Combatting Stress on Skin
Mr Stephen McCulley details how stress can affect the skin and provides advice on how to recognise the symptoms in patients to manage it effectively
Activation of stress
Stress can have a damaging influence on the skin, from contributing to premature ageing to aggravating symptoms of chronic skin conditions such as eczema and psoriasis.1 When we experience stress our bodies respond with a chemical reaction. When we feel threatened, a signal is sent to an area of the brain called the amygdala, which is responsible for regulating our emotions.2 Once a threat is recognised here, the amygdala triggers a response in the hypothalamus, which is responsible for the production of hormones in the body. Simultaneously, the peptide hormone corticotrophinreleasing factor (CRF) is activated and is responsible for triggering a response in the stress hormone system (also known as the hypothalamic-pituitary-adrenal axis).2 The CRF activates the release of adrenocorticotropic hormone from the pituitary gland, which moves through the bloodstream to the adrenal glands, causing the stress hormone cortisol to be released into the bloodstream.3 When cortisol has been triggered, a person will experience a ‘flight or fight’ response to the stress and a number of changes in the body occur, including appetite suppression, increased blood pressure and increased anxiety.4,5
Influence of cortisol
Chronic stress can be the result of a person having too much CRF in their body and therefore high levels of cortisol, which can have a negative impact on the skin and general wellbeing.6 A recent study on the effect of stress on the skin of mice claimed that mice subjected to chronic psychological stress experienced oxidative damage to proteins (protein carbonylation) and lipids (lipid peroxidation) in the skin.7 Mice were exposed to rotational stress for 28 days and the skin was then analysed. The study indicated that chronic stress induces wrinkle formation in mice skin and causes the dermis to thin.2 It’s clear there is a direct link between stress and skin deterioration in normal skin, but it’s also important to note that psychological stress may intensify skin disorders by impairing the recovery of the skin barrier function, for example, through patients picking, scratching or rubbing the skin. I will now detail some of the issues high levels of cortisol can have on the body and how this affects the skin.
Increase in blood sugar levels
Cortisol causes blood sugar levels to increase in order to give the body enough energy to perform a ‘fight or flight’ response in a stressful situation.2 As well as making a person more vulnerable to health conditions such as diabetes, a long-term increase in blood sugar levels can have a negative impact on the skin. A high level of sugar in the blood encourages the glycation process. Glycation happens when excess sugar molecules in the body crosslink with protein and fat molecules to form advanced glycation end products (AGEs).8
AGEs are not recognised as normal proteins by the body so the immune system responds by producing antibodies, which can cause the skin to become inflamed. A further negative effect of AGEs is that the proteins collagen and elastin, which are responsible for keeping the skin looking youthful, are most at risk from glycation.9 Glycation hardens and discolours collagen and elastin, which makes wrinkles more prominent and causes skin to lose its natural glow.10 A vicious cycle can occur when a person under stress seeks to handle this stress by comfort eating foods that will increase sugar levels further, such as sweets and fast food, therefore increasing the level of sugar in the blood.
Decrease in hyaluronic acid
High cortisol levels can also cause the skin to dry out by decreasing the production of hyaluronic acid, which is a natural moisturiser. Hyaluronic acid plumps the skin by absorbing water so when levels are reduced, the skin can become dry and damaged, intensifying the ageing process.11
Weakened digestive and immune system
When the body is poised to fight or run away, blood flow is redirected to major muscle groups to give the body a burst of energy to respond to the perceived threat. This means the blood is directed away from areas such as the digestive system and the immune system – both of which play a part in the condition of the skin. A poorly functioning digestive system can cause or exacerbate a myriad of skin issues including acne, rosacea and eczema, as well as causing less serious problems such as blemishes and a dull complexion. If there’s not enough blood flowing to the digestive system then this can result in a decrease in the amount of nutrients being absorbed by the body.12 Nutrients such as vitamin A, B and C, omega-3 fatty acids and the antioxidant beta-carotene are vital for healthy skin, and, if the digestive system is compromised, it’s very difficult for the body to absorb these. Long-term high levels of cortisol can also weaken the immune system.13 This can cause problems for people who suffer from chronic skin conditions such as eczema, which can be exacerbated by allergens, which the immune system fights off.14 If the immune system is weakened then allergens can more easily trigger histamine, which increases itchiness and therefore aggravates the itch-scratch cycle associated with eczema.15
Detecting levels of stress in patients
Sometimes stress presents itself clearly on the skin in eczema, acne or psoriasis flare-ups, but in many cases the effect of stress on the skin is much more subtle and is visible in wrinkles, a sallow complexion or dry patches. It’s important to take a holistic approach to identifying stress as the cause of skin problems by discussing common symptoms of stress with a patient, including
- Sleep problems
- Headaches
- Palpitations
Combatting Stress on Skin Mr Stephen McCulley details how stress can affect the skin and provides advice on how to recognise the symptoms in patients to manage it effectively
How to treat stress-induced skin conditions
The best ways to treat skin conditions that are caused by or aggravated by stress is to identify what triggers stress in the patient and then work to manage this accordingly. Once a patient’s stress can be managed more effectively, skin treatments are more likely to be successful.
Managing stress
Successful stress management is not a quick fix and often takes a long-term commitment before symptoms improve. Depending on the cause and the severity of the stress there is a range of management techniques including yoga, meditation, improvements to diet and exercise, which can help a patient to manage moderate stress levels.17 For more severe or long-term cases of stress, patients may consider psychotherapy, cognitive behavioural therapy or medication such as beta-blockers or antidepressants. In some patients, issues such as obsessive-compulsive disorder or anxiety disorders can cause compulsive skin picking or scratching, so psychological treatment alongside dermatological treatment may help reduce symptoms. Taking action to manage stress can often make patients feel more in control of their skin conditions, which in itself can help to reduce symptoms.
Creating healthy skin habits
Habits such as itching, picking and rubbing can make many skin conditions worse, particularly conditions such as eczema, psoriasis and acne. Not scratching a condition such as eczema is easier said than done, but cultivating better skin habits can help to reduce these urges over time. In many cases itching, picking and rubbing are self-soothing techniques, which patients have developed as a way to cope with stress and anxiety. As well as identifying the cause of stress and anxiety, patients can make small changes, which should help them to control compulsive picking and itching by gradually unlearning the habits:
- Ask patients to be aware of what situations trigger the need to scratch or pick. In some cases it might be something as simple as removing tweezers or a mirror from their bathroom if these trigger the urge to pic when stressed, for example.
- Patients should be aware of the time they spend ‘scanning’ the skin for dry patches, spots, bumps or scabs, which they may be tempted to pick or scratch. Increasing awareness of negative behaviour is often the first step in taking action to decrease this behaviour.
- Encourage patients to use the time normally spent itching or picking to do something soothing for their skin instead, such as a facemask or a warm bath. Medication The third approach to combating skin conditions caused by stress is medication. As previously mentioned, in some patients, anxiety, depression or conditions such as OCD can exacerbate skin conditions. If this is the case then these conditions can be treated with appropriate medication, such as antidepressants, to help control a patient’s need to aggravate the skin. As well as medication to treat psychological conditions, patients can also be prescribed medicatio to tackle skin conditions as a two-pronged approach. Topical creams such as steroid cream for eczema and psoriasis, and retinoids and antibiotics for acne, are just some of the medications that can help control flare-ups.18,19
Caring for the skin - An effective skincare routine can help to reduce the impact of stress on the skin, from helping to manage chronic conditions, to reducing the effects of ageing:
- Fragrance free products – hypoallergenic products with a low or neutral pH level can help prevent inflammation by reducing irritation caused by harsh chemicals drying the skin.20
- For conditions that cause redness such as rosacea, anti-inflammatory creams such as those containing extract of liquorice root or allantoin can help alleviate redness.21
Conclusion
Treating skin problems that are caused by or exacerbated by stress has to be managed holistically, so that the root cause of the stress is tackled alongside an effective skincare routine. Without adopting this approach, we can treat problems with the skin but the results are unlikely to be as effective unless the cause of the stress is managed too. By encouraging patients to effectively deal with stress in their lifestyle, they should have much more noticeable, long-term results than if you were to simply treat the skin alone.
REFERENCES
- Pyschosocial (US: National Eczema Association, 2016)
- Understanding the stress response (US: Harvard Health
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- Why stress causes people to overeat (US: Harvard Health
Publication, 2012) - Understanding the stress response (US: Harvard Health
Publications, 2011) http://www.health.harvard.edu/stayinghealthy/understanding-the-stress-response - Stress and Blood Glucose Levels, Diabetes, the global diabetes
community (UK: Diabetes, 2016) - Bruna Romana-Souza, Gracineide Santos Lima-Cezar, Andréa
Monte-Alto-Costa, ‘Psychological stress-induced catecholamines
accelerates cutaneous aging in mice’, Department of Histology
and Embryology, (2015). - Karyn Repinski, Face Facts About Sugar (US, Prevention, 2011)
http://www.prevention.com/beauty/natural-beauty/how-sugarages-your-skin - Kris Campbell, Glycation and the Skin (US, Skin Inc., 2013)
- What is glycation? (US, Sharecare, 2016)
- How to Reduce the Effects of Stress on Your Skin (US, Skyn
Iceland, 2016) http://www.skyniceland.com/beauty-guides/howto-reduce-the-effects-of-stress-on-your-skin - Sharon Feieresisen, Why improper digestion might be screwing
up your skin (UK, The Fashion Spot, 2013) - Michael Randall, The Physiology of Stress: Cortisol and
the Hypothalamic-Pituitary-Adrenal Axis (US: Dartmouth
Undergraduate Journal of Science, 2011) - Atopic Dermatitis/Eczema (UK: Allergy UK, 2016)
- Dr Victoria Lewis, The immune system and the skin (UK:
netdoctor, 2014) http://www.netdoctor.co.uk/conditions/skinand-hair/a3653/the-immune-system-and-the-skin/ - 50 Common Signs and Symptoms of Stress, (US: The American
Institute of Stress, 2016) http://www.stress.org/stress-effects/ - Rick Nauert, Stress Management Improves Skin Conditions, (US:
Psych Central, 2015) - Mild Psoriasis: Topical Steroids (US, National Psoriasis
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- Best sensitive skin care products you must have – creams,
moisturisers, lotions (US, skincarederm.org, 2016) - Dr Jeanette Jacknin, Rosacea Series: Licorice – a sweet solution
for rosacea and melasma (US: Curezone, 2016) http://www.
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