Sana* sits in the magnolia-walled office of a dermatologist’s office. Angry red bumps line her chin, climbing all the way up to her cheek on the right-hand side of her face. She twirls her chestnut-brown hair anxiously. There used to be a lot more of it there. Now, there is dry flaking scalp where baby hair used to sprout. Someone at the front desk calls her name. A woman in a white coat with a clipboard says that the psychodermatologist will see her now.
As you probably already know, there’s something strange going on with India’s Bright Young Things—those twenty- and thirty-somethings speed-walking alongside us through the city streets. Hair loss, breakouts, cystic acne, dermatitis, or eczematic eruptions on their bodies or faces have gone from unlucky fluke to uncomfortable norm in just a few short years. And not only can we barely keep up with the raft of new products supposedly designed to help stem the problem (that’s those grown-up spot serums, redness-soothing cleansers and follicle-stimulating scalp scrubs)—and a growing number of private and government clinics around the world are adding psychodermatologists to their roster of experts. Specialising in treating the psychological causes (and effects) of skin and scalp disorders alongside the physical ones, they take a 360° approach to what are clearly mushrooming problems. But why on Earth is it that a generation credited with being the most clued-up cosmetic consumers and skin-tellectuals that ever existed has its beauty goals so blighted by breakouts, angry rashes, and follicular issues? And, more importantly, what can really be done to tackle it?
Alexia Inge knows a thing or two about what makes young women (and men) tick. As the Co-Founder of Cult Beauty (the online beauty emporium), she’s taken the pulse of the twenty- and thirty somethings of the UK and found them...anxious. “Questions about adult acne make up 35% of all skincare queries, having grown to a point of real concern,” she says. ‘What are the reasons for hair loss in women?’ is the fastest-growing search term on her site, she tells us, while sales in the hair- and scalp-treatment category saw lifts of 250% year on year. Equally telling, according to a recent study by Mintel, is that millennials report roughly double the instances of acne, spots, allergies, and eczema than the UK population as a whole.
The reason that we’re all falling apart, one pore at a time? Yep. You guessed it. Stress. Of course, as most of us will know from experience, the fact that we’re exposed 24/7 to major worries about career, housing and the world going to pot can lead to sallow, sleepless complexions. But it’s the more insidious ways stress can chip away at your health (and, by extension, your looks) that are actually causing the most trouble. At least that is the gospel according to Dr Alia Ahmed of London’s Eudelo clinic. She’s a consultant psychodermatologist (practising in NHS clinics in London), and the fact that she’s seen an uptick in the number of young women lining her waiting room is almost certainly a sign of the times.
“The relentless social pressure to be a high achiever and the general awareness of ‘imperfection’ are a real threat to millennials’ physical and emotional health,” Alia tells us. A steady diet of social media, not known for its warts-and-all depictions of reality, leads, she says, to heightened and frankly unrealistic expectations of life, love, looks, and everything else. “My young patients often don’t even realise how overwhelmed they are. They have adapted to a state of chronic stress to the point where it feels ‘normal’, but their tearfulness and skin issues are just some ways the body’s telling them it is not,” says Dr Alia. What ensues is the perfect storm at the heart of conditions such as acne and rosacea, as well as the seemingly random skin rashes that bring Alia’s young patients flocking to her: “Stress causes skin disease and skin disease causes stress,” she says. “Anxiety affects the immune system, driving allergic-type reactions and manufacturing chemicals in the body that set off inflammation and disrupt skin’s protective barrier.”
But it isn’t only that our always-on lifestyles are chemically changing our bodies. It’s the distortion of reality that some doctors are most concerned about. Take, for example, consultant dermatologist
Dr Sam Bunting in London. According to her, the spike in young patients with acne complaints might have as much to do with a real increase in cases (she tells us she has “no doubt” we are in the middle of an acne epidemic) as it does with their zero-tolerance attitude to anything that doesn’t resemble the filtered and Facetuned faces of their Insta-universe. “Many think a flawless complexion with zero imperfections is a realistic goal.” (Newsflash: it’s not.) Dr Esho, of the Esho Clinics in London and Newcastle, whose patient base is predominantly those aged 25 to 35, adds, “I’ve had patients Facetune their photos in front of me to show me what they expect.”
Dr Sam admires the knowledge and research involved in seeking solutions, but worries about the extreme “pore-gazing” that ensues: once acne improves, these patients immediately move on to the next skin gripe without pausing to recognise their progress. This, in turn, can cause anxiety and stress and...well, the entire cycle starts again.
Too much, too young
The ‘more is more’ attitude to both skin and haircare is also, unfortunately, both a symptom and a cause of the rise in problem conditions. Clinical treatments like peels and laser-based ‘photofacials’ are being sought out far too soon and often, sensitising skin to a point of no return. It’s all reflected in beauty-buying habits: according to another Mintel research, twenty- and thirty-somethings spend their money on ‘instant hit’ masks and overnight plumping treatments. Acid toners and serums have also seen a sales boom, led by breathless reviews for an army of potent ‘skin-transformers’. The goal: instant, ’Grammable results, fast. The reality? Angry breakouts galore.
Because, according to the experts, this endless product-hopping has unforeseen consequences. Inspired by multiple, but not necessarily expert, sources online, “my younger patients often suffer from both breakouts and irritation”, says Dr Sam (who, by the way, also singles out beauty editors for their slap-happy, dermatitis-prone ways). “They will combine ‘natural’ products, such as cleansing balms and essential oils, with powerful ‘techie’ acids and retinols. And they top it all off with long-wear, pore-plugging foundations that are incredibly hard to remove. ‘Too many products’ is one of the most common diagnoses I make,” she informs.
Scalps are suffering from closer scrutiny, too. According to UK-based dermatologist Sharon Wong, clients’ hyper-critical eyes (comparing their reality to online images that are, more often than not, created with hairpieces or airbrushing) are part of the reason she’s seen a rise in millennial women visiting her hair clinic. That, and damage caused by over-styling and extensions sustained in an effort to keep up with the Insta stars. But she has also noted more hair shedding, or “telogen effluvium (TE)”, among young women. Consumers certainly think stress is at fault: the Google search term ‘hair loss due to stress’ was up 350% in the past year. Yet, while Sharon confirms it’s one cause of TE (pushing hairs out of their growth phase prematurely, resulting in a spate of hair loss three to four months after an intense period of stress), she says that hormonal and nutritional issues are as great a threat to our locks.
Low protein, low iron levels and overall restricted calorie intake are bad news for hair growth, meaning the current vogues for veganism (unfortunately not all new vegans know to mainline their non-animal proteins) and ‘healthy’ juicing really aren’t helping. Unfortunately, hormonal disruptions are aggravated by pretty much everything the average millennial can’t or won’t avoid: pollution, the wrong foods, certain chemicals in products, hormonal medications like the Pill (UK-based consultant dermatologist Dr Nick Lowe blames teenage uptake of the pill for a “delayed puberty” after women come off it) and that word again—stress. “A surge in cortisol (the stress hormone) throws off your oestrogen and progesterone balance and can spike your testosterone levels. Potential result: cystic, oily breakouts (the fact that we see so many of them erupting on jaws and chins is a sure sign of hormones at work) and hair loss,” explains UK-based holistic GP Dr Sohère Roked.
So far, so gloomy. So what’s the solution?
Back to Basics
One response has been to at least partly throw in the towel, with hashtags such as #FreeThePimple and #SkinPositivity providing an antidote to the crushing pressure of fake perfection. But, says Dr Sam, while it’s “incredibly healthy” to take the stigma out of skin diseases, it mustn’t prevent those affected from tackling them properly. Right now, that often isn’t the case: according to a recent survey, 33% of millennial acne sufferers have tried 10 or more over-the-counter remedies to treat their spots.
“Chronic conditions like acne, psoriasis or rosacea warrant the attention of a cosmetic dermatologist. They can consider medication, but they’ll also prescribe a consistent skincare approach, using evidence-based products and stripping out all the confusing noise,” says Dr Sam. Outside the dermatologist’s office, managing reactive, flaring skin is a matter of mildness, not chemical warfare. Pare down your regime to three or four products, avoid sulphates, alcohol, and any kind of fragrance. Seek out barrier-building ceramides, niacinamide and essential fatty acids along with anti-inflammatory ingredients such as camomile, salicylic acid, and oatmeal. Even if your skin is blissfully normal, this kind of simplicity is likely to keep it that way. When it comes to hair loss, the same applies. As with skincare, a huge and lucrative “stress-busting” haircare industry has sprung up, tempting people away from the professional help needed on one hand and, at the same time, from the simple basic strategies you already have in your cupboard. “Many patients have spent an exorbitant amount on commercial hair-loss treatments to no avail,” says Sharon. “Solutions need tailoring to your type of hair loss, so you really need to see a reputable specialist (that is, a trichologist or dermatologist) to diagnose your problem.”
Non-stripping shampoos and the odd invigorating scalp scrub are great for long-term maintenance, but won’t halt hair thinning or shedding. You certainly don’t need to pay a premium for one labelled “growth-boosting” or “stress-relieving”.
As for hormonal causes, a doctor like Roked, specialising in holistic integrative medicine and bio-identical hormone therapy, can create a prescriptive plan. But she also has some solid lifestyle tips for keeping hormones balanced. “Plenty of healthy fats, few refined carbs and sugars, a good amount of protein with every meal, and high-fibre and fermented foods for gut health will naturally regulate your hormones, as may supplementation with agnus castus (a herbal remedy) or B vitamins.” Weightlifting, she says, evens out hormone levels by building muscle. As for the ever-present spectre of stress, she also reminds her patients of the soothing powers of actual friends. “In cities, where everyone is transient and too busy to take stock, we forget that we are social animals meant to exist in tight-knit communities: it’s proven to be seriously stress-relieving.”
In a world where the dialogue between our bodies and our brains has never been more known, and yet less possible to listen to, it’s no wonder that people and solutions that work at the intersection between the two are now a growing necessity. The psychodermatologists of this world and the new salons and retail spaces you’ll soon see popping up (specifically designed to heal the internal as well as beautify the external) will be as ubiquitous one day as the blowdry bar. Until that point, next time you’re worried about your skin, your hair, or both, it could do more good than you know to realise you’re very, very far from alone.
Skin and hair saviours
Forest Essentials Mashobra Honey, Lemon & Rosewater Delicate Facial Cleanser, Rs. 1,250. A deep-clean without any harsh skin-stripping.
Innisfree Green Tea Seed Serum, Rs. 1,950. Balances oily skin and quenches dry patches.
Kérastase Initialiste Scalp & Hair Serum, strawberrynet.com, Rs. 4,400. Strengthens and grows hair fibres by restoring uniformity and smoothness.
Dermalogica UltraCalming Mist, Rs. 2,660. This nourishing mist helps rapidly soothe skin sensitivity and pacifies redness and irritations.
Yves Rocher Low ShamPoo Delicate Cleansing Cream, Rs. 490 Won’t irritate angry scalps.