Most of us know stress well, as it affects so many aspects of our day-to-day life, from our work to our family lives and even external pressures placed on us by society. No wonder why an estimated 8 in 10 Americans say they encounter stress in their daily lives, per a 2017 Gallup Poll. Unfortunately, the pandemic has only worsened stress levels in America, per the 2020 Stress in AmericaTM survey, with the highest stress levels seen in the millennial generation at 48 percent.
Stress is more than just an uncomfortable feeling — it is one of the major catalysts to poor health, as it’s linked to everything from heart disease, obesity, and diabetes to depression, anxiety, and even our skin health. That last one is incredibly important, mainly because so few of us realize that stress affects our skin at all.
Meet the Experts
Jeremy A. Brauer, M.D., a New York-based dermatologist.
Blair Murphy-Rose, M.D., a dermatologist at the Laser & Skin Surgery Center of New York and Clinical Instructor of Dermatology at Weill Cornell Medical College.
Marisa Garshick, M.D., a dermatologist at Medical Dermatology & Cosmetic Surgery (MDCS) in New York.
Erum Ilyas, M.D., a dermatologist at Schweiger Dermatology in King of Prussia.
When we are stressed, there are changes in the levels of certain hormones (i.e. cortisol) in our bodies, as well as an increase in free radicals, that directly and indirectly impact our skin and make it more sensitive or reactive, explains Jeremy A. Brauer, M.D., a New York-based dermatologist. “Stress (and increased cortisol levels) results in impairment of the skin’s natural barrier function by reducing other natural oils and resulting in a flare-up of underlying conditions that individuals may periodically suffer from such as psoriasis, rosacea, eczema, and cold sores,” he says.
“Acne worsens, eczema flares, psoriasis becomes more widespread and itchier when stress plays a role; it is a very common and real phenomenon,” says Blair Murphy-Rose, M.D., a dermatologist at the Laser & Skin Surgery Center of New York and Clinical Instructor of Dermatology at Weill Cornell Medical College. “Though these conditions are not caused by stress, they are commonly exacerbated by it.” In fact, research, including one study published in Archives of Dermatology, has shown that stress can worsen breakouts in patients suffering from acne.
Here, dermatologists break down some of the things that can happen to your skin when you’re stressed out.
Increased signs of aging
Chronically elevated levels of cortisol are also known to contribute to the breakdown of collagen, the most abundant protein in the human body, and elastin, the protein that forms in the connective tissues, explains Dr. Murphy-Rose. The result? Accelerating signs of skin aging like wrinkles and laxity. “Reducing stress levels will help to keep your skin healthier and more youthful,” she says. “While there are many factors contributing to the development of these skin conditions and to skin aging, like genetics, environmental exposures, lifestyle habits, etc., keeping physical and emotional stress under control can certainly help.”
To protect against these skin conditions or their exacerbations, she recommends making lifestyle changes that reduce your stress levels such as participating in yoga and meditation, exercising, maintaining a well-balanced diet, and avoiding smoking and excessive alcohol intake.
Psoriasis or eczema flare-ups
High levels of the stress hormone cortisol are known to lead to flare-ups in inflammation, which can worsen skin conditions such as psoriasis and eczema, notes Murphy-Rose. One study published in the peer-reviewed journal Acta Dermato-Venereologica showed how high amounts of cortisol can significantly worsen eczema as a result of its impact on the immune system. “It is the immune system dysregulation that results from the cortisol that then triggers inflammatory responses in the skin that worsens psoriasis and eczema, among many other conditions,” she says. “Increased inflammation brings about redness, flakiness, and itching.”
Another study published in the journal The International Journal of Environmental Research and Public Health linked the stress during pregnancy to an increased risk for the baby to suffer eczema outbreaks.
Pimples or acne
Acne can start because of stress or can worsen in the setting of stress. “When someone is stressed it can trigger an increase in the stress hormone cortisol level, which can then contribute to increased sebum production and inflammation, which can subsequently contribute to worsening breakouts,” says Marisa Garshick, M.D., a dermatologist at Medical Dermatology & Cosmetic Surgery (MDCS) in New York.
To treat these breakouts, she recommends first consulting the opinion of a board-certified dermatologist about the best treatment options and then working to keep your stress levels at bay.
In response to stress, your body releases higher levels of cortisol and this, in and of itself, can lead to oily and greasy skin, warns Dr. Murphy-Rose. “Among many functions, cortisol increases oil production from sebaceous glands which worsens acne,” she says. The good news is that decreasing your stress levels can help get your skin under control.
In addition to decreasing emotional and physical stress as much as possible, Dr. Murphy-Rose suggests using an over-the-counter acne medication containing salicylic acid to dissolve oils trapped in pores.
External stressors, like cold weather or exposure to sunlight, aren’t the only factors that can impact the skin barrier, the outermost layer of skin that protects all the other layers. In fact, psychological stressors can also disrupt the skin barrier, leading to increased moisture loss as well as making the skin more susceptible to irritation and sensitivity notes, notes Dr. Garshick. “In these cases, it is especially important to help restore moisture by moisturizing the skin regularly, specifically opting for a cream or ointment when possible and minimizing anything that can strip the skin of its natural oils,” she says.
Yes, hair does qualify as a modified type of skin, as it grows from the scalp and, just as with the skin on your face, your hair is also impacted by both physical stress and psychological stress in a form of temporary hair loss known as telogen effluvium, explains Dr. Garshick. “This hair loss is a temporary shedding that occurs 2-3 months after a stressful event but tends to improve with time,” she says. “It is always good to speak with your dermatologist if you are experiencing hair changes to discuss potential treatment options.”
If you’ve ever felt particularly itchy during times of stress, it wasn’t just your imagination — there’s a real correlation. Some people actually experience hives — raised, puffy welts — when they are experiencing high levels of stress, per the American Institute of Stress. The classic scenario is someone experiencing a stressful situation either at work or at home and finding themselves distracted by an itchy feeling on their arm, legs, neck, or back of the scalp, explains Erum Ilyas, M.D., a dermatologist at Schweiger Dermatology in King of Prussia. “People are often convinced there is something on their skin — a ‘creepy-crawly’ sensation is common and will pinpoint areas that they cannot help but want to dig or pick out of their skin,” she says.
If this happens to you, Dr. Ilyas suggests trying your best to hold off on the scratching, as it will likely only lead to bleeding and scarring. “Start to recognize these rashes as a ‘check engine light’ on your skin that tells you when you are managing more than you can handle,” she says. “When I take the time to point this out to patients, I find that patients are better able to understand the impact of stress on their skin and learn to use it as a clue that they need to take some time for themselves or seek help.”
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