Pending job cuts at the office. Back-to-back final exams. A messy divorce. An unexpected surgery. What do they all have in common? In a word—stress. While everyone knows that stress can take a toll on a person physically and psychologically, it also can lead to dermatologic problems, such as acne, brittle nails or even hair loss.
In recognition of National Healthy Skin Month, dermatologist Flor A. Mayoral, MD, FAAD, clinical instructor in the departments of dermatology and cutaneous surgery at the University of Miamis Miller School of Medicine in Miami, Fla., spoke at the American Academy of Dermatology's SKIN Academy on the most common outward signs of stress on the skin, hair and nails, and offered stress management tips to control these symptoms.
“In treating hundreds of patients over the years with skin conditions such as eczema, rosacea, acne and psoriasis, I have seen first-hand how stress can aggravate the skin and trigger unexpected flare-ups that, in effect, create more stress for patients,” said Dr. Mayoral. “Learning how to manage the effects of stress on your skin can help alleviate some of the anxiety and symptoms.”
Stress and the skin
When a person becomes stressed, the level of the body's stress hormone (cortisol) rises. This in turn causes an increase in oil production, which can lead to oily skin, acne and other related skin problems. Dr. Mayoral noted that even patients with skin that is not affected by acne tend to develop temporary stress-related acne due to increased oil production.
In fact, a study in the January 2001 issue of the Archives of Dermatology entitled “Psychological Stress Perturbs Epidermal Permeability Barrier Homeostasis,” found that stress has a negative effect on the barrier function of the skin, resulting in water loss that inhibits the skin's ability to repair itself after an injury.
Specifically, the study involving 27 medical, dental and pharmacy students examined how periods of higher stress—in this case, during final examinations—impacted the skin's response to repeated stripping of cellophane tape on the subjects' forearms versus periods of lower stress, such as after returning from winter vacation. Researchers found that it took longer for the skin to recover from the minimally invasive tape stripping during periods of perceived higher stress than during less stressful periods.
“This study was the first of its kind to suggest what dermatologists anecdotally have known for years—that psychological stress adversely affects the normal functions of the skin," said Dr. Mayoral. “While the subjects in this study did not have any pre-existing skin conditions, I would suspect that people with skin conditions such as eczema or psoriasis would have been even more adversely affected by this experiment.”
There are many reasons why men and women lose their hair, but Dr. Mayoral believes that stress may be the primary reason for unexplained hair loss. When someone is under stress, hair can go into the telogen (fall-out) phase. Telogen effluvium is a very common hair loss problem that can occur up to three months after a stressful event. After the initial hair loss, hair usually grows back in six to nine months.
Life-changing events such as childbirth or surgery also can cause hair loss. Dr. Mayoral explained that during these times, the body takes a “time-out” from growing hair to concentrate on recovery and healing. As such, hair does not grow as much and some could shed and not grow back right away.
“Stress affects people differently—some may develop an ulcer, or have a heart attack, or lose their hair,” said Dr. Mayoral. “Hair loss is a normal response to stress, but patients should see a dermatologist for a proper evaluation to rule out other medical causes. I also advise patients to avoid any strange diets where only one or two foods are allowed, as improper nutrition and extreme or rapid weight loss can result in hair loss.”
Effects of stress on nails
Nails are not immune to showing outward signs of stress, and some people develop the nervous habit of biting their nails or picking at them when they feel stressed. Another stress-related nail habit that Dr. Mayoral discussed is people who rub their fingers over their thumb nail, which can create a ridge across the nail. This rubbing causes a distortion of the nail plate, and when the nail grows, a raised ridge forms in the middle of the nail.
In addition, physical or emotional stress, certain diseases, and chemotherapy can cause white horizontal lines to appear across the nails. Brittle, peeling nails also are a common side effect of stress.
“Sometimes patients with nail problems are not aware that their habits or tics from being stressed out or nervous are at the root of their problem,” said Dr. Mayoral. “There are instances where patients self-inflict skin, hair or nail problems that go beyond what we normally expect from stress, and these patients often need psychological help to modify their behavior.”
In her practice, Dr. Mayoral finds it beneficial to give patients the tools to help themselves cope with stress-related skin flares, particularly patients with eczema, acne, psoriasis, or seborrheic dermatitis where outward symptoms are obvious. For example, Dr. Mayoral teaches her acne patients how to modify their treatment regimen to deal with flare-ups from stress, which gives them control to help themselves during stressful periods.
“Being in control of your situation can help relieve stress,” said Dr. Mayoral. “For instance, I teach my acne patients who use a topical acne medication once a day how to safely use the medication more frequently to counter the effects of stress. If this doesn't work, they know to call me or come in to the office so we can make further adjustments in their treatment. I find that initially giving them the power to fix the problem is very empowering to them.”
In addition, Dr. Mayoral offered tips to curb the effects of stress both internally and externally:
* Learn to recognize the underlying problem that is triggering your symptoms and develop skills to help minimize the stress.
* Exercise helps release endorphins in the body that can reduce stress.
* Avoid very hot showers or baths and use detergent-free soaps. Moisturize as soon as possible after bathing.
* Wear a broad-spectrum sunscreen with an SPF of 15 or higher daily to protect your skin from sun exposure.