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Stress & Psoriasis

Stress, the immune response, and inflammatory skin conditions

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.

The stress response and skin—too much of a good thing

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.

Immune function, T cells and the skin

Scientists are investigating the impact of acute (sudden) and chronic (ongoing) stress on relevant immune functions in patients with inflammatory skin conditions that are mediated by the immune system, such as psoriasis and dermatitis. In a series of recent studies published in the Journal of Clinical Endocrinology & Metabolism, Psychoneuroendocrinology, and Brain, Behavior and Immunity, German researchers evaluated some of the differences between the effects that stress triggers in these patients.

A diminished responsiveness of the HPA axis was thought to explain susceptibility to allergic inflammation in dermatitis patients. They also recognized that in psoriasis patients, T1 lymphocytes tend to increase inflammation that results in epidermal hyperproliferation and psoriatic plaques, whereas in patients with dermatitis the same psychosocial stressor will induce more of a T2-mediated allergic response.

In one study comparing the responsiveness of the HPA axis in psoriasis patients against a control group, both the patients and the normal group showed elevated ACTH, a hormone produced and secreted by the pituitary gland but also secreted by immune cells under duress, in response to stressful stimuli. In a normal stress response, ACTH in turn stimulates the adrenal cortex to produce corticosteroids, mainly cortisol, and in this study, cortisol levels were likewise found to be equivalent in both psoriasis and control groups. In other words, unlike dermatitis patients in prior studies, psoriasis patients demonstrated normal HPA axis responsiveness. However, what was noted to be different in psoriasis patients was increased reactivity in another portion of the nervous system known as the sympathetic adrenomedullary [SAM] system.

In several studies, both subjects with psoriasis and those with atopic dermatitis demonstrated elevated epinephrine and norepinephrine levels in response to the stress test as compared to normal subjects. While more studies are needed to clarify the pathways involved, these and other altered immune responses may explain how stress triggers flare-ups of psoriasis, dermatitis, and other immune-mediated skin conditions.

* Buske-Kirschbaum, A., et al. 2007. Altered distribution of leukocyte subsets and cytokine production in response to acute psychosocial stress in patients with psoriasis vulgaris. Brain Behav. Immun. 21 (1), 92-99.

Buske-Kirschbaum, A., et al. 2006. Endocrine stress responses in TH1-mediated chronic inflammatory skin disease (psoriasis vulgaris)—do they parallel stress-induced endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)? Psychoneuroendocrinology, 31 (4), 439-446.

Buske-Kirschbaum, A., et al. 2002. Altered responsiveness of the hypothalamus-pituitary-adrenal axis and the sympathetic adrenomedullary system to stress in patients with atopic dermatitis. J. Clin. Endocrin. Metab., 87 (9), 4245-4251.

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.

The molecules of stress and your skin

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.

How does the skin view stress?

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.

Causes of stress-induced skin outbreaks—you have more control than you think!

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:

1) those over which we have no control; and
2) those in which we have a say

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!

Coping with stress—the DermaHarmony approach

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.

  • Explore mind-body techniques. Numerous schools of mind-body techniques exist for achieving a physical state of deep rest. These include various types of meditation, yoga, guided imagery, and the Relaxation Response. All these and similar techniques serve to relax the nervous system, decrease anxiety, improve sleep, and boost the body's immune response. Additional insight into the psychological aspects of stress can be gained through counseling, which can lead us to a better understanding of how emotions may be at the root of skin conditions.
  • Move your body! Exercise is an excellent way to blow off stress and tension. Its physiochemical and psychological benefits are too numerous to list here, but include better oxygenation of all body tissues, improved self-esteem and mood regulation, improved resilience to stress and infection, and deeper, more restorative sleep.
  • Consider a detox regime. Stress, improper dieting, and lack of exercise can all compromise the body's ability to metabolize and rid itself of toxins. Periodic detoxification can help the liver and other digestive organs clear toxins so they don't accumulate and show up later in the skin. If you've never tried a cleansing diet or program, this may be the perfect time to give it a try.
  • Get a good night's sleep. During the day our bodies and minds experience a great deal of stress, and as we explained above, the skin cannot distinguish between all the factors that perturb it. It is hard to overstate how important it is for people under stress —particularly those who suffer its effects most in the form of troubled skin— to get a solid night's sleep. No matter how difficult it may seem, turning in at a reasonable hour—preferably by 10:00 p.m.—can work wonders on the body's overall organ reserve. It's one of the best things you can do for your adrenal glands, and hence your immune response, and we can promise you that getting 8 hours of sleep a night will improve your skin's appearance.
  • Optimize your diet and digestion. Proper dietary intake and good digestion are crucial for keeping the skin healthy. Your Healing Guide by Deirdre Earls offers many great tips on how different foods can improve conditions of the skin. Choosing high-grade probiotic supplements will also facilitate proper digestion and optimize absorption of the nutrients in your food.
  • Don't forget your vitamins. Taking a high-quality multivitamin-mineral complex daily is one of the least expensive and simplest ways for stressed-out people to ensure they bridge dietary gaps and get the nutrients their bodies need to respond to stress. It's well-known that a number of vitamins and minerals are essential for nervous system health, particularly the vitamin-B complex. Vitamins A, C and E are powerful antioxidants that help fight free radicals that damage the cells. Vitamin C is also important for a healthy immune system; vitamin E has healing properties, and vitamin D3 provides relief from many inflammatory conditions. In fact, vitamin D supplementation is frequently suggested for improving skin health, where much of the population gets inadequate sun exposure and dietary sources are limited. In addition, having adequate calcium and magnesium on board is a prerequisite for restful sleep. These are just some of the most important nutrients for an optimally functioning nervous and immune system. Click here to learn more.

Healthier skin through managing stress

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.)

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Visit DermaHarmony to learn more about our alternative, science-based approach to psoriasis, rosacea, acne, dermatitis, and other common skin conditions. At DermaHarmony our goals are to educate chronic skin care sufferers about the latest alternative research in dermatology, encourage a holistic approach to healthy skin and wellness, and to support our readers in every way we can.

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Principal Authors: M. Ofiyeva
Date of Publication: 10/05/2007
Updated: 06/07/2011