82 ALLURE MAY 20 19
because you look better? Botox’s latest
clinical trial, though, is tenuously
based on a different proposition,
Darwin’s “Facial Feedback Hypothesis.”
It’s pretty simple: If you are unable
to frown, you could be more likely
to keep your expression neutral
(or even smile!), and are therefore
more likely to feel happy.
On Christmas Day, the Botox
calcifies, rendering my forehead
useless. My emotional inventory is
limited to a handful of available
expressions: closed-mouth smile,
open-mouth smile, enormous
cartoon grin. But instead of unbridled
happiness and joy bursting forth
from my every nose pore, I don’t feel
a thing. I don’t feel bad, but I don’t
feel fantastic, either. To strangers,
I look like I’m either feeling happy
or nothing at all.
Despite the
relative newness
of psychoder-
matology as a field of
study, the connection between your
characterized by the feeling that
bugs or other foreign creatures are
living under your skin.
In 2006, the same year Allure first
covered psychodermatology, the
National Institutes of Health published
a study linking problem acne
and increased rates of depressive
tendencies in teens. A little over a
decade later, a report in the Journal of
the American Medical Association
found that dermatology patients with
atopic dermatitis were 44 percent
more likely to have suicidal thoughts
than those without; they were 36
percent more likely to act on those
thoughts. Atopic dermatitis is the
most common type of eczema,
afflicting about 30 million Americans.
And then there was the Botox and
depression study in 2014, scientifically
rooted in the psychiatric connection
between our moods and our face. The
Darwinian theory has held over time
that facial expression influences
overall emotional experience. It’s
worth noting that Botox isn’t making
you happier but is in theory making
you less sad—taking peaks and
valleys and bringing them closer to
baseline, which is similar in effect
to antidepressants that have proven
benefits for people with major
depressive disorder. The benefit is felt,
but not overwhelmingly so, which is
basically what Allergan (the company
that makes Botox) found out during
phase-two trials. (At the time, doctors
noted that the results, while not
statistically significant, were “clinically
meaningful” in support of this
hypothesis and bode well for phase-
three trials, scheduled for later this
year.) Despite all of this, there are still
far fewer psychodermatologists than
UFOlogists or chemtrail conspiracy
theorists. The psychodermatologists
I spoke to told me that most of
their practice comprises cosmetic
and medical dermatology: good,
old-fashioned mole removal and
filler injections. (When I asked Rieder
about treating my eczema, the
psychodermatologist’s approach bore
a striking resemblance to the regular
dermatologist’s approach: Use fewer
moisture-stripping soaps and apply a
corticosteroid. Wear tights when
running. Don’t scratch your legs,
even if they are begging to be
scratched.) Most of these doctors’
psych cases are appraised and then
referred elsewhere—they simply
don’t have the time to take on weekly
45-minute cognitive behavioral
therapy sessions. Instead, a psych-mind and your skin is neither novel
nor medically experimental. In the
human embryo, the central nervous
system and the cutaneous (skin)
system descend from the same
layer of cells. “We’ve known about
it since embryologists figured
that out a century or so ago,” says
Amy Weschler, one of a handful of
psychodermatologists (board-certified
MDs in both specialties) in the United
States. “There are many physical
neurological connections between
the brain and the skin, and they’re
bidirectional. We’ve always known
that. I just don’t think that people
focused on it for a long time.”
The term “psychodermatology”
was coined as early as the ’70s (in
Dutch and French medical literature).
It was more recently defined
in a 2001 report published by the
American Academy of Family
Physicians that outlines a series of
skin disorders that are aggravated by
emotional stress, including eczema
and psoriasis, and skin-related
psychiatric disorders, like delusions
of parasitosis, or Morgellons disease,