Stress and skin diseases: when the skin reflects what we feel

Many people have experienced at some point that, during a period of stress, pimples appear, psoriasis worsens, a herpes reappears or itching increases.

It is not a coincidence.

The skin and the nervous system maintain a constant communication through hormones, neurotransmitters, inflammatory mediators and the immune system.

This relationship is called the neuro-immuno-cutaneous axis and explains why stress can trigger or worsen numerous skin diseases.

Faced with a stressful situation, the organism activates mechanisms designed to help us respond quickly.

Different substances are released, among them:

• Cortisol.
• Adrenaline.
• Noradrenaline.
• Neuropeptides.
• Inflammatory cytokines.

When this response is occasional, it is useful. However, when stress is maintained for weeks or months, it can alter the normal functioning of the skin.

Chronic stress can cause:

• An increase in inflammation.
• An alteration of the barrier function.
• Greater water loss.
• An increase in oxidative stress.
• Delayed healing.
• Alteration of the immune response.
• Greater skin sensitivity.
• Worsening of itching.

For this reason, skin subjected to stress is usually more reactive and more vulnerable.

Stress is not usually the sole cause of these diseases, but it can act as a trigger or aggravate the flare-ups.

Among the most frequent are:

• Psoriasis.
• Atopic dermatitis.
• Rosacea.
• Acne.
• Urticaria.
• Alopecia areata.
• Telogen effluvium.
• Chronic lichen simplex.
• Chronic pruritus.
• Vitiligo.
• Recurrent cold sores.

Each person responds differently, but the influence of stress is widely recognised in the field of skin health.

Psoriasis is one of the best-studied examples.

Many people clearly identify that the flare-ups appear or worsen after:

• Family problems.
• Work conflicts.
• Exams.
• Illnesses.
• Important losses.

Stress favours the inflammation that characterises this disease.

Itching produces stress. Stress increases itching.

Thus a vicious circle is established that is very difficult to break.

Sleeping badly, scratching continuously and anxiety can keep the flare-ups active for longer.

Stress does not produce acne on its own.

However, it can favour:

• Greater production of sebum.
• An increase in inflammation.
• Manipulation of the lesions.
• Worse adherence to treatment.

All of this contributes to the worsening of acne in many people.

After a period of intense stress a telogen effluvium can appear, a diffuse hair loss that usually begins between two and three months after the triggering event.

In most cases it is reversible.

It can also influence some people with alopecia areata.

Healing depends on the good functioning of the immune system and on numerous repair mechanisms.

Sustained stress can:

• Delay the closing of wounds.
• Favour prolonged inflammation.
• Delay recovery after a surgery or a medical skin procedure.

Yes.

The sustained increase in cortisol and in oxidative stress can contribute to:

• Greater degradation of collagen.
• Loss of elasticity.
• Early appearance of wrinkles.
• Alteration of the barrier function.

Ageing depends on many factors, but controlling stress is part of a healthy longevity strategy.

The relationship works in both directions.

A visible skin disease can affect:

• Self-esteem.
• Social relationships.
• Sleep.
• Anxiety.
• Mood.

For this reason, treating a skin disease means taking care of both the skin and the patient's quality of life.

It is not always possible to eliminate stress, but it is possible to learn to manage it.

The measures with the greatest scientific support include:

• Sleeping between seven and nine hours.
• Practising physical exercise regularly.
• Maintaining a balanced diet.
• Breathing and relaxation techniques.
• Meditation or mindfulness.
• Maintaining healthy social relationships.
• Seeking professional help when necessary.

These strategies do not replace medical skin treatment, but they can improve its efficacy.

• Myth: All skin diseases are psychological. Fact: No. They are real diseases with a biological basis. Stress can influence their evolution, but it does not mean that "everything is in the mind".
• Myth: If I control stress, the disease will disappear. Fact: Controlling stress helps, but it must normally be combined with the appropriate medical treatment.
• Myth: Stress only affects mood. Fact: It also modifies the functioning of the immune system, inflammation and the repair capacity of the skin.
• Myth: Stress can make hair fall out. Fact: Yes. It is one of the most frequent causes of telogen effluvium.
• Myth: Emotions do not affect the skin. Fact: The communication between the brain and the skin is widely demonstrated by scientific research.

• The skin and the nervous system maintain a constant communication.
• Chronic stress favours inflammation and alters the barrier function of the skin.
• It can trigger or worsen diseases such as psoriasis, atopic dermatitis, rosacea, acne, urticaria and some forms of hair loss.
• It can also delay healing and accelerate skin ageing.
• Skin diseases can, in turn, generate anxiety and stress, creating a vicious circle.
• A comprehensive treatment must include the control of the disease, together with good rest, physical exercise, a healthy diet and effective stress management strategies.