Ever suffered from an acne breakout right before an important meeting? Do your fine lines and wrinkles tend to be more pronounced when you’re in the middle of a hectic week? The evidence may be anecdotal, but there’s reason to believe stress has a direct impact on skin. “The reality is, the skin is part of the body. Everything is connected. Most of the time, I think we don’t truly appreciate what the body really needs,” says Dr. John Ku, Professor and Vice Chairman, UCSF Department of Dermatology, Board Certified in Psychiatry and Dermatology.
To learn about theories surrounding the connection between stress and the skin, we spoke with Dr. Koo, as well as Dr. Richard Thomas, Clinical Associate Professor of Clinical Dermatology, Department of Dermatology and Skin Science, University of British Columbia.
1. Breakouts and pre-existing skin conditions
“They say emotional stress is the number one thing that worsens inflammatory skin conditions like psoriasis, eczema, and acne. When people are stressed out inflammation often becomes worse. People with adult acne often point out that when they’re stressed out, their acne is worse.”
– Dr. John Koo, Professor and Vice Chairman, UCSF Department of Dermatology, Board Certified in Psychiatry and Dermatology
2. Aging
“This isn’t proven but it has been observed that under horrible and prolonged stress, people seem to age. There are many accounts of skin aging as a result of extreme situations, like war. In World War II there were groups of young soldiers, 18 and 19 year-olds, who were in horrible battles for weeks. Afterwards they looked like they were middle-aged. They just didn’t look the same. They were 18 but they looked middle-aged.”
– Dr. John Koo, Professor and Vice Chairman, UCSF Department of Dermatology, Board Certified in Psychiatry and Dermatology
3. Hair loss
“Hair goes through a cycle of growth and transition. There’s a well-known phenomenon called telogen effluvium. Telogen is when the hair is in hibernation and falls out. It’s not permanent hair loss because the hair follicle stays in the skin, but the hair does come off. If somebody’s stressed out, all of their hair can go into the resting phase instead of the usual proportion, causing them to lose hair and suddenly look so much older because they look like they’re balding. That’s a well-known hair loss reaction to both emotional stress and physical stress.”
– Dr. John Koo, Professor and Vice Chairman, UCSF Department of Dermatology, Board Certified in Psychiatry and Dermatology
4. Redness
“For those suffering from rosacea, acute stress in the form of embarrassment can cause blood vessels to dilate”
– Dr. Richard Thomas, Clinical Associate Professor of Clinical Dermatology, Department of Dermatology and Skin Science, University of British Columbia
5. Inflammation
“It is said that inflammation is triggered or increased by stress. We hear this all the time in those who have acne, psoriasis, or alopecia areata (patchy hair loss). There are mechanisms that have been defined but it is so difficult to prove with absolute certainty.”
– Dr. Richard Thomas, Clinical Associate Professor of Clinical Dermatology, Department of Dermatology and Skin Science, University of British Columbia
6. Phantom itches and burning sensations
“There are many people who experience sensations of the skin, like burning sensations and itching when there isn’t anything actually wrong with the skin; no rash, just a sensation. It can be caused by stress.”
– Dr. John Koo, Professor and Vice Chairman, UCSF Department of Dermatology, Board Certified in Psychiatry and Dermatology
How to alleviate stress
“It’s important to determine whether the stress is situational or inter-psychic. Everyone has their own stress management strategy that works for them, whether it be meditation, exercise, or something else. Mild stress can be alleviated by simply doing the things that help you relax. If your stress is more severe, it may be worth looking into whether the stress is internal or external. Sometimes external arrangements need to be adjusted. For example, if your work schedule is taking a toll, talking to your boss and adjusting your routine can greatly improve quality of life. If your stress is inter-psychic then you may be chronically unhappy or chronically unhappy due to conditioned ways of thinking, in which case you may need to seek therapy or explore pharmaceutical medications.”
– Dr. John Koo, Professor and Vice Chairman, UCSF Department of Dermatology, Board Certified in Psychiatry and Dermatology
What to do if your skin condition is the cause of your stress
“Unlike other organs, skin is visible. When people have skin conditions they look and feel ugly, so their self-esteem is devastated and their self image is devastated. Having a painful physical illness is bad enough –also having an effect on self image makes it worse,” says Dr. Koo, “The best treatment of all is getting rid of the disease by offering appropriately aggressive therapies. There are so many treatment options available – not just topical treatments but also injectable biologic therapies, oral medications, laser treatments, and phototherapy. If you consider all the options it’s pretty rare I have somebody that I cannot improve.”
– Dr. John Koo, Professor and Vice Chairman, UCSF Department of Dermatology, Board Certified in Psychiatry and Dermatology