When it comes to stress and skin conditions, I've always found the connection a really irritating vicious circle. Stress definitely caused my eczema and psoriasis to flare, I'd then stress about how bad my skin looked and that only seemed to make things worse! So, is there a connection? And if so, how do we break the cycle?

What Happens When we Stress?

The intricate relationship between stress and skin conditions has been documented since ancient times. Recent studies on the 'Brain / Skin Axis' and our Gut Microbiome are further highlighting a correlation. 

Psychological stress arises when we're put under mental, physical, or emotional pressure. This could be financial, work related or even due to complex personal relationships. When we experience stress, our body releases certain hormones.

In our caveman days, these short bursts of adrenaline were designed to instigate a 'fight or flight' response. Back then, stress might have meant a pending attack by a wild animal, so our body's response to fight back or run away was much needed. These days we get stressed about much less life threatening scenarios - such as coping with rush hour traffic, paying the bills or arguments at home. Yet we still see that same rush of adrenaline. The problem comes with chronic stress, when that feeling of anxiety just does not go away. There's no release and consequently the hormones constantly pump around our body with no outlet. 

Stress and Our Gut

I am a big believer in our gut health being integral to our skin health. Multiple studies are revealing what dieticians and naturopaths have been preaching for years! Our delicate gut microbiome balance directly impacts what we see on the surface of our skin. 

When it comes to stress and the gut, there is a very real connection. Stress affects our digestive tract in many different ways. For some of us it slows digestion, causing bloating, pain and constipation, while for others it can speeds it up, triggering diarrhoea or frequent trips to the loo. Some of us lose our appetite entirely. And chronic stress has been shown to worsen digestive conditions like stomach ulcers and irritable bowel syndrome.

There is no doubt that the connection between what happens in our brain and the impact it has on our stomach is closely connected. That feeling of 'butterflies in your tummy' when you're nervous. Or the feeling of dread that's often described as sitting 'in the pit of the stomach'. 

Studies are focusing on what they're calling the gut / brain axis. The connection between what happens in our mind and how it translates to our gut bacteria. Scientists agree there is a strong connection between our enteric nervous system, linking emotional and cognitive centres of the brain with peripheral intestinal functions.

Insights into exactly how this link works are complex, but research reveals that stress can deplete our 'good' gut bacteria. A good quality probiotic can replenish important microbiota, particularly where chronic stress is endlessly depleting it.

I've written in past articles about the important connection between our skin and gut health. For me the gut remains a crucial factor in stress playing a pivotal role in our skin health. 

Stress and Our Skin

As the largest organ of our body, skin plays crucial barrier and immune functions, it maintains an important balance between external environment and internal tissues. The hormone we're talking about when it comes to stress is cortisol and cortisol can have a major impact on our immune system. 

When cortisol is released, we feel certain physical changes. Our heart rate and breathing speeds up, there's a constriction of blood vessels except in our muscles, we might perspire more, and often there's a notable dilation of our pupils.

Stress is shown in studies to affect various diseases and conditions, for example, asthma, arthritis, migraines, and multiple sclerosis - highlighted here. Specifically in skin, multiple neuroinflammatory conditions can be triggered or aggravated by stress, such as: psoriasis, atopic dermatitis, acne, contact dermatitis - highlighted here and here, and even the hair loss condition alopecia - highlighted here.

Stress and Psoriasis

The National Psoriasis Foundation acknowledge that stress is both a consequence of living with psoriasis, and a cause for psoriasis flares. I know from personal experience that getting stressed about things didn't help my skin. In turn, seeing my skin flare caused me more anxiety. If you struggle with a skin condition I'm sure you can relate. 

A visible skin condition such as psoriasis impacts so much of our daily life. From what we wear to how we socialise, our relationships, our work. Seemingly every day things are massively affected by the way we perceive ourselves. 

Stress can also increase because of the physical aspects of psoriasis, such as coping with intense itching. It's incredibly stressful to not get a decent night's sleep, and the pain and itching associated with skin conditions can definitely cause that.  

According to research, forty-six percent of psoriasis patients believe their skin disease was stress reactive and fifty-four percent recall stressful events leading up to a flare. This updated study from 2018 reveals that up to eighty-eight percent of patients report stress as being a trigger for their psoriasis. There was also a reported higher incidence of psoriasis in subjects who had a stressful event the previous year, suggesting that stress may have a role in triggering the disease in predisposed individuals.

Stress and Acne

We've learnt that stress has long been thought to induce acne flares through clinical experiences and anecdotal observations. It was officially confirmed ten years ago by a controlled study and in a student exam stress study, increased acne severity was significantly associated with raised stress levels as highlighted by this research. 

In adult women with acne, chronic stress also increases the secretion of adrenal androgens (the increase in cortisol we talked about) and this can result in 'sebaceous hyperplasia' - tiny bumps under the surface of the skin on the forehead or cheeks. Furthermore, for people with acne, psychological stress can also delay wound healing, which in turn can affect the repair of acne lesions and pimples.

Stress and Eczema

Just like psoriasis, eczema symptoms and psychological stress seem to form a vicious cycle. Eczema patients have been reported to suffer from anxiety and depression prior to skin flares, while the ongoing psychological stress of dealing with a skin condition can in turn can exacerbate their dermatitis. 

Because the link between emotional stress and eczema is multi-faceted, it's complex and still not fully understood. Research highlights that stress is a significant contributor to eczema through its effects on our immune response and skin barrier function. It's thought stress can negatively affect skin’s permeability and in eczema patients, this disruption to the skin's barrier could lead to increased sensitisation to allergens, increased water loss, and potentially lower the threshold for itching. 

Stress Damages the Skin Barrier

Multiple studies prove that stress causes damage to our skin's delicate outer barrier. Studies prove that this disruption can lead to flaky or dry skin. Furthermore, research highlights that changes to our skin barrier has also been linked to diseases such as atopic dermatitis and psoriasis.

When we stress excessively, our skin seems to lose its ability to retain water, leaving it dry and parched. Some studies even highlight an increase in wrinkles as a result of too much stress. In this 2003 study, scientists looked at the correlation of relationship breakups and skin. The study was designed to observe the effects of stress on the skin's barrier strength and recovery. Individuals with high stress levels appeared to recover more slowly than the individuals with low stress.

Another interesting study was conducted on carers looking after elderly relatives suffering from dementia. If you've ever been in this situation, you'll know how stressful and emotionally taxing it can be. The results highlighted that caregivers needed twenty percent more time for their wounds to heal completely. Anxiety and depression were also highlighted as being associated with delays in the skin's ability to heal properly. It was found that elevated cortisol level was among the contributing factors.

Treating Stress Related Skin Flares

As of today there is no proven medical treatment that can either prevent or treat stress-induced or exacerbated skin conditions or skin ageing, but that isn't to say you can't do anything about it!

In the case of psoriasis for example, several controlled studies have demonstrated that relaxation, hypnosis, biofeedback, and behavioral and cognitive stress management therapies have been particularly effective.

I used to hate people saying to me 'well try not to get so stressed then!'. Often stress is inevitable. We're living stressful lives and currently going through very stressful times. Whilst we might not be able to do anything about the stress that comes into our lives, we can alter our reaction to it. This puts us back firmly in control and that feeling of empowerment can help us to relax. 

If you think your skin flares might be associated with stress, the first thing to do is explore the root cause of the problem. Sometimes it's obvious - a financial or relationship issue. Other times it's more complex - deep childhood trauma for example. 

I tend to find working on mental health a tougher challenge for most people than diet change. It's easy to accept that you need to eat more healthily to reduce inflammation, but so often the impact of stress is dismissed. This might be because our emotional wellbeing is tougher to work on. We don't like the thought of addressing deep rooted emotional issues, but as you can see from all the evidence above, it really is important. 

Self Help

When it comes to coping with chronic stress, there are lots of steps we can all take individually, without the need for outside help and support. 

Meditation

You might have heard about the benefits of meditation, but not know where to begin. The Headspace and Calm apps can be a fantastic starting point. Both offer short, guided meditations. Commit to doing one per day. During meditation we focus our attention on breathing and eliminate the stream of jumbled thoughts that often crowds our mind. This process can result in enhanced physical and emotional well-being.

Exercise 

Exercise has the added benefit of increasing our overall health and sense of well-being. But it also offers some direct stress-busting benefits. When we exercise, the action of movement pumps up our endorphins. Physical activity can help boost our brain's feel-good neurotransmitters, known as endorphins. These in turn lower that flood of hormone induced stress. Whether it's walks in nature, a relaxing yoga practice or vigorous cardio, it's important to find an activity that best suits you in terms of enjoyment and benefits. 

Seeking Outside Help for Stress

Speaking With a Counsellor 

Asking somebody else for help can feel incredibly daunting, but equally incredibly relieving when it comes to coping with stress. Here in England we're still a little awkward about going to speak to a stranger about our mental health, as though we don't want to admit something is 'wrong' with us! In America it seems much more widely accepted and actually healthy for emotional wellbeing.

Whilst perspectives in Britain are changing, it might still feel a little weird opening up to somebody else about your problems for the first time. I personally love working with a therapist for the following reasons:

• It gives me the tools to cope with day to day stress
• I can park a stressful situation and discuss it in my therapy session
• I can work on building better relationships thanks to having a better understanding of myself
• I can seek professional opinion on how to cope with past trauma

Don't be afraid to reach out. Talking therapies can help all sorts of people in lots of different situations. It might specifically be your skin flares and how they impact you that you'd like to address, or it might be that you'd like to explore your response to stressful situations to learn how to react differently. A counsellor can help you work through all these things. 

Here in the UK you can get talking therapies like cognitive behavioural therapy (CBT) on the NHS. You can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP. You may have to wait a few weeks for therapy to begin and you won't necessarily have much choice in who you see.

Alternatively, you can seek private help through face to face or online coaching. If you're not sure whether therapy could help, what type of therapy you need, or how to find a safe and effective counsellor or psychotherapist, the BACP can help you find all the information you need.