As anyone with a chronic, inflammatory skin condition, such as psoriasis, rosacea or acne, knows, dealing with unpredictable flares can cause considerable stress and have a negative impact on a person's overall well-being. Now, an ever-growing body of research shows how the complex link between the skin and the psyche—including the role of stress—affects skin conditions.
At the American Academy of Dermatology's Summer Academy Meeting 2011 in New York, dermatologist and clinical psychologist Richard G. Fried, MD, PhD, FAAD, of Yardley, Pennsylvania, discussed the skin-psyche connection and how incorporating various stress management techniques into a dermatologic treatment regimen can help patients with skin conditions feel better physically and emotionally.
“Stress is personal, so what might be stressful for one person may be a non-stressor or even exhilarating for someone else,” explained Fried. “In terms of how stress can exacerbate or even initiate a skin condition, we are talking about distress, such as feelings of anger, anxiety, depression or tension, and how these emotional states translate to physiological problems.”
To understand the complex relationship between stress/distress and the skin, Fried noted it is important to consider the biological response that happens when a person experiences stress. Neuropeptides, the chemicals released by the skin's nerve endings, are the skin's first line of defense from infection and trauma. When responding to protect the skin, neuropeptides can create inflammation and an uncomfortable skin sensation, such as numbness, itching, sensitivity or tingling. However, Fried explained that stressful situations can cause neuropeptides to be inappropriately released, which can lead to a flare of skin conditions.
“Until recently, it was thought that neuropeptides only stayed in the skin when they were released,” said Fried. “But we now know that they travel to the brain and ultimately increase the re-uptake of neurotransmitters—meaning that stress depletes the chemicals that regulate our emotions, such as serotonin, norepinephrine, and dopamine. For example, when psoriasis patients feel stressed about their condition, it can aggravate their symptoms and lead to a further decline in their emotional state, which becomes a vicious cycle.”
To help patients combat stress-aggravated skin conditions, Fried recommends that appropriate stress management strategies be used in conjunction with traditional dermatologic therapies. These strategies include psychotherapy, cognitive behavioral therapy, meditation, hypnosis, tai chi, yoga, antidepressants and beta blockers. Fried noted that stress management makes patients feel more empowered and in control, which can make them more likely to comply with a treatment plan for their skin condition and see improvement.
“In my practice, I find that patients with chronic skin conditions tend to withdraw from normal, everyday activities and sometimes shut down emotionally, which can really impact their personal lives,” said Fried. “In addition, when you are withdrawn and have more time alone, it can make your symptoms seem more pronounced and you can end up feeling worse. That's why it is so important for patients to seek a treatment plan from their dermatologist to help reduce their stress level and break the cycle of stress-related flares.”
Fried added that the skin barrier function, which is the skin's protective outer layer, can be impaired by stress as well. Stress can make the skin more permeable, more sensitive and more reactive, which is why dermatologists recommend the use of over-the-counter moisturizers to enhance the skin barrier function. If stress compromises the skin's barrier function, more irritants, allergens, and bacteria can penetrate the skin and cause problems. Specifically, stress can make a person's rosacea more red or acne lesions more inflamed and more persistent. It can worsen hives, fever blisters, psoriasis and seborrheic dermatitis.
“Visiting a dermatologist can provide patients with hope and a treatment plan for their skin problem,” said Fried. “A simple explanation as to the cause and treatment of a patient's skin condition can decrease their level of distress. Alleviating or minimizing stress goes a long way in improving their overall health.”