Stress is a well-known trigger and aggravator of eczema - a chronic condition with damaged, inflamed, and itchy skin. While most cases occur in childhood (10-20% of the world population), for some people it can persist into adulthood (2-3%). While genetics have a role to play, environmental factors such as psychological stress are involved in several pathways that exacerbate eczema. We highlight some of these here, before considering what you can do to eliminate stress.
Pathways of stress
We can group the effects of stress into three interlinked pathways:
- Changes in the nervous system.
- Changes in the immune system.
- Breakdown of skin barriers.
These are all interlinked because the shift in the balance of chemicals within each pathway has effects on all the other pathways as well.
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Altered activity of the nervous system
When we feel stressed, cortisol - ‘the stress hormone’ - is released by the adrenal glands. This, combined with the release of other chemicals such as serotonin (‘the happy hormone’) and adrenaline, diverts the immune system away from fighting specific cells to producing antibodies. IgE is an antibody that is involved in many eczema patients.
The IgE antibody is also activated when you scratch the skin. Sensory nerves near the skin activate cells coated in IgE, which can cause inflammation, redness and swelling. This also causes chemical signals to be sent to other nerves too, which increases the inflammation. Eczema is often very itchy, but scratching an itch does damage and trigger the nerves which can lead to even more itchiness! Therefore, it is important to try to break the itch-scratch cycle.
Altered activity of the immune system
In the previous paragraphs, we have touched on how the immune system is involved in stress and eczema. There are many more studies that support this. IgE and eosinophils involved in blood-based immunity are higher in eczema sufferers. Greater stress in pregnancy is associated with higher rates of eczema in children.
We also discussed that serotonin is involved. Immune cells in eczema have more receptors to serotonin. The action of serotonin is interesting however, in that locally at the skin it can induce itch however deep in the nervous system it can act as an antidepressant and anti-anxiety molecule thereby reducing the desire to itch overall. SSRI drugs that increase serotonin in the central nervous system like paroxetine, sertraline and fluoxetine improve itchiness.
Breakdown of skin barriers
Hormones such as cortisol lead to the breakdown of skin and make it easier for infections to occur. This is partly due to damage to fat-based molecules in the skin, so simply using fat-based emollient creams can decrease the severity of eczema.
With skin being the largest organ of the human body it is important we take care of it. In addition to moisturizing the skin and avoiding abrasion, we need to see the bigger picture. We need to set our minds to be calmer and more resilient. This way our body can avoid being in overdrive and avoid skin conditions flaring up.
In order to reduce stress, practice some following tips:
Identify your personal triggers of stress
- The first way to solve an issue is to recognize where things are going wrong.
Organize your time to avoid stresses
- Giving your day more structure can relieve the burden of stress, knowing you are sticking to planned goals.
Try to make changes in your life to reduce stress
- Lifestyle changes can include relaxation techniques, hobbies and practicing mindfulness to stay in the present.
- Psychological interventions like cognitive behavioral therapy can be a powerful way to reduce stress and sympathetic activation.
- Make time for friends and have a regular-work life balance. This way you will feel supported and give yourself time to recover.
Improve your physical health
- Get good sleep regularly.
- Exercise and eat healthily.
Psychology, immunology and skin diseases are ultimately tied together such that stress worsens eczema. While research is out there hunting the specific molecular processes behind why and potential drugs to target these processes, the best way to reduce eczema is to reduce stress in your life in the first place. There are many ways to do this and to become more resilient when faced with stress. Implement these tips gradually if you need to and do not be disheartened by setbacks.
From Medzino, here is to a healthier you.