The Invisible Mark of Skin Conditions

Graphic by Agnes Lee.

Your skin is your identifying feature and everyday uniform. It's the first thing people notice about you, and it is probably one of the first things you notice about yourself when you wake up every morning and look in the mirror. 

So, it comes as no surprise that when we feel bad about our skin, it can take a toll on our self esteem and mental health.

A new study reports that 10 million people in the UK have suffered from mental health issues as a result of skin conditions. Research into the wellbeing of acne sufferers also found that over 20% of those with acne had thought about or attempted suicide and 63% reported a fall in self-confidence. The figures surrounding this issue are alarming, yet understandable given the visibility of the condition.

Whether it’s due to a lack of research, misdiagnosis from doctors or increasing pressure from social media to be flawless, it’s no revelation that we live in a society where ‘bad’ skin contributes to mental health issues. 

While there are plenty of readily available foundations and concealers to suppress breakouts, it’s a lot harder to fix damaged self esteem. For many, makeup is nothing but a magic bullet solution.

“There are so many misconceptions surrounding skin issues,” said Remi in an interview with Stitch, “Although I can pretty much disguise my acne with makeup, it doesn’t really make me feel more confident.” “The makeup is just a mask I wear in the outside world… it doesn’t fix my skin, it just disguises it.”

And then comes the issue of social media… with platforms like Instagram and TikTok increasingly pushing the ‘perfect’ image onto society, it’s no wonder there is a strong link between ‘bad’ skin and self esteem. “I have never seen anyone like me on social media,” said Maddie who suffers from Rosacea, “every influencer I see has perfect glowing skin without any hint of red in her complexion.” “I don’t feel seen or represented on social media and it can be incredibly isolating.” 

The preoccupation society and social media have with self-image and their stigmatization of perceived imperfections can make people with skin conditions less willing to engage in social situations. “If there’s a day where my eczema is flaring up, I’ll avoid interacting with people,” said Vanu, “I don’t wear things that show too much skin and the main thing I can put it down to is that I tell myself people don’t want to see it… I feel like they’ll think it’s ugly.” 

Vanu wasn’t the only person I interviewed who felt this way. “I will always put on concealer before engaging in social activities,” said Maddie, “I feel like I can’t walk outside without putting on a full face of makeup… even at a place like the gym, I get nervous that people will judge me.” 

Research shows that perception of one’s skin condition also plays a key role — it’s not necessarily the severity of a condition or skin disorder that makes you suffer mentally, but if you perceive your skin to be worse than it is or dwell on it, you’re likely to feel far worse. “Stress about my eczema and acne definitely makes it worse,” said Vanu, “it’s a vicious cycle because then you can’t help but start stressing about being stressed.”

Psychodermatology, which looks at the interaction between the mind and skin, is becoming a more common discipline. It focuses on the ways stress can cause skin flare-ups but also how skin conditions can cause stress itself. Prior to the introduction of psychodermatology, you would struggle finding a medical professional willing to conflate the two. “Patients were disempowered, told: ‘It’s only your skin, it’s just acne,’” says Dr Anthony Bewleym. “Patients felt completely isolated, and like imposters, and that just made things worse rather than better.”

“A key discovery seems to be the body’s ability to turn intensely experienced ideas and fantasies into physical realities.” It’s comparable to when you think someone is following you down the street — your body goes into high alert and your heart rate increases, just as if the threat were real. 

In a classic experiment analyzing how expectation influences experience, Japanese physicians Ikemi and Nakagawa organized two sets of volunteers. The first group was told that a leaf applied to their skin was a toxic plant and the second was told the plant was innocuous. Interestingly, results showed that the first group’s skin became red and irritated but no biological reaction occurred with the second group. 

That the expectation alone of a skin eruption can lead to one tells us that there is a lot more to be discovered about the mind-body connection, especially in relation to our skin.