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The effects of stress on your skin

WebMD Feature
Medically Reviewed by Dr Rob Hicks

Does your acne get worse during exams? Is your eczema more likely to flare-up when you are tense and anxious? Is your psoriasis triggered by a stressful event?

If you have a skin condition you probably know the effects that stress can have on your skin. More and more doctors are aware of this mind and skin connection, which is called psychodermatology. It's a growing field of study but could provide more integrated treatment options for people with skin conditions.

"At least half of patients with a skin condition have psychological factors affecting their skin according to a 2013 report," says Dr Anthony Bewley, consultant dermatologist at Royal London Hospital and Barts Health.

So working on stress and emotional issues with a psychologist, psychiatrist or other talking therapist may help soothe the skin condition.

The stress cycle

It can be hard to work out what comes first, the stress or the skin condition. There's no evidence that stress is the primary cause of a skin condition but it definitely can make it worse.

"Stress, as well as being caused by having a skin condition, can actually trigger flare-ups of skin disorders," says Nina Goad of the British Association of Dermatologists. "This is commonly the case with eczema, psoriasis, acne, vitiligo and alopecia, but is true of many more diseases.

"This can lead to a vicious circle of stress leading to a skin disease flare-up, which then leads to additional stress. Breaking this cycle is crucial," says Nina.

Why is there a connection?

"As a baby grows in the womb its skin and brain develop from the same type of cell so there is definitely a mind and skin connection," says Dr Susannah Baron, consultant dermatologist at Guys and St Thomas's hospital in London.

When you are stressed it sometimes shows elsewhere in your body. For some people it may lead to stomach ulcers or headaches for others it may have an effect on the skin.

"The brain is connected to the skin through nerves," says Dr Bewley. "The skin is actually a manifestation of what's going on in the body. People read our skin for clues to what's happening inside our bodies and the brain picks up the signals from the skin."

Stress may work differently on the so-called big three skin conditions, acne, eczema and psoriasis.

"Many of my patients report that their skin disease may flare during times of stress," says Dr Emma Wedgeworth, consultant dermatologist and British Skin Foundation spokesperson.

"With itchy skin conditions, such as eczema, stress may amplify the itch sensation and therefore increase itching and damage to the skin. But that's only part of the story. How stress exacerbates other skin diseases such as psoriasis, acne and hair loss is not fully understood by dermatologists," says Dr Wedgeworth.

"However, it is thought that stress may increase inflammation in the body by affecting a group of hormone stimulating glands known as the hypothalamic-pituitary-adrenal (HPA) axis. Activating the HPA axis can lead to release of a number of chemical mediators which increase inflammation and in turn could trigger or exacerbate a number of skin conditions," she explains.

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