Well-Being//

How Skin Conditions Get Worse With Stress — and 4 Ways to Cope

A dermatologist explains the scientific connection between stress and skin conditions.

GeorgePeters/Getty Images
GeorgePeters/Getty Images

Ever suspected that stress wreaks havoc on your skin? You’re not imagining things. While it may feel like your skin is waging a personal attack on you, it’s simply biology at play — and there’s some science to prove it.

Any stress — whether it’s related to work, your personal life, finances, or something else — can have an adverse impact on the skin, the largest organ in the body, says Dr. Mamta Jhaveri, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine. 

The reason comes down to what research calls the “brain-skin connection.” As Jhaveri explains it, stress increases cortisol, also known as the “stress hormone”, which can increase inflammation — and make the swelling, redness, or bumps more of an issue. “People with acne, particularly teens and young adults, often find their condition worsens during times of stress because the elevated cortisol makes the oil glands more active,” adds Dr. Jhaveri.

Skin mast cells are activated by stress, and in turn they also produce stress hormones and inflammatory factors. This could lead to a vicious cycle of stress-induced inflammatory events. 

Dr. Jhaveri is careful to point out that stress itself doesn’t cause skin conditions, “but it can make them harder to control.” It is “bi-directional,” she says, explaining that, for example with eczema, “stress can lead someone to scratch their skin, even when they’re not experiencing an ‘active’ eczema episode.” And scratching in turn can trigger inflammation, resulting in an eczema flare-up and keeping the itch-scratch cycle active.

Emily Fesler-Young, a 29-year-old product designer in northern California, knows the vicious cycle all too well. She’s one of the 31.6 million people in the United States, according to the National Eczema Association, with chronic eczema. “In the past, every time I got stressed, my skin would fall to pieces,” Fesler-Young says, recalling how outbreaks of both eczema and acne interfered with her social interactions. “In high school, I was a bit of a loner.” It’s not uncommon for skin problems to make it difficult for people “to have a normal social life and work schedule,” says Dr. Jhaveri, adding that severe eczema, acne, and psoriasis are associated with higher rates of anxiety and depression.

Given the emotional and physical impact of a skin condition, Dr. Jhaveri is an advocate for a “holistic, integrative, rather than ‘one-size-fits-all’ approach, taking into account each patient’s individual needs,” she says. For many people, finding the right treatment plan is a matter of trial and error. Two years ago, Fesler-Young had an outbreak that caused her whole face to swell up for a week. “It was scary and motivated me to do something different,” she says, noting that the incident led her to make a strong commitment to lifestyle changes, which helped her to manage the stress. Eating nutritiously, practicing yoga, and maintaining a positive outlook through mindfulness have all been helpful. “My skin is improving, I feel more content, I am building my confidence and I’ve got a new lease on life,” she says.

Keep reading for ways to keep your own stress in check while also improving your skin.

Practice mindfulness   

There’s a reason this tip comes first: “Incorporating mindfulness techniques into your daily routine is the number one priority,” says Dr. Jhaveri. “Studies have shown the more people practice mindfulness, the less likely they are to have a spike in inflammatory markers and cortisol when they are confronted with something stressful.” That may translate to a positive effect on the skin. Dr. Jhaveri encourages her patients to try meditation as well as simple breathing exercises. “Find something that works for you, that brings you joy and do it regularly — even if it’s just for five minutes a day.”

 Choose the right exercise for you

Exercise may not be the first thing that comes to mind when you’re stressed, but the benefits of movement (even in small doses) may help bring calm to you and your skin. Of course, “the exercise you should do depends on your specific skin condition,” says Dr. Jhaveri, who suggests walking and yoga. Often, people with eczema don’t respond well to activities that involve sweating a lot, like hot yoga or spinning, because they can lead to flare-ups.

Listening to your body and making adjustments is key. Nathan Jetter, a dermatology resident at the University of Illinois in Chicago who has been dealing with eczema all his life, is a big fan of exercise to reduce his stress. But he has had to find ways to modify his routine. “I used to play tennis, but being out in the heat of the sun could exacerbate the eczema. So now I work out in air-conditioned gyms,” he says.

Find your (skin) tribe

“I started an Instagram account, posting pictures and stories, to connect with others going through this condition,” says Fesler-Young, who is involved in the National Eczema Association (N.E.A.) and attended their Eczema Expo, a multi-day gathering for the eczema community. “Forming friendships with people who share similar struggles has been a huge source of emotional support for me.”

Jetter also sees the value of seeking out connections with other people managing skin conditions. “It can be lonely having eczema. Sometimes there’s a sense of isolation for me, and meeting other people who have gone through the same experience has given me a great sense of community, which is beneficial in lots of ways.”

Make sure your doctor is an ally

Having a skin condition may be a lot less stressful if you have a doctor you trust who can cater your treatment plan to your individual needs. Jetter has managed his eczema with a range of treatments including topical steroids, bleach baths, and phototherapy, a technique which involves shining specific wavelengths of sunlight onto the skin.Dr. Jhaveri isn’t afraid to look outside of the drugstore for remedies that can help her patients. In addition to prescription medicine, she has seen people benefit from things like acupunctureAyurvedic medicine, as well as from certain vitamin supplements and oral probiotics. “My main goal is for people to get as much control of their skin condition as possible, to manage stress and establish a good maintenance regime,” she says. “Most people are able to do that. It’s about setting goals and finding the right combination of treatment and support that works for you.”

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