Are Dermatologists the New Therapists?

Something is driving young women into the derm’s office—and it’s more than a mole check.


One hundred percent of my breakouts have to do with stress,” she says. Being able to talk to her derma about what’s nagging at her has not only helped her skin, it’s also helped her sense of self. While dermas are in no way a substitute for mental health professionals, it’s easy to see why some women are drawn to them when the going gets rough.

FOR SOME WOMEN, a trip to the derma is stressful. But when Manika, 34, visits her dermatologist of six years, it’s pure relaxation: calming music fills the space, and she gets face time with the woman who, in addition to prescribing  Manika’s acne medications, introduced her to meditation and yoga and advised her on how to navigate tricky friendships.


“At the derm, you often find yourself revealing that you don’t like something about your appearance,” says Vivian Diller, PhD, a psychologist who specialises in women’s issues. What makes this different from confiding in a friend or your hairstylist? Dermas, says Diller, have an air of authority. “You’re hoping that this parental figure can say, ‘I know what we can do!’ and reach into their toolbox. They have a lot of power.” 

Derma visits are more frequent these days, too. Rather than dragging themselves in for an overdue skin check or a funky rash, many women see dermas as often as they see their hair colourists. “More and more people go regularly for cosmetic purposes—lasers, peels, Botox, fillers—so relationships develop... sometimes very intimate, dependent ones,” says Diller.

“If you’re not happy with your relationship, job, or self-esteem, it’s easier to pick on your appearance, even go to a professional to ‘fix it’,” says New York-based facial plastic surgeon Michelle Yagoda, MD. Recently, Dr Yagoda had a woman come in to discuss a light, anti-ageing peel, but the patient quickly began rattling off a laundry list of treatments she wanted—from facial injections to surgery. “I stopped her right there,” says Dr Yagoda. “I said, ‘I see you’re turning 30. How is that for you?’ She broke down,” she says. “She confessed she thought she’d be married with children by now, and her fiancé had just left her. It became a therapy session.” Dr Yagoda asked the woman to work on herself—pursue hobbies, spend time with friends—and see if she still wanted work done in six months. (She didn’t.)

Patricia Wexler, MD, a New York-based dermatologist, is all too familiar with ‘fix me’ syndrome. It’s usually when they have a wishlist, she says. “That’s when I say, ‘This isn’t about your face. You should stop working on your appearance and work on your mind’. Then they’ll tell me what’s really bugging them.”


The psych-skin link is a logical one. There’s even a growing area of study around it: psychodermatology, which looks at patients from a dermatological, psychological, and psychiatric perspective. While there’s no formal training for it (though it’s more established in Europe), these physicians try to get inside their patients’ heads—not just address the surface—with a combination of treatments like skin meds, talk therapy, meditation, and anti-anxiety treatments, if necessary.

“A lot of my patients have skin conditions that are exacerbated by stress—acne, psoriasis, eczema—which they’ve described as ‘wearing their emotions on their skin’,” says Josie Howard, MD, a San Francisco psychiatrist, who specialises in this field. One of the pioneers of the stress-skin field, Howard Murad, MD, a celebrity derm, is disturbed by the hamster wheel of self-improvement that’s driving so many into his office. “All they see on Instagram is people who look phenomenal, and they feel they can never live up to that expectation.” The more you chase an ideal, the more miserable you become, he says. Cosmetic treatments won’t make that go away.

It’s great to have an open, confiding relationship with your derma, but for women who don’t have that,
Dr Wexler has a word of advice: “If you’re depressed or in the middle of a breakup, it’s not the best time to make any changes (to your appearance),” she says. “Most likely, you won’t be happy with anything at that point.” Her suggestion: relaxing baths, new lingerie, even a life coach. “Not lip injections!”