If you break out in a rash when you’re stressed, you’re not alone. Find out how two women in the public eye cope when anxiety affects their skin – and discover the science behind the spots
by Anna Fielding
Spots, rashes and flushing can often affect your emotions, making you self-conscious or even embarrassed. But did you know that, conversely, heightened emotions can aggravate your skin, making it vulnerable to breakouts – and that this is scientifically recognised?
“It’s been shown, on a molecular level, that there are changes to the chemicals in the skin when we get stressed,” says consultant dermatologist Dr Justine Hextall. “The blood vessels dilate and then you often get a flushed red face.” Stress will change the skin barrier, the outer layer of skin cells and the ceramides, cholesterols and fatty acids that hold them together, making inflammation more likely.
Candice Brathwaite knows all about skin inflammation. As a teenager she was prescribed steroids for acne. Adesso 32, she still gets the occasional breakout before her period or when under pressure. “I’m the kind of person who’s like: 'Oh, this isn’t stressful at all! I’m doing really, really fine,'" lei dice. “And of course I’m not, and my skin will tell the story.”
As an author and influencer, Brathwaite is used to pictures of herself being in the public eye, but when she gets spots she also experiences “something like an acne version of PTSD, if that doesn’t sound too dramatic – because my acne as a teen was so crippling. So now, I get really panicky and start thinking: ‘Is this going to ruin my life?’ Anyone who has suffered with skin problems for a long period of time will know it can be really hard.”
Katie Piper needs to be particularly careful with her skin “because it’s been rebuilt with a man-made dermal substitute and then skin grafts on top, so it doesn’t have the same pliability and structure. Also my sebaceous gland doesn’t secrete oil, so it’s quite dry and dehydrated.” Now 37, Piper has had many years of surgery and other treatments “in and out of hospital, my face changed constantly. I would get to know it and it would change again.”
The most recent change to her skin was one many of us will recognise, the effect of lockdown. “I looked more sallow," lei dice. “I also had more redness and was getting breakouts, which is very unusual for me. I put it down to the stress caused by the uncertainty of that period. And the fact that I kept on doing things like eating chocolate bars for dinner.”
Skin, stress and the digestive system form three points of a triangle. “I’m very interested in what we call the skin-brain-gut axis,” says Hextall. “They all feed in together. Quite often I talk to patients and I don’t just talk about their skin barrier, I talk about their guts and how they feel. People often sit in front of me and say: ‘Whenever I’m stressed, I get bloated, I get flushed,’ and so on.” The solution for these patients, lei dice, is often to look at what they’re eating.
Hextall says she does recommend looking at the causes of stress “but you have to be realistic about people’s lives. If you have a job, a family, problems to deal with, then you can’t just ask someone to ignore all that.”
Both Piper and Brathwaite have used the knowledge they’ve gained from dermatologists to create daily routines, and both stick to the “cleanse, tone, moisturise” mantra. “I encourage people to look at the ingredients,” says Brathwaite. “And not to think that they need to have a routine with 55 different steps or to throw money at the most expensive products.”
Both of them also emphasise the importance of SPF. “I only started wearing it in the last two years,” says Brathwaite. “I thought that because I had really dark skin I didn’t need it, but Black people do, we’re really prone to skin cancer.”
Her other revelation as a Black woman “was discovering I had rosacea. You might not be able to see the redness on my skin, but the warmth, the pimples, the itching … suddenly I had a name for it. We need to have the language, the understanding of what certain conditions look like on darker skin tones.”
Piper has spent years having to focus on her skin and how her face relates to her body and her emotions. “We live with it. If we are struggling, then our skin tries to communicate with us, in the only way it can – it’s kind of like a baby crying in that respect," lei dice.
“Without sounding too deep, it’s a privilege to have a face, to have skin, to be able to touch it and feel the contours and have sensation. So when I have a sensitivity issue, it makes me feel that I’m alive, and I’m working, and my body’s communicating with me. I would never be critical, because it’s all working. I want to say to other people: ‘You’re unique, no one else has your skin. Stop making comparisons. This skin is your unique shell.’”
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This article is intended as general information only. You should seek advice from a medical professional if you are concerned about your skin or before starting any new regime or course of conduct.
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