Ever wonder why when the going gets tough, the tough get eczema? Or when life gives you lemons, it also gives you a pimple? You don’t need to know much about skin or stress to know that the two are definitely linked. Think back to the last time you woke up with a planetary zit living in the middle of your face. You probably examined it, poked and prodded in disbelief. How could something that didn’t exist when you went to bed last night be so glaringly prominent now? Houses aren’t constructed overnight. Rome wasn’t built in a day. Yet somehow, a Mall-of-America-sized pimple can erupt on your chin in a matter of hours. If life has been especially hectic, you may chalk it up to stress and go about your day. For some people though, a sudden breakout or an unexpected flare up can take a toll on their mental health, until whatever’s going on at the surface becomes the source of stress rather than the result.
From acne to eczema, and everything in between, it’s fair to say that skin imitates life and life imitates skin—at least when it comes to stress. But what’s actually going on beneath the surface? We can’t talk about stress without talking about cortisol, a steroid hormone produced in the body’s adrenal glands. Though commonly referred to as the stress hormone, cortisol also plays a role in reducing inflammation and regulating blood sugar, among other things.
We reached out to board-certified dermatologist, Dr. Elyse Love to get the facts on how stress can impact your skin. “Acute increases in cortisol are healthy and help us push harder during a workout, fight off an infection, slam on the brakes to avoid running red lights, and escape danger if needed,” says Dr. Love. On the other hand, long-term stress can have detrimental effects both internally (think: diabetes or high blood pressure) and externally, potentially making it more difficult to control certain skin conditions.
“Our skin is a dynamic organ that is constantly performing several tasks including serving as a physical barrier from outside toxins, regulating our temperature, supporting good bacteria growth, and protecting us from infection-causing bacteria,” says Dr. Love. Stress triggers an inflammatory process, which affects your skin’s ability to perform these functions. Skin conditions—especially chronic ones like psoriasis, acne, eczema, and seborrheic dermatitis—tend to flare up when business as usual is thrown out of whack.
It often feels like emotional stress begets skin stress, which in turn begets more emotional stress, and so on… We know that stress can trigger skin conditions, but how can skin conditions trigger stress? According to Dr. Love: “Stress and skin flares are often on what’s termed a positive feedback loop. So, a stressful life situation leads to a flare in an otherwise controlled skin condition. This flare then creates an additional life stress that also leads to a worsening of the skin condition.” In other words: a vicious chicken-or-the-egg cycle.
Feel like you might be stuck in a positive feedback loop? Don’t worry, there’s hope. This is where psychodermatology may be helpful. Generally speaking, the field of psychodermatology addresses the crossover between psychology and dermatology. This can refer to psychiatric conditions like compulsive skin picking, as well as “holistic treatment of skin conditions that includes addressing their psychological impact,” says Dr. Love. She notes that it’s not uncommon for depression and anxiety to present in patients with severe acne.
Whether you’re dealing with a stress-induced psoriasis flare or the stress induced by a psoriasis flare (for example), treatment should focus on stopping the feedback loop. It helps to find a physician you connect with—someone you can trust. Dr. Love understands the emotional connection we have with our skin. “In addition to answering all questions to alleviate my patients’ anxiety of the unknown, I often ask my patients to leave their anxieties related to their skin condition with me,” says Dr. Love. Being able to put your trust in the hands of a medical professional, especially an empathetic one, is a great first step to alleviating skin stress. Dr. Love will also advise her patients to focus on healthy lifestyle practices such as diet, sleep, and physical activity to help reduce stress.
Seeing a dermatologist and practicing stress-reducing techniques can go a long way. For many people though, working with a mental health professional is another crucial piece of the skin-stress puzzle. So next time you get a rash after burning the candle at both ends, or find yourself feeling low after discovering a new pimple, cut yourself some slack. Because we’ve all been there before, and we’ll all be there again. Dr. Love’s advice? “Remember, there is no stigma in seeking help when you need it, in whatever form that may be. Also, when you feel you are your busiest, block out time to do your thing.”
Written by Cleo Gold