NEW YORK—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. Dermatologist and clinical psychologist Richard G. Fried, M.D., Ph.D., FAAD, of Yardley, Pa., 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 at the American Academy of Dermatology’s Summer Academy Meeting 2011 in New York.
“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, that stressful situation can cause neuropeptides to be inappropriately released, which can lead to a flare of skin conditions.
“Until recently, it was thought neuropeptides only stayed in the skin when they were released," Fried said. “But we now know they travel to the brain and ultimately increase the reuptake of neurotransmitters, meaning 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 psychotherapy, cognitive behavioral therapy, meditation, hypnosis, tai chi, yoga, antidepressants and beta blockers, noting 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.
Fried added 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, allergen, 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.