Next to itchy skin diseases acne is probably the most prevalent problem in dermatology. At first sight it would appear hard to relate pustular acne, with its nasty spots, and the emotions. But a link there is and a very strong one.

We know today that the fundamental problem in acne is a change in the physical characteristics of the sebum (skin grease) that is produced in the sebaceous glands. This sebum is a valuable protective to skin health in normal circumstances. An optimum degree of skin greasiness repels bacteria and protects against skin damage. It also helps to waterproof the skin; a dry skin easily cracks and becomes prone to infection as well as becoming very sticky and irritating due to a leaking out of subcutaneous tissue fluids.

In acne, however, the sebum becomes over-thick. We know that the stickiness factor of sebum (its viscosity) is influenced by hormones circulating in the blood (notably the predominantly male hormone testosterone, a substance also produced in women). But testosterone is not the only factor involved in sebum secretion. A group of scientists set up an experiment that actually measured the rate of sebum production on the face under two conditions. The first was during periods of tranquillity. During this period sebum production was remarkably stable. But during periods of stress in which feelings of anger were artificially induced into the test situation, greatly increased sebum production occurred.

These simple dermatological facts tell us a lot about acne. In adolescence and young adult life, testosterone makes the sebum very sticky and so instead of gradually being eased out of the sebaceous glands, like toothpaste on to a brush, it tends to remain in these glands making them swell (into a blackhead) and then burst into the tissues around the hair follicles. This ultimately causes the acne spot. Under conditions of stress the whole process is compounded. Not only is the hormone-produced sticky sebum difficult to shift, but the stress-produced excess sebum provides an extra hazard for the skin to contend with. Thus acne and stress become closely linked, and the fact that a girl’s acne is always worse when she wants to look at her best is easily understood.

With acne the very nature of the appearance of the disease further complicates the psychological picture. It makes the victim resentful (why am I like this when she looks beautiful?), withdrawn (suppressed anger), and feel inferior. Good medical treatment will help with the sticky sebum aspect of acne. Learning to relax will slowly but relentlessly and surely diminish the stress factors and help the skin to improve naturally too. Dermatologists will often state blandly that acne is cured by marriage. Really they are saying that when the tense and adolescent girl settles down to a more relaxed life as a young bride then her skin will improve.

Thoughtful doctors are much less liable to label their difficult skin patients as ‘neurotic’ these days. When eczema, dermatitis, and even in some people psoriasis, seem intractable or recurrent an examination of the sufferer’s stress load or anxiety quotient may be much more important than changing the ointment they use on their skin. By learning to relax many patients with difficult complexions first of all find the projection of their nervous system (the skin) is less difficult to cope with. Later their skin usually starts to behave itself, reflecting the state of their more relaxed inner self, and instead of battling with a skin problem they allow their body as a whole to ease it better.

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