they suffer damage from the environment. Your skin has a natural supply of protective antioxidants but when it is hit with environmental aggressors like pollution, UV and infrared light, temperature changes and smoke, this supply is depleted.

But then of course there is the stress we feel. The brain has a stress-activated pathway that causes the release of various chemicals and hormones that affect the body and the skin. Stress is very pro-inflammatory, and there are studies to show all the effects on the skin like redness, flushing and sweating. It can make it itchy, more flaky or dry because of the inflammation. It can also make skin more greasy because the stress hormone cortisol drives the production of oil in your skin, which is why some patients say they get breakouts when they’re stressed.

“Stress can affect production of hyaluronic acid, leading to dehydration and can affect skin ageing.”

Long-term stress that can send the body into a permanent ‘stress-response’ state, aggravating existing skin problems through a poor natural immune response and inflammation. This can alter your production and breakdown of collagen, proteoglycans and elastin, all of which are part of the skin’s building blocks. Loss of these results in loss of elasticity and firmness, thus predisposing us to lines, wrinkles, increased pigmentation and dull skin. Stress can affect production of hyaluronic acid, leading to dehydration and can affect skin ageing through cell DNA damage and poor repair.

WHAT’S THE FIRST THING YOU SAY TO SOMEONE WHO COMES IN SAYING ‘MY SKIN’S BAD, HELP ME!’?

I normally open it up by asking, ‘So how does your skin make you feel?’ I encourage people to really think about what their skin behaves like, especially when they're stressed. People aren’t always great at spotting their own stress triggers.

“People aren’t always great at spotting their own stress.”

Coping strategies for building resilience are often centred around managing your environment. It could be getting fresh air on the walk to work or phoning a friend to share your problems with. I always ask about sleep. When you're sleep deprived, your body interprets that as stress, then it kicks off a whole proinflammatory response. Night is where cortisol levels are low and it can repair all the damage you sustained during the day. Sleep is especially good for repairing UV damage So, if you get the right sleep, you are building your skin’s natural resilience.

I will always look at what I can help them do to protect the makeup of their particular skin against environmental aggressors. Your skin is always battling aggressors like pollution, temperature changes and UV and infrared light that can cause a breakdown of its building blocks.

HOW DO YOU DEAL WITH THE EMOTIONAL SIDE OF SKIN ISSUES?

I talk a lot about expectations. I might tell someone how much I can help improve their skin and ask, ‘how is that going to make you feel? Are you expecting that in two weeks’ time your skin is going to look like that person you follow on Instagram?’ There is nothing wrong with wanting to keep your skin in great condition, but people’s expectations of their skin matter. Like if I meet a 40-year-old I might say, ‘don't you think that most women should have a few little lines around the eyes by now?’ Young people are more aware of the importance of caring for the skin you are in. I am really pleased that people realise there are things they can do to help protect their skin from premature ageing. I met a young woman the other day who was doing absolutely everything right. She had the right mix of protection with antioxidants, hydration and sunscreen regime. I could have sold her a really expensive anti-ageing serum she didn’t need, that’s not what I am about. I told her she looked great.

WHAT DO YOU TELL CLIENTS WHO ARE WORRIED ABOUT AGEING?

We have to think about why people might fear ageing. Is it because people think that they won't be attractive anymore? Is there something historic behind it, is it something someone said to you, or a person you're following on social media and comparing yourself to? I say, ‘well, actually, you know what, I can see what’s bothering you. Maybe your skin isn't as elastic as it was when you were 15. But this is all normal.’ It’s what I call ‘age appropriate.’ It should be happening, in fact. Good skincare is not about trying to turn the clock back. It's about supporting and caring for what you've got.

“Maybe your skin isn't as elastic as it was when you were 15. But this is all normal.’”

WHAT IS INFLUENCING THE WAY PEOPLE VIEW THEIR SKIN?

I am definitely seeing younger and younger patients who want to stave off ageing. I'm sure the media didn't mean to create flawless images but it creates what I call ‘skin guilt’ because people don’t look like what they see. Even if you watch an advert for nappies, the new mum will always have perfect skin. Nobody’s skin looks like that when they've got a tiny baby. There are also these subtle changes in culture, like social media filters. It distorts our perceptions. I tell people what I know, which is that so much of what they see is not ‘real’ skin. It's probably a filter or Botox. I don’t think there is anything wrong with choosing to have these treatments or even wanting to look younger, it’s more an issue of transparency about what is ‘normal’. Skincare sales in this area so often play on unrealistic expectations of ageing.

“Skincare sales in this area so often play on unrealistic expectations of ageing.”

HOW DO YOU GIVE PEOPLE REALISTIC EXPECTATIONS OF AGEING?

I try to avoid language that makes people feel bad. It’s really hard in this industry not to say anti-ageing. I also try not to say ‘normal skin’. I just call it ‘tolerant’ skin. Your skin is on a journey. I don't see what's so embarrassing about that. People’s concerns are often fuelled by unrealistic expectations. I think people associate getting older with so many negatives. But actually, you're amassing all this experience that’s something to be proud of. Why are we trying to reverse that?

“I try to avoid language that makes people feel bad. I try not to say ‘anti-ageing’ or ‘normal’ skin.”

WHAT CAN PEOPLE DO TO LOOK AFTER THE SKIN THEY’VE GOT? CAN YOU SHARE FIVE EASY TIPS?

1. WEAR SUNSCREEN

Everyone can look after their skin a lot better than they probably are. Anyone, any age, should be using high factor sunscreen during the day, even in winter. This can help protect skin against harmful UV rays that are responsible for changes like fine lines, wrinkles, loss of collagen, pigmentation spots.

2. CLEANSE

Cleanse your face because it's good to get the dirt and grime off in the morning and in the evening if you've been out all day. It can also be a really positive routine to enjoy, that helps lower cortisol before bed.

3. USE ANTIOXIDANTS

Antioxidants help protect the skin from environmental aggressors. Our skin is battling cell damage created by free radicals like increased pollution, so we need antioxidants more than ever. Also, sunscreens alone don't block all of the free radicals generated by UV exposure. UV filters can't provide protection from damaging infrared radiation. For protection against the full range of environmental aggressors, topical antioxidants used in conjunction with a daily sunscreen will help build the skin's resilience.

4. ADAPT YOUR ENVIRONMENT

Building in some level of positive activity during the day, whatever that is. A walk, mindfulness session, exercise, seeing a friend. I recommend doing one positive thing every day that's not related to the things that cause you stress.

5. BUILD YOUR SELF LOVE ROUTINE

People are really harsh on themselves. Negative self-talk is a huge stress trigger. When you're putting your products on, I want you to enjoy the smell and the feel of it. Or the little face massage that goes along with it. If your routines are built on fear, when you're putting products on, all you're thinking is ‘was this wrinkle there yesterday?’ That’s going to raise your cortisol levels.

WHAT ABOUT THE PANDEMIC? WHAT HAVE PEOPLE BEEN SAYING ABOUT THEIR SKIN DURING THIS TIME?

The face masks were an issue because a lot of people were complaining of new breakouts because of the occlusive effect of the mask. Now people are back in the office, they are in a less controlled environment and their skin is reacting. There is also a lot of angst. There's a lot of anxiety about, ‘Oh, I've developed some spots during lockdown and I don't want someone to comment on this’. There are emotional effects like social anxiety returning to work, or people saying their skin looks tired but it’s because they’ve been staring at themselves on video calls for three months. People are saying ‘I don't look like how I looked five years ago’ - but it’s a whole new world. But there are little skin hacks you can use like using facial mist for mask dryness. But as always, for me it’s about finding ways to manage those cortisol levels that will improve your life inside and out.