How does stress effect your skin? Stress - the word alone can trigger a heightened response. We all have dealt with stress in our lives. Some of us even deal with it daily on a chronic level. Stress can have negative effects on your health - including skin problems. This in turn, adds to the amount of stress and it's a vicious cycle. When the stress plays out on your skin, you see and feel it immediately.
The classic example is stress and acne; so many of us can't even begin to count the number of times during our teen years that acne flared up on our face inconveniently after stressful days or sleepless nights. Do you ever wonder why stress triggers health problems, including skin problems? Here is what we know about stress, chronic stress and skin problems.
What is Chronic Stress?
First, before understanding how stress can affect your skin, you need to understand the stages of stress, including chronic stress. Stress is not always bad. In fact, stress is designed as an adaptive mechanism to harm. As the famous endocrinologist Hans Selye showed through research, way back in 1946, our body's response to "stressful" stimuli is a 3-stage process that he called "general adaptation syndrome."
The 3 stages of stress:
Stage 1, The Alarm Stage
This is the initial reaction that signals your brain to ready its defenses, such as the "fight or flight" response, which is fueled by adrenalin.
Stage 2, The Stage of Resistance or Adaptation
Here your defenses are fully activated and several hormones are released, including cortisol, (aka the stress hormone) to continue the battle.
Stage 3, The Stage of Exhaustion
In stage 3, the buildup of stress and hormones reach a peak load that the body can no longer endure or compensate for. The result is a disruption of the body's homeostasis or the onset of disease. This is when chronic stress occurs.
Everyone is familiar with the increased heart rate during the Alarm Stage of immediate stress. It's much more difficult to be aware of the Adaptation Stage and the Exhaustion Stage of chronic stress. This is when the internal damage caused by chronic stress happens, especially on our inflammatory and immune responses. It's complicated to understand, but chronic stress leads to our immune system becoming dysregulated and this, in turn, can fuel chronic inflammation, or the release of important building blocks in the body called proinflammatory cytokines. It also leads to hormone changes that drive inflammation and fuel skin problems.
Chronic stress leads to dysregulation of our inflammatory and immune responses and this leads to health problems.
The impact of chronic stress on our heart, digestive system, and other body systems are numerous - including issues with skin and acne!
The skin is our body's largest organ, readily visible to us and our primary barrier against many germs. When the skin's barrier becomes compromised, it leads to skin problems and potentially opens our body to a host of infections.
Chronic stress compromises the integrity of the skin barrier and immune balance and this can lead to some of the most common skin problems: eczema and psoriasis, acne, rosacea and seborrheic dermatitis, neurodermatitis, generally dull skin that lacks brightness and the appearance of vitality. If these are problems for you or someone you love, it's important to know how to repair and prevent these skin conditions when chronic stress occurs.
5 Ways Stress Effects Your Skin and How to Fix Each of Them
Acne is "famous" for flaring up when you are in the midst of a stressful period in your life. This is the stress barometer for many.
How does stress cause acne?
- The cortisol hormone released during stress stimulates increased production of skin oil.
- The immune system dysregulation disrupts the skin's ability to effectively combat the bacteria on your skin and triggers more severe inflammatory reaction to germs that are associated with acne.
When you are under chronic stress, it's good to give your skin a little assistance to fight off the microbes. In other words, identifying the culprit organism is helpful in picking the right acne products.
A cleanser with an antibacterial or anti-skin yeast agent is the first-choice treatment for stress-induced acne.
My Foaming Benzoyl Peroxide Acne Treatment Cleanser is effective for bacterial-type acne caused by P. acnes (now called C. acnes germ).
I also recommend pairing an acne cleanser with a day or an overnight acne treatment product. This is useful to further keep the pores clean, to help remove excess oil, and to keep microbes at bay. The best routine is available in my Ultimate Acne Solutions Skin Care Kit which combines all the essential products to treat acne with instructions to guide your daily skin care routine.
The Ultimate Acne Solution Kit products can be used in the morning and the Calming Zinc or Foaming Benzoyl Peroxide Cleanser can be used at night followed by the Acne Treatment Pads and Benzoyl Peroxide Acne Treatment Cream in the Kit. For any areas of skin dryness, you can apply Daily Moisturizing Face Cream for Oily to Normal Skin on top. This moisturizer is well loved by people suffering from acne because it is formulated to help soothe irritation and dryness.
2. Eczema and Psoriasis
Eczema is a word that describes a type of skin reaction, it is not a specific skin diagnosis or condition itself. There are different types of eczema, which I explain in an article I wrote on eczema here.
Among the various causes of an "eczema-type" skin reaction, stress often brings on the typical itchy rash and worsens the itch, which in turn leads to scratching and potentially skin wounding and infection.
Similar to acne, the immune system disruption provides opportunities to bacteria that live on our bodies naturally, such as Staph aureus, to suddenly cause skin issues such as a worsening of eczema or infected lesions of eczema.
Psoriasis is a very specific skin problem. It is often inherited and can be associated with other health problems such as heart disease. It too involves a red skin rash, itching, scratching, and potential skin wounding.
In order to calm the inflammation of eczema and/or psoriasis it is important to restore and support a healthy skin barrier. A hypoallergenic and natural moisturizer is best. I recommend applying a rich skin moisturizer after a daily warm/tepid bath or shower. I recommend hypoallergenic products such as my Natural Face and Body Lotion, which contains a mixture of natural oils, including coconut oil in a hypoallergenic formulation.
My Face and Body Butter Cream is slightly richer and is also made from a blend of botanical hypoallergenic oils such as shea butter, avocado oil etc. Both are entirely unscented.
Rosacea is another skin condition triggered by stress. I have treated thousands of people suffering from rosacea over my 30+ year career and I suffer with it myself. If you would like more information on rosacea click here. Rosacea often overlaps with facial seborrheic dermatitis. My patients find that both facial skin problems flare up during times of stress.
Rosacea and seborrheic dermatitis prone complexions are highly sensitive and notorious for having a compromised skin barrier. Rosacea, in particular, often has a heightened inflammatory response to just about everything! That includes skin care products that are irritating the inflamed skin.
I like to educate patients and customers on how to create a skin care routine to successfully calm, treat, and protect rosacea-prone and seborrhea-prone facial skin. For the simplest treatment, my Facial Flaking and Redness Solution Kit does the trick. It not only calms the redness and irritation of rosacea skin, but it also fights a yeast in the skin that proliferates in both of these skin problems because the Calming Zinc Soap contains pyrithione zinc.
Neurodermatitis is an unexplained itching in a particular area that develops into thick scaly patches from repeated scratching. Although the exact cause is unknown, stress is one of the triggers for this condition. The best way to prevent further inflammation of the area is to not scratch the itchy area. However, the itching can disturb sleep or focusing at work, thus it may prove to be difficult to fight the urge to scratch.
Gain some relief from itchy neurodermatitis by properly hydrating the area with hypoallergenic moisturizers, such as the Natural Lotion or Natural Butter discussed in the eczema section. This will help the damaged skin barrier heal. It also helps to reduce itch. Also, instead of scratching, apply an ice pack or cool tap water-soaked towels to itchy skin. This will help to protect skin from being susceptible to infection, it is best to consult your local physician to determine the exact cause of your dermatitis. Your local physician may prescribe corticosteroid creams or other medications that will help stop the "itchy feeling."
5. Reduced Blood Flow
Chronic stress leads to overall reduced blood flow because the body diverts blood to essential organs as a survival mechanism. Additionally, the stress response includes a narrowing of blood vessels to increase our blood pressure and eventually raise our heart rate, further reducing the overall blood flow.
When the blood flow in our skin is reduced, the exchange of nutrients and wastes is also reduced, leading your skin to look pale, sunken, or even darkened in some areas. The area under your eyes shows the most dramatic effects in the form of dark circles. These can be addressed nicely with my Advanced Corrective Eye Cream that is formulated to brighten skin and target vascular congestion to reduce under eye circles, bags, and puffiness.
And, this is not the end of the misadventure between stress and your skin …
Stress can cause skin problems and it also makes many existing skin problems worse.
Authors of a detailed scientific review paper out of Germany conclude that there is “mounting evidence that stress in the sense of psychosocial stress alters the ability of the skin – through neuroendocrine and immune changes – to respond to environmental challenges. Especially in case of skin damage, due for example to a chronic disease such as atopic dermatitis, there is a more rapid and severe exacerbation of the skin disease under psychosocial stress. It therefore seems obvious: Anything that reduces stress must also reduce inflammation. This possibly also plays a role in the development of skin tumors.” (1)
As a dermatologist, I know that skin problems cause stress. I’ve also observed over the years, that when my patients are under stress, their skin problems are much worse. In my 30 years of practice, I’ve even seen patients whose skin formed a flurry of basal cell skin cancers over several years when they were under severe life stress. Once the stress dissipated, their skin stopped forming basal cell cancers.
Stress reduction can help improve skin problems.
Now that researchers are working out the neuroendocrine immunologic pathways for skin problems, we know that stress reduction is an important component for improving them. Whether the problem is classic eczema (atopic dermatitis), rosacea, psoriasis, acne, hives and even skin cancer, the neuroendocrine immune state of your overall physiology will be impacted by stress - and so will your skin. Stress, whether acute or chronic, shifts the state of your body’s immune balance, and that will impact your skin problems.
Any patient with a skin problem will tell you that the problem also causes them stress. It can be a ‘which came first, the chicken or the egg’ question with stress and skin problems. We are now able to say that no matter which came first, stress reduction will help. This is important.
How can you lower your stress to help your skin problem?
Mindfulness has been shown to help reduce stress and improve your skin problem.
According to Susan Abbey, MD, “Dermatology was actually the first area to show an impact of mindfulness… because the skin has been regarded as an organ that responds to emotional stimuli and psychological influences.”
Dr. Abbey gave what I think is a really important example, one that may help you creates a fundamental shift in a perspective regarding a skin problem, “Instead of a treatment being applied to get rid of a skin condition that is bothersome and aesthetically unpleasing, mindfulness would bring a perspective of being compassionate to one's self by applying the treatment.”
There are mindfulness-based forms of therapy and also stress reduction. There are mindfulness tapes and books. Dr. Abbey recommends Jon Kabat-Zinn PhD, Executive Director of the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School.
I’ve read a number of his books. They helped me through breast cancer treatment. In my experience, mindfulness helps you manage stress with less reactivity. I’m a huge fan. I always have a mindfulness book by my bedside to read before falling asleep. Ten years ago, I also studied mindfulness in daily living for several years with a local mindfulness center, and I see a therapist who helps me with my own personal approach to reacting to my life stresses in a more mindful way. I ramped up all of these mindfulness tools during the year that I was treated for breast cancer. It helped.
Mindfulness does not take the place of medical care, it supports it.
I used mindfulness tools during breast cancer treatment along with chemotherapy and surgeries. I know that modulating the stress helped support my physiology to heal well.
Combining care with lifestyle recommendation is now more common in dermatology.
As a dermatologist, I know the value of treating skin conditions comprehensively, with both traditional medical care and, what is now called Integrative Care. That includes mindfulness, diet and exercise advice and stress reduction among other things. Patients get their dermatologic care and we talk about their life, stress and diet and how we can use these to help their healing.
As an Integrative Dermatologist, I approach the combination of stress and skin problems with 3 key steps:
Step 1. Create a foundational Complete Skin Care Routine to address the specific skin problem from the outside in.
This helps set up the skin to heal. A Complete Skin Care Routine is one that works holistically to provide everything the skin needs to restore balance. I specifically recommend skin cleansing recommendations, correcting/treating products, moisturizers to protect skin barrier and sunscreens to block UV rays known to reduce skin immunity. This Complete Skin Care Routine is specific for the skin problem we are addressing.
Step 2. Prescribe medications and treatments.
I only use these if they are needed to heal a skin problem such as cortisone creams, antibiotics for skin infections, antihistamines for severe itch, etc. Many times, prescriptions are not needed or only needed for a limited time.
Step 3. I discuss supporting lifestyle changes to lower overall body inflammatory physiology.
These include recommending a low inflammatory diet (described in my diet eBook), regular sleep, regular exercise appropriate for their fitness level, and stress reduction such as a mindfulness practice.
I’m also a big fan of being outside in nature as often as possible, so that’s usually a recommendation - along with sun protection advice, of course.
I’m glad to see rigorous scientific study supporting stress reduction as an important therapeutic aspect of medical care in dermatology.
Good self-care, including mindfulness, is now mainstream treatment for skin problems and that’s a real step forward!
Stress and Skin Connection Bottom Line
Even though we covered the 5 main effects of stress on the skin, there are countless others or variations on the effects discussed. Reducing stress in your life is the best method to decrease resulting skin symptoms. However, we understand often our skin's feel and appearance further adds to our stress. Armed with methods to treat stress-induced skin conditions will at least knock off one stressor on your list!
- Peters Eva M.J., Stressed skin? A molecular psychosomatic update on stress-causes and effects in dermatologic diseases, Journal of German Dermatologic Society, Volume 14, Issue 3, March 2016 https://doi.org/10.1111/ddg.12957
- Fordham B, Griffiths CE, Bundy C. A pilot study examining mindfulness-based cognitive therapy in psoriasis. Psychol Health Med. 2015;20(1):121-7.
- Montgomery K, Norman P, Messenger AG, Thompson AR. The importance of mindfulness in psychosocial distress and quality of life in dermatology patients. Br J Dermatol. 2016 May 12.
- The National Eczema Association: Neurodermatitis