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Does Your Skin Need to See a Psychologist?

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Your skin is no longer the domain of just your derm. Now doctors such as gastroenterologists, gynecolo­gists, and a burgeoning class of specialists called psych­dermatologists are applying their perspect­ives to better understand how our insides affect our biggest organ: the skin. This fresh take on acne, inflammation, and the aging process could supply the beauty breakthrough that's been eluding you. (Related: Why Everyone Should Try Therapy)

The Collagen Optimizers

Your mood can affect the quality of your skin in stealthy ways, which is why psych-dermatologists (doctors who are board-certified in psychiatry and dermatology) take a shrink-like approach to examining the epidermis. "I don't ask a patient about just her skin. I ask about her life," says Amy Wechsler, M.D., a psych-derm in New York City. "This includes detailed questions about sleep, relationships, work, diet, exercise, and mindset." A negative emotional state, for instance, can express itself as breakouts, dullness, even wrinkles—thanks to the stress hormone cortisol. "During periods of depression, anxiety, or bad moods, cortisol levels are elevated," Dr. Wechsler says. "That cortisol boost breaks down collagen, which is the start of wrinkles, and increases inflammation and oil production, both of which create acne. "And if you suffer from eczema, psoriasis, or dry skin, then they flare up," she adds. Cortisol also weakens the skin barrier, causing water loss and slow cell turnover, which makes skin appear sallow and dull.

Getting seven to eight hours of sleep becomes very import­ ant to your skin during this time. "While you sleep, cortisol is at its lowest and anti­inflammatory molecules like beta­endorphins and growth hormones are at their highest, so that's when skin heals," Dr. Wechsler says. An hour before bed, read instead of watching agitating TV shows like the news. Also key: Finding ways to de­stress your waking hours. (For one, try this 10-minute trick to de-stress). Start by getting social. "Studies show that when friends see each other face-­to­-face, cortisol levels decrease," Dr. Wechsler says. "Exercise, deep breathing, or even getting outside does it too." In addition, reach for prod­ucts that are fragrance­ free and loaded with healing antiox­idants, since skin is extra sen­sitive during these moody times. Try Malin+Goetz Vitamin E Face Moisturizer ($84; malinandgoetz.com) or Chanel La Solution 10 De Chanel ($80; chanel.com).

The Clear-Skin Chemists

It's no revelation that hormones wreak havoc on our skin. (After all, they're the biggest cause of adult acne). Too much testosterone can result in breakouts; too little estrogen, and skin can appear dry or dull. "You can't stop your monthly cycle, but you can negotiate with it," says Rebecca Booth, M.D., a gynecologist in Louisville. Three days after a woman's period starts, positive effects begin on the skin as estrogen, a natural antioxidant, increases. "These higher estrogen levels create an increase in collagen, elastin, and hyaluronic acids," Dr. Booth says. Testosterone follows, adding a wanted amount of sebum or oil to keep skin supple. "When these hor­mones peak at day 12 or 13, right before ovulation, that's optimized skin," Dr. Booth says. "It is luminous, has minimized pores, and is usually acne-­free."

Around day 21 your brain real­izes that you aren't pregnant and resets these hormones. "When they fall, acne may erupt and skin can look ruddy," Dr. Booth explains. During this time, watch your intake of sugar and carbohydrates. They increase insulin, which spurs testos­terone to levels that cause breakouts. Instead, eat more protein to stabilize insulin. Plant proteins, like lentils, nuts, and chia and sunflower seeds, are also heavy in phytoestrogens, which simulate the estrogen our body makes, so they'll offset the hormonal fluctuations that stimulate acne and redness.

You can also find phytoestro­gens in skin­care products. Topically these ingredients can reduce pore size, increase collagen and elastin, and help reverse the signs of hormonal aging. Try Murad Intensive Age-Diffusing Serum ($75; murad.com) or Dr. Booth's own VENeffect Anti-aging Intensive Moisturizer ($185; veneffect.com).

The Inflammation Tamers

At the first sign of acne, you may reach for the closest salicylic acid treatment. But a gastro­enterologist would also have you fight the underlying cause of that flare-­up. "Skin is a direct reflection of the body's internal balance," says Roshini Raj, M.D., a gastroenterologist in New York City. When the bacteria in your gut are imbalanced, the results can show up on your face. Too many bad bacteria overstimulate the immune response and pro­duce chemicals called cytokines, which promote inflammation. They can also destroy the lining of the intestines, letting proin­flammatory molecules enter the bloodstream—and mess with your skin. "But unhealthy bacteria are present not only in the gut but also on some people's skin," Dr. Raj says. Acne can be a telltale sign that your bacte­ria levels are off. The antidote: probiotics, a buzzword usually associated with yogurt. These microorganisms—bacteria, yeasts, and viruses—are benefi­cial because they help keep the harmful bacteria in check.

To pump up the probiotics in your diet, regularly eat fer­mented foods such as kimchi, miso, tempeh, and yogurt with active cultures, as well as high­fiber foods like beans, nuts, and lentils, which promote the growth of probiotics. (Here: new ways to add more probiotics to your diet.) "If you don't eat these foods, talk to your doctor about a probiotic supplement," Dr. Raj says.

Some skin­care products include probiotics. "Besides preventing the skin's cells from reacting to bad bacteria, they decrease redness and encourage the production of collagen and elastin," Dr. Raj says. Spritz Mother Dirt AO+ Mist ($49; motherdirt.com) or apply Biossance Squalane + Probiotic Gel Moisturizer ($52; sephora.com). At night, try Dr. Raj's Tula Overnight Skin Rescue Treatment ($85; tula.com) to reverse damage while you sleep. So you don't have to dream of great skin; you can actually have it.

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