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Stress—we all experience it. How much it bothers us, which of our systems is most upset by it, how long before its effects become apparent—in these and countless other ways, the toll stress exacts on us varies widely from person to person. Unfortunately for many, its impact shows up worst on our largest and most outwardly visible organ, the skin. For people with psoriasis, acne, dermatitis and other chronic inflammatory skin conditions with an emotional component, distressing flare-ups may seem to appear overnight in response to increased anxiety and pressure.
We've known for decades that stress can cause or aggravate skin conditions such as psoriasis, eczema, rosacea, acne, hives, dermatitis and herpes, though stress is not the sole antagonist of skin health. Heredity and environment too have a role to play, but the focus of this article is on how the molecules of stress contribute to inflammatory skin conditions by way of our immune systems. Research is shedding new light on the mechanisms underlying this immune-mediated response. This knowledge is accompanied by the hope that by understanding and managing stress in our lives, we can reduce outbreaks and improve the skin's appearance.
Let's take a look at stress from the skin's point of view, then delve a little more deeply into stress-induced exacerbations of skin conditions like psoriasis and dermatitis. Once we gain a better understanding of the process, we can take steps to strengthen the immune response and counteract the damaging effects of stress.
At the dawn of ages, humans evolved a physiological system for dealing with danger called the "fight or flight" response. This system, which is mediated through the sympathetic division of our autonomic nervous system, enables us to react quickly to any challenge—to battle our foes, to outwit them or, alternatively, to flee rapidly in the opposite direction.
Once the brain sounds the alarm, the hypothalamic-pituitary-adrenal (HPA) axis leaps into action, cueing the adrenal glands to pump out cortisol, adrenaline (epinephrine), and noradrenaline (norepinephrine). These stress hormones target certain organs, priming them to produce and utilize the burst of energy needed to engage in violence or flee from it. Once the danger's passed, the body is meant to return to homeostasis, and the mind to a state of calm.
While this design served us well for millennia, we rarely face the kind of overt physical danger nowadays that requires such an intense physiological response. Regardless, our bodies remain hardwired for action. Because our nervous systems are programmed to respond this way whether a threat is real or simply a perceived one, we tend to become hyperaroused to all kinds of stimuli that do not in actuality threaten our existence.``
This is only problematic because people in the modern world are chronically "stressed-out"—so much so that this condition seems the norm. But for the most part, the preponderance of today's stressors are perceptions rather than reality—the long commute, the irksome boss, the upcoming PowerPoint presentation, the bills to pay, the negative performance review, the incessant bark of a neighbor's dog. Experts refer to this package of stressful perceptions in modern life as "psychosocial stress." In fact, a new field of medicine has arisen to address how our emotional tone affects our skin: psychodermatology.
Some people feel they have little reprieve from unremittent stress. When the body's pathways aren't supported adequately for clearing the molecules of stress, their detrimental effects show up on our skin.
With chronic stress, the body increases its production of cortisol, one of two hormones responsible for elevating blood pressure and priming the body for action. As a side effect of excess cortisol, the immune system is suppressed and the inflammatory process increases. (See the box at left for more on the immune-mediated effects of stress on the skin.) With this comes skin that is more sensitive and prone to infection and troublesome outbreaks such as acne, psoriasis, hives and shingles.
During emotional stress, the blood flows to the body's fight-or-flight response regards as critical to coping with stress: the heart, lungs and musculoskeletal system. Lack of blood flow to the digestive system can impair digestion, which in turns jeopardizes skin health in many ways. Without an adequate blood supply, the digestive organs cannot fully absorb the nutrients in the food we eat.
Nor can the body under stress properly metabolize nutrients or optimally rid itself of waste products. Other organs in the metabolic pathway, including the gallbladder, intestines, kidneys, and liver, as well as the lymphatic system may become compromised by chronic stress. As a result, responsibility for clearing toxins may get handed off to the skin, contributing to outbreaks of acne, psoriasis, dermatitis, hives, and other skin eruptions.
It is also known that stress can cause insomnia. A good night's sleep is vital for maintaining healthy skin. The skin repairs itself best at night, especially between the hours of 11:00 pm and 4:00 am. When we are in a state of deep sleep the body releases growth hormone and other healing chemicals to help repair damaged cells.
These are just some of the broader physiological responses to stress that can add up to troubled skin. Together their effects have a way of compounding one another, but by overcoming one of these problems and by providing the body with greater support, you can offset the adverse effects of stress on your skin's health.
Our skin can't readily distinguish between different kinds of stress. Like the body as a whole, most of the key stressors that upset it—whether poor diet, a demanding job, cigarette smoke or insufficient sleep—are viewed through much the same lens. That means that any one or all of these various "insults" may cause or worsen a particular skin condition.
It also means that as with other major organs, how well your skin is prepared to deal with both daily and cumulative stress depends greatly on its organ reserve1. Though this term is generally not applied to the skin as an organ per se, it's useful to describe what amounts to our skin's physiological capacity to respond to stress.
Resilience to the damaging effects of stress—whether we're talking about our skin as an organ or our overall health—depends on two types of factors:
So while the tendency to develop skin problems is influenced to some degree by our genetics—indeed numerous skin conditions, including psoriasis, are believed to have a genetic component—our skin's overall health is governed by factors we can control: namely, environmental exposures, dietary and lifestyle choices.
The key word here is choices. It's axiomatic that we're presented daily with the opportunity to improve or compromise our skin's health. By avoiding damaging environmental toxins, as well as by choosing a less stressful lifestyle and a diet that supports skin physiology from the inside out, we can lessen inflammation, improve our immune response, and make a visible difference. Studies demonstrate that all these efforts can translate into fewer outbreaks, an improved appearance and—best of all—a slower aging process!
There are many natural steps we can take to mediate the stress response and improve our skin. Chief among these are mind-body techniques, counseling and support groups, regular exercise, optimal nutrition and supplementation, and detoxification. You need not adopt all the measures at once but can choose from among the steps listed below, which are intended to offer a blueprint for reining in the stress in your life.
Every day researchers shed new light on the effects of stress on inflammatory skin conditions such as psoriasis, eczema, and dermatitis. We hope this information helps provide you with a better understanding of your own capacity to control stress and its impact on your immune system and skin condition. Rather than allowing stress to control your life and your appearance, take it one step at a time, and you will see improvement on the outside of the work you're doing on the inside. Our skin has a miraculous ability to heal when given the support it needs.
(For more general information and guidance, see our article on Stress and your skin.)
1This can be defined as "the difference between basal and maximum organ function." (Montgomery, H. 2000. Cardiac reserve: Linking physiology and genetics. Intensive Care Med., 26 [Suppl. 1], S137-S144.)