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Appearance Goals

Healthy skin, hair, and nails start from the inside. Nutrition can help—but managing expectations is key.

📖 The Story​

Meet Maya, James, and Priya​

Maya, 32, "The Product Collector": Maya had a bathroom full of expensive skincare—retinols, serums, acids, masks. She followed elaborate 10-step routines. Yet her skin remained dull, prone to breakouts, and perpetually irritated.

When a dermatologist asked about her diet and lifestyle, Maya laughed. "What does food have to do with skincare?"

Everything, it turned out. Maya slept 5 hours, lived on processed food, drank coffee all day, and was chronically dehydrated. Her body didn't have the building blocks for healthy skin—no topical product could compensate.

Six months of adequate sleep, protein, vegetables, water, and one basic moisturizer transformed her skin more than years of expensive products.

James, 38, "The Thinning Hair Panic": James noticed his hair thinning and immediately bought every supplement marketed for hair growth—biotin, saw palmetto, special shampoos, scalp treatments. Hundreds of dollars, zero results.

His doctor ran bloodwork: ferritin (iron storage) was very low. He'd been eating mostly chicken breast and salads for his "health"—but almost no red meat or iron-rich foods.

Iron supplementation (prescribed, because his levels were truly low) plus better nutrition. Within 4 months, shedding slowed. Within 8 months, noticeable regrowth. The biotin had done nothing because he wasn't biotin-deficient.

Priya, 45, "The Realistic Optimizer": Priya wanted to age gracefully. She didn't expect miracles but wanted to do what science supported.

Her approach: sun protection (the #1 evidence-based anti-aging intervention), adequate protein, colorful vegetables, omega-3s, good sleep, and stress management. She skipped most "anti-aging" supplements but took vitamin D (she was deficient).

At 55, Priya looks healthy and vibrant. Not 30—that's unrealistic. But her skin is clear, her hair is strong, her nails don't break. She optimized what's controllable and accepted what isn't.

The pattern:

PersonApproachResult
MayaTopicals without foundationsYears of frustration
JamesRandom supplements without testingWasted money
PriyaFoundations + realistic expectationsSustainable health

The lesson: Your appearance reflects your overall health. Skin, hair, and nails are built from what you eat and how you live. Products and supplements can enhance—but not replace—good foundations.

🚶 The Journey​

Appearance changes happen slowly because skin, hair, and nails take time to regenerate.

Skin Cell Turnover​

The biology: Skin cells are born in the deeper epidermis, migrate to the surface over ~28 days (longer with age), then shed. What you do today shows up in 4-6 weeks.

Week 1-2:

  • Hydration improvements visible quickly
  • Inflammation reduction begins
  • No visible changes to skin quality yet

Week 4-6:

  • First cycle of new cells reaching surface
  • Subtle glow improvement
  • Texture beginning to smooth
  • Breakouts may temporarily increase (purging)

Week 8-12:

  • Second full cell turnover
  • Noticeable improvement in tone
  • Reduced inflammation visible
  • Clearer complexion

Month 3-6:

  • Collagen changes beginning (slow process)
  • Significant clarity improvement
  • Sun damage effects starting to show or fade
  • Full nutritional effects visible

Year+:

  • Anti-aging effects of lifestyle accumulate
  • Sun protection benefits compound
  • Long-term collagen support visible

🧠 The Science​

What Skin Needs​

Collagen: The structural protein providing firmness

  • Requires: Vitamin C, protein (amino acids), zinc, copper
  • Declines ~1% per year after age 20
  • Sun exposure accelerates breakdown

Hyaluronic acid: Holds moisture

  • Produced naturally but declines with age
  • Supported by: adequate hydration, vitamin C

Elastin: Provides bounce-back

  • Cannot be replaced once damaged
  • Protection > restoration

Ceramides: Skin barrier integrity

  • Supported by: omega fatty acids, adequate fat intake

The Gut-Skin Axis​

Your gut and skin are connected:

Mechanism:

  • Gut inflammation → systemic inflammation → skin inflammation
  • Gut microbiome imbalance associated with acne, rosacea, eczema
  • Gut permeability ("leaky gut") allows inflammatory compounds into bloodstream

Research connections:

  • Acne: associated with gut dysbiosis, responds to probiotics in some studies
  • Rosacea: linked to SIBO (small intestinal bacterial overgrowth)
  • Eczema: gut microbiome differences in affected individuals
  • Psoriasis: gut inflammation connection documented

Gut-skin interventions:

  • Fiber: feeds beneficial gut bacteria
  • Fermented foods: provide probiotics
  • Polyphenols: support microbiome diversity
  • Reduce ultra-processed foods: reduce gut inflammation
  • Address food sensitivities if present
## 👀 Signs & Signals

Signs Your Approach Is Working​

SignalWhat It MeansTimeline
Skin more hydratedBasic hydration improving1-2 weeks
Less redness/irritationInflammation reducing2-4 weeks
Subtle glowCell turnover improving4-6 weeks
Fewer breakoutsGut/inflammation improving4-8 weeks
Hair shedding slowingDeficiency correcting (if was cause)2-4 months
Nails less brittleNutritional support reaching nails3-4 months
Hair texture improvingNew growth coming in healthier4-6 months
Visible nail improvementNew nail growth visible4-6 months

Warning Signs (May Need Medical Attention)​

SignPossible CauseAction
Sudden hair loss (clumps)Medical issue, thyroid, autoimmuneSee doctor
Patchy hair lossAlopecia areataDermatologist
Severe acne (cystic)Hormonal, needs RxDermatologist
Rash that won't clearContact dermatitis, infectionDoctor
Nail changes + other symptomsSystemic illnessDoctor
Yellow skin (jaundice)Liver issueUrgent medical care
New moles changingSkin cancer riskDermatologist urgently

Signs of Nutritional Deficiencies​

DeficiencySkin SignsHair SignsNail Signs
ProteinPoor wound healing, dullThinning, slow growthWeak, ridged
IronPale, itchyShedding (especially women)Brittle, spoon-shaped
ZincDermatitis, slow healingLossWhite spots
Vitamin CEasy bruisingCorkscrew hairsSpoon-shaped
Omega-3Dry, roughDry, dullBrittle
BiotinDermatitis (rare)Loss (rare)Brittle (if deficient)

🎯 Practical Application​

Skin Nutrition Priorities​

  1. Eat enough protein — Collagen building blocks
  2. Colorful vegetables — Antioxidants, polyphenols
  3. Fatty fish or omega-3s — Inflammation reduction
  4. Adequate hydration — Not excessive, just enough
  5. Limit sugar/refined carbs — Reduces glycation

Foods for Skin​

FoodKey NutrientsBenefit
Fatty fishOmega-3s, vitamin EReduces inflammation
AvocadoVitamin E, healthy fatsSkin barrier support
Sweet potatoBeta-caroteneNatural sun protection
Bell peppersVitamin CCollagen synthesis
TomatoesLycopeneSun protection
BerriesAntioxidantsProtects against damage
NutsVitamin E, zincMultiple skin benefits
Bone brothCollagen, glycineDirect collagen source

Lifestyle for Skin​

  • Sun protection: #1 anti-aging intervention—SPF 30+ daily
  • Sleep: 7-9 hours—repair happens during sleep
  • Don't smoke: Major skin ager
  • Manage stress: Stress worsens acne, eczema, psoriasis
  • Gentle cleansing: Over-washing strips protective oils
## 📸 What It Looks Like

Sample Day for Skin Health​

Morning:

  • Glass of water upon waking
  • Breakfast: Eggs + spinach + berries + green tea
  • Apply sunscreen (SPF 30+) before leaving house

Midday:

  • Lunch: Salmon salad with olive oil dressing, colorful vegetables
  • Water throughout morning
  • Brief walk outside (vitamin D, circulation)

Afternoon:

  • Snack: Handful of walnuts + apple
  • Continue hydration
  • Avoid excessive caffeine (can be dehydrating)

Evening:

  • Dinner: Chicken or tofu + sweet potato + broccoli
  • Evening skincare: gentle cleanser + moisturizer
  • Wind down for 7-9 hours sleep

Sample Day for Hair Health​

Focus: Protein and iron if female/vegetarian

Morning:

  • Breakfast: Greek yogurt with berries and pumpkin seeds (zinc)
  • Or: Eggs with spinach (iron + vitamin C for absorption)

Midday:

  • Lunch: Beef or lentils with vegetables (iron)
  • Include vitamin C source to enhance iron absorption

Afternoon:

  • Snack: Trail mix with pumpkin seeds

Evening:

  • Dinner: Salmon (omega-3s) or chicken (protein) with quinoa and vegetables
  • Ensure adequate overall calories (restriction causes hair loss)

Budget-Friendly Approach​

Affordable appearance-supporting foods:

  • Eggs ($3-4/dozen) — Protein, biotin, choline
  • Canned sardines ($2-3) — Omega-3s, protein
  • Frozen spinach ($2) — Iron, vitamin C, folate
  • Sweet potatoes ($1/lb) — Beta-carotene
  • Carrots ($1/lb) — Beta-carotene
  • Frozen berries ($3-4) — Antioxidants
  • Pumpkin seeds ($4/bag) — Zinc
  • Sunflower seeds ($3/bag) — Vitamin E

Free interventions:

  • Sun protection (stay in shade, wear hats)
  • Adequate sleep
  • Stress management
  • Gentle handling of hair and nails
  • Hydration

🚀 Getting Started​

6-Week Foundation Protocol​

Week 1-2: Assess and Hydrate

  • Honestly assess: How's your diet? Sleep? Hydration?
  • Increase water intake (aim for pale yellow urine)
  • Note current skin, hair, nail condition (take photos)
  • Get bloodwork if you suspect deficiencies (iron, D, thyroid)

Week 3-4: Nutrition Foundations

  • Protein at every meal (palm-sized portion)
  • Add colorful vegetables daily
  • Include omega-3s (fatty fish 2x/week or supplement)
  • Reduce ultra-processed foods
  • Establish consistent sleep schedule

Week 5-6: Optimize

  • Address any deficiencies found in bloodwork
  • Add gut-supporting foods (fiber, fermented foods)
  • Ensure sun protection is consistent
  • Evaluate any problematic products (irritating skincare)
  • Stress management practice

Month 2-3:

  • Maintain foundations
  • Look for early signs of improvement (skin hydration, less irritation)
  • Patience—visible hair/nail changes take 4-6 months
  • Consider dermatologist if specific concerns not improving

Month 4-6:

  • Visible improvements should be appearing
  • Continue what's working
  • Address any remaining concerns with professionals

If You Have Specific Concerns​

Acne:

  • Start with gut health (fiber, fermented foods, reduce sugar)
  • Consider food sensitivity testing (dairy is common trigger)
  • Gentle skincare (no harsh scrubs)
  • If severe: dermatologist for prescription options

Hair loss:

  • Get bloodwork first (iron, ferritin, thyroid, vitamin D)
  • Ensure adequate protein and calories
  • If pattern baldness: discuss with doctor (minoxidil, other options)
  • Give interventions 6 months to show results

Brittle nails:

  • Try biotin 2.5-5mg for 3-6 months
  • Ensure adequate protein
  • Protect from water exposure
  • Check iron if other symptoms present

🔧 Troubleshooting​

Common Challenges​

Problem: "My skin keeps breaking out despite eating well"

Possible causes:

  • Food sensitivities (dairy, gluten common triggers)
  • Gut issues (dysbiosis, SIBO)
  • Hormonal factors
  • Skincare products causing irritation
  • Stress

Solutions:

  • Try eliminating dairy for 4 weeks
  • Focus on gut health (fiber, fermented foods)
  • Simplify skincare routine
  • Consider dermatologist if persistent
  • Address stress

Problem: "My hair is thinning but bloodwork is normal"

Possible causes:

  • Ferritin "normal" but suboptimal (<50 ng/mL)
  • Telogen effluvium (stress-related, temporary)
  • Genetic pattern baldness
  • Thyroid on edge of normal
  • Chronic stress or overtraining

Solutions:

  • Ask doctor about ferritin (optimal is 50-100+, not just "normal range")
  • Consider stress as factor
  • If pattern baldness: discuss medical options
  • Give any intervention 6+ months

Problem: "Supplements aren't helping my nails"

Possible causes:

  • Not a biotin deficiency (usually isn't)
  • Underlying issue (iron, thyroid)
  • Not enough time (nails take 6 months)
  • Environmental factors (water exposure, chemicals)

Solutions:

  • Get bloodwork (iron, thyroid)
  • Protect nails from water/chemicals
  • Ensure adequate protein
  • Wait full 6 months before judging
  • Consider it might be mechanical, not nutritional

Problem: "I want anti-aging but don't know what actually works"

Evidence hierarchy:

  1. Sun protection — Most important, proven
  2. Don't smoke — Proven
  3. Retinoids — Proven (prescription or OTC)
  4. Vitamin C serum — Good evidence
  5. Adequate protein and sleep — Logical, supportive evidence
  6. Collagen supplements — Some evidence, modest effects
  7. Most "anti-aging" supplements — Limited evidence

Focus on #1-4 before worrying about supplements.

Problem: "I have skin issues and gut issues—are they connected?"

Likely yes. Gut-skin axis is real.

Approach:

  • Address gut health first (fiber, fermented foods, reduce processed)
  • Skin often improves as gut improves
  • Consider food sensitivity testing
  • See gastroenterologist if significant gut symptoms

❓ Common Questions​

Q: Does collagen supplementation work?​

Evidence: Some studies show modest improvements in skin hydration and wrinkles. Dose: 2.5-15g/day. Type I and III are most relevant for skin.

Reality check: Effects are modest. Protein from any source provides amino acids for collagen. Vitamin C is required for your body to make collagen.

Bottom line: May help, won't harm, but don't expect miracles. Ensure adequate protein and vitamin C first.

Q: Is biotin worth taking for hair?​

For most people: No. True biotin deficiency is rare in people eating a normal diet.

When it might help: Documented deficiency (rare), very restricted diets, certain medications.

The hype: Biotin is heavily marketed for hair/skin/nails, but evidence only supports it for actual deficiency.

Better approach: Check iron, vitamin D, thyroid, and protein intake first.

Q: How much water do I need for good skin?​

Short answer: Enough that your urine is pale yellow. Exact amount varies by person, climate, activity.

Reality: Drinking excessive water doesn't "hydrate skin" beyond adequate intake. Skin hydration depends more on:

  • Skin barrier function
  • Humidity
  • Topical moisturizers
  • Overall nutrition

Don't: Force excessive water intake thinking it's a skin solution.

Q: Can diet really clear acne?​

For some people, yes. Acne has multiple causes; diet is one factor.

Dietary factors with evidence:

  • High glycemic foods may worsen acne
  • Dairy (especially skim milk) associated with acne in some studies
  • Gut health affects skin inflammation

What often helps:

  • Reducing sugar and processed carbs
  • Trial elimination of dairy
  • Increasing fiber and vegetables
  • Omega-3s (anti-inflammatory)

Important: Severe acne often needs dermatologist care regardless of diet.

Q: Do I need expensive skincare products?​

No. Basic, affordable skincare is often better.

What you actually need:

  • Gentle cleanser
  • Moisturizer
  • Sunscreen (SPF 30+)
  • Retinoid if anti-aging is a goal (OTC or prescription)

What's often unnecessary:

  • Most serums and "actives" beyond the basics
  • Expensive "luxury" products
  • 10-step routines
  • Constantly rotating products

The truth: Skincare marketing vastly exceeds what science supports. Nutrition and sun protection matter more than most products.

Q: Why is my skin worse when I eat healthier?​

Possible reasons:

  • Purging: If using new actives, skin may temporarily worsen
  • Gut adjustment: Dietary changes cause temporary gut shifts
  • Detox myth: This isn't "toxins releasing"—could be stress, sleep, or adjustment period
  • New foods: You might be sensitive to a "healthy" food you've increased

What to do:

  • Give it 4-6 weeks (one full skin cycle)
  • If worsening continues, evaluate what specifically changed
  • Consider food sensitivity testing

⚖️ Where Research Disagrees​

Collagen Supplements​

Position A: Collagen peptides are absorbed and support skin collagen

  • Some clinical trials show improvement in hydration, wrinkles
  • Type I and III collagen most relevant

Position B: Collagen is digested into amino acids like any protein

  • Body uses amino acids as needed, not specifically for skin
  • Regular protein intake provides same building blocks

Practical approach: If budget allows and curious, try for 3 months. Ensure adequate protein and vitamin C regardless.

Biotin Dose for Nails​

Disagreement: What dose helps brittle nails?

Range in studies: 2.5mg to 10mg daily

Evidence quality: Limited and mixed

Practical approach: If trying biotin for brittle nails, 2.5-5mg for 6 months is reasonable. Check iron first.

Gut-Skin Connection Strength​

Position A: Gut health is central to skin health

  • Compelling mechanistic evidence
  • Many anecdotal improvements

Position B: Direct causation unclear

  • Correlation doesn't prove causation
  • Many confounding factors

Practical approach: Gut health is important for overall health anyway. If skin issues, addressing gut is low-risk and potentially helpful.

Dairy and Acne​

Position A: Strong link, especially skim milk

  • Multiple observational studies show association
  • Hormones in dairy may contribute

Position B: Individual variation is high

  • Not everyone reacts to dairy
  • Other dietary factors may be more important

Practical approach: If acne-prone, 4-week dairy elimination trial is reasonable. Not everyone needs to avoid dairy.

✅ Quick Reference​

Key Nutrients for Appearance​

NutrientForBest Sources
ProteinAll (keratin building block)Meat, fish, eggs, legumes
Vitamin CCollagen synthesisPeppers, citrus, berries
Omega-3sInflammation, skin barrierFatty fish, walnuts
Vitamin EAntioxidant protectionNuts, seeds, avocado
ZincWound healing, hair/nailsMeat, shellfish, seeds
IronHair (especially women)Meat, legumes, spinach
Vitamin ACell turnoverSweet potato, carrots, eggs
BiotinKeratin (only if deficient)Eggs, nuts, legumes

Timeline Expectations​

GoalWhen to Expect Results
Skin hydration1-2 weeks
Skin clarity4-8 weeks
Reduced hair shedding2-4 months
New hair growth visible4-6 months
Full hair effect6-12 months
Nail improvement visible3-4 months
Full nail effect6 months

Evidence Tier for Common Interventions​

InterventionEvidence Level
Sun protection (anti-aging)⭐⭐⭐⭐⭐ Strong
Don't smoke⭐⭐⭐⭐⭐ Strong
Retinoids (topical)⭐⭐⭐⭐⭐ Strong
Iron for hair (if deficient)⭐⭐⭐⭐ Strong
Adequate protein⭐⭐⭐⭐ Strong
Vitamin C (topical)⭐⭐⭐⭐ Good
Omega-3s⭐⭐⭐ Moderate
Collagen supplements⭐⭐⭐ Moderate
Biotin for nails⭐⭐ Limited
Biotin for hair (if not deficient)⭐ Minimal
Most "beauty" supplements⭐ Minimal

💡 Key Takeaways​

Essential Insights

  1. Appearance reflects overall health. Fix the basics (sleep, nutrition, stress) before buying products.

  2. Protein is foundational. Skin, hair, and nails are made of protein.

  3. Sun protection is #1 for skin. No supplement or product matches sunscreen for anti-aging.

  4. Deficiencies matter most. Supplements help deficiencies, not already-adequate levels.

  5. Timelines are long. Hair grows slowly; skin turnover takes weeks. Be patient.

  6. Gut health affects skin. The gut-skin axis is real—gut issues often show on skin.

  7. Manage expectations. Nutrition optimizes; it doesn't transform genetics.

📚 Sources​

Tier A (Systematic Reviews, Meta-Analyses)​

  • Cao et al. 2020 — "Dietary carotenoids and vitamins A, C, and E and risk of hearing loss" — Antioxidants and tissue health
  • de Miranda et al. 2021 — "Effects of oral collagen supplementation on skin aging" — Systematic review showing modest benefits

Tier B (Clinical Studies, Position Statements)​

  • Schagen et al. 2012 — "Discovering the link between nutrition and skin aging" — Dermato-Endocrinology review
  • Pappas 2009 — "The relationship of diet and acne" — Dermato-Endocrinology
  • Guo & DiPietro 2010 — "Factors affecting wound healing" — J Dent Res — Nutrition and healing
  • Rushton 2002 — "Nutritional factors and hair loss" — Clin Exp Dermatol

Tier C (Expert Opinion, Guidelines)​

  • American Academy of Dermatology — Sun protection guidelines
  • Linus Pauling Institute — Micronutrient information (skin, hair, nails)
  • Dermatology textbooks — Structure and function of skin, hair, nails

Key Papers​

  • Gut-skin axis: Salem et al., "The Gut Microbiome as a Major Regulator of the Gut-Skin Axis" (Frontiers in Microbiology)
  • Hair loss nutrition: Guo & Katta, "Diet and hair loss: effects of nutrient deficiency and supplement use" (Dermatol Pract Concept)
  • Collagen: Bolke et al., "A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density" (Nutrients)

🔗 Connections to Other Topics​

TopicLinkWhy It Matters
Gut-skin connectionGut HealthGut issues often show on skin
Protein requirementsProteinBuilding block for skin/hair/nails
Sleep for repairSleepRecovery and repair happen during sleep
Stress effectsStressChronic stress affects appearance
Anti-agingLongevityLong-term skin health
SupplementsSupplementsWhat works vs. marketing
For Mo

Key Context​

Appearance goals require managing expectations. Nutrition supports skin, hair, and nail health but cannot overcome genetics or reverse aging. Products are secondary to foundations.

Assessment Questions​

  1. What specific concern? (Skin, hair, nails, general)
  2. How long has this been an issue? (Sudden vs. chronic)
  3. What's their current diet like? (Protein, vegetables, variety)
  4. Sleep and stress levels? (Often overlooked factors)
  5. Any medical conditions? (May need referral)
  6. What have they tried? (Products, supplements—often too much)
  7. Have they had bloodwork? (Iron, vitamin D, thyroid for hair loss)

Recommendations by User Type​

User TypePriorityGuidance
Acne concernsGut health, dairy trialFiber, fermented foods, eliminate dairy 4 weeks
Hair thinningBloodwork firstCheck ferritin, D, thyroid before supplements
Brittle nailsProtein, protectionAdequate protein, gloves for wet work, maybe biotin
Anti-agingSun protectionSunscreen > any supplement or product
General optimizationFoundationsSleep, protein, vegetables, omega-3s
Product overuserSimplifyBasic routine: cleanser, moisturizer, sunscreen

Common Mistakes to Catch​

  1. Taking biotin without checking iron — Iron deficiency is more common hair loss cause
  2. Expecting quick results — Hair/nails take 6+ months for visible change
  3. Over-complicated skincare — Simple is usually better
  4. Ignoring sun protection — #1 anti-aging intervention, often skipped
  5. Not eating enough protein — Common in those trying to "eat clean"
  6. Blaming genetics without trying foundations — Worth optimizing first
  7. Expensive supplements before cheap interventions — Sleep and food first

Example Scenarios​

Scenario 1: "I want better skin but don't know where to start."

Response: "Let's start with the foundations that make the biggest difference: adequate protein (skin is built from it), colorful vegetables (antioxidants), omega-3s (anti-inflammatory), adequate sleep (repair time), and sun protection (prevents 80%+ of skin aging). Most skincare products are secondary to these basics. What does your current diet and sleep look like?"

Scenario 2: "My hair is thinning and I've been taking biotin but it's not helping."

Response: "Biotin rarely helps unless there's an actual deficiency, which is uncommon. For hair thinning, the more likely culprits are iron (especially for women), vitamin D, thyroid issues, or stress. Have you had bloodwork? Specifically ferritin (iron storage)—it should be above 50, not just 'in range.' Severe calorie restriction can also cause hair loss. Let's check the real causes before supplements."

Scenario 3: "What anti-aging supplements actually work?"

Response: "Honestly, the evidence for anti-aging supplements is weaker than marketing suggests. The interventions with real evidence are: sun protection (by far #1), not smoking, adequate protein and sleep, and topical retinoids. Collagen supplements have some evidence but effects are modest. Most 'anti-aging' supplements have minimal proof. I'd prioritize sunscreen over any supplement."

Scenario 4: "I have acne and gut issues—are they connected?"

Response: "Very likely, yes. The gut-skin axis is real—gut inflammation and dysbiosis are associated with acne, rosacea, and other skin conditions. Addressing gut health often helps skin: increase fiber, add fermented foods, reduce ultra-processed foods, and consider a dairy elimination trial (dairy is a common acne trigger). Your skin might improve as your gut improves."

Red Flags​

  • Sudden hair loss (clumps) → Medical evaluation needed
  • Severe cystic acne → Dermatologist, may need prescription
  • Nail changes + other symptoms → Possible systemic issue
  • Skin changes that won't heal → Doctor
  • Extreme concern about minor appearance issues → Possible body dysmorphia, approach gently