The Importance of “Skinternal Care”
Stress has become so familiar it’s almost banal. But with the breakneck speed of life that many of us have now, is stress management a realistic goal? Doctors say it better be. One physician, Dr. Verallo-Rowell, a dermatologist-dermatopathologist who believes in a systemic approach to skin health — not just topical treatments and procedures but also nutrition, exercise, and stress management — points out that research into the ways stress affects the body shows more (and more systemic) repercussions from stress than we previously were aware of.
A longtime meditator, daily exerciser, and processed-food shunner, Dr. Verallo-Rowell, asserts that learning more about stress can help us better manage it. She emphasizes that the skin plays a major role in this project because A) It is a trigger for many conditions from atopic dermatitis to psoriasis; B) It can lead to inflammation which is linked to several skin and health concerns; and C) The skin is the one organ that can rapidly and visibly indicate that something might be wrong with our bodies internally. If your body is over-stressed, your skin may show the earliest warning signs. And if you heed them, you can potentially de-stress before further damage is done. She continues…
“The body’s largest organ is the skin. It too is the part of your body that can alert you — way before internal organs manifest disorders in a blood test, ultrasound, x-ray, or MRI — to a possible internal problem. Quite often, the skin serves as a direct indicator about what is happening inside us.
For instance, before blood sugar values are elevated, diabetes may show tiny distinctive scarred patches on the leg or small areas of numbness; a slow thyroid gland can be indicated by a form of skin thickening in various parts of the body; tiny red spots can signal inflammation of blood vessels both in the skin and in the body’s internal organs.
Similarly, stress-related changes in the skin and hair very visibly warn you that something inside could be off, too.
Stress breaches the skin’s barrier; slows recovery.
The outermost layers of your skin are tightly-packed epidermal cells that form a protective barrier. They permit certain active molecules in creams, like those used to treat rashes, acne, or signs of aging to enter, while resisting the entry of bacteria and other disease-causing organisms. This barrier also prevents the exit of water, to keep the skin nicely hydrated and soft to the touch.
One study tested 27 medical, dental, and pharmacy students during periods of high stress (final exams) versus low stress (after winter vacation, after spring break), for their responses to repeated cellophane tape strippings on the skin of the arms (a well-known, minimally invasive method to test the integrity of the barrier function of the skin). A device measured the amount of water lost from the skin, at base line, during repeated tape strippings, and afterwards.
Result: it took longer for the skin to recover from the strippings during periods of higher stress than during less stressful periods.
What does this mean? When your skin’s barrier function is breached — from any injury, such as sunburn, insect bites at the golf course, a strong laundry soap, an irritating cosmetic — recovery is slowed down. Water loss, skin dryness, itchy, dry skin, and/or rashes appear, and skin problems like psoriasis, eczema, acne, seborrheic or contact dermatitis, rosacea and urticarias are aggravated.
Worse, microorganisms can more readily enter the skin leading to recurrent boils and other skin infections. Along with these problems, stress further affects immune cells negatively which can cause flare-ups of immunity-related skin infections, such as cold sores, viral warts, and even shingles.
Stress, Cortisol + Acne
Cortisol, the body’s own steroid, has many internal effects including high blood pressure, diabetes, and weight gain. In the skin, cortisol causes an increase in sebaceous gland production of sebum, which can lead to oily skin and plugging of the follicular pores, then to acne and related skin problems. Even patients without oily skin who are not acne prone tend to develop acne during stress-triggered cortisol-sebum production. In a study done at Stanford University among 22 college students during final-exam week, those more highly stressed by their exams had worse acne than calmer, less stressed students.
Stress is one of the causes of the emergence of more cases of adult acne (beyond the teenage period, and even into the 40s and 50s) that dermatologists now see.
Stress tics: self-inflicted damage
Patients under stress sometimes have nail and hair problems that they themselves may be causing. This self-inflicted damage is often induced by stress-relieving habits or tics. Most cases are simple enough to recognize. Once the association is pointed out to the patient, stopping the habit clears the problem.
What to look for: habitually picked-at skin showing wounds, gouging, excoriations and thickening;
• hair-pulling that results in a scalp with different hair lengths;
• nail defects or infections from damaging the cuticles.
Stress + shedding hair
Telogen effluvium is a form of hair shedding that is very common during periods of high stress. Fortunately, it is temporary and does not generally lead to baldness. But during the time it is happening — usually lasting 2 months or so -— it can be scary. The forms of stress that initiate telogen effluvium are varied, including:
• stress from birthing
• a fever of any kind (flu, dengue, typhoid, a urinary tract infection)
• the stopping of birth control medicines
• some chemotherapy and other physically taxing treatments
• rapid weight loss from dieting
• strenuous exercise.
Scalp hairs respond to this stress by rapidly going from the growth phase (which about 85% of scalp hairs are usually in), to the resting or telogen phase, which usually lasts 2-3 months before going into the growth phase again. Telogen hairs are not well rooted into the scalp so they normally fall out a little at a time. The condition becomes much more noticeable when the hairs accelerated into telogen by the stress begin to grow again 2-3 months later. The hair shedding can be so noticeable as to make a person feel that baldness is imminent.
What to expect? Hair recovery is first noticed when fewer hairs are shed, followed by the appearance of short hairs. A full head of hair is in place after about 6 months. This is the usual time frame for the process of hair growth recovery in acute telogen effluvium. But if the stress is retained or additional stress occurs, a chronic form of telogen hair shedding and thinning can continue, and in time, may even lead into the inherited form of male type pattern hair loss (in those with this genetic trait of baldness).
Sleep deprivation + obesity
Cutting back on sleep is a common response to the time pressures of modern societies. The average night’s sleep decreased from about 9 hours in 1910 to about 7.5 hours in 1975, a trend that continues today. Millions of shift workers average less than 5 hours per workday. In the United States, the average sleep hours for adults per night have changed in the past 4 decades. In 1960, US adults averaged 8.5 sleep hours per night versus 7 sleep hours per night in 2002. In 1960, only 15.6% of young adults slept less than 7 hours versus 37.1% in 2002.
Why is this important? Because of what happens during sleep.
After sleep deprivation (4 hours of sleep), profound alterations of endocrine and hormonal body functions occur, some resembling type-2 diabetes mellitus. Some subjects took 40% longer than normal to regulate blood sugar levels after a high carbohydrate meal. Some showed a decrease in their Glucose Tolerance Test (GTT) and in their ability (by about 30%) to secrete insulin in morning tests.
Studies show that for normal body functions to fully recover following 4 hours of sleep deprivation, it needs not just 8 hours, but 12 hours of sleep.
As well, lack of sleep makes you hungry. Sleeping for just 4 hours results in an increase in the level of the hormone ghrelin (which increases appetite) over leptin (which makes you feel full).
Furthermore, studies show that our food choices get worse with sleep deprivation. After two nights of curtailed sleep the volunteers found foods such as candy, cookies, salty foods such as chips and nuts, and starchy foods such as bread, pasta, and cake, far more appealing. The desire for fruit,, vegetables, or dairy products increased far less. Why is this so? The brain, which is fueled by glucose, seeks simple carbohydrates when distressed by lack of sleep. The difficulty of making decisions while sleepy also weakens the motivation to push away the donuts in favor of more nutritious foods. Thus, people who sleep less are more likely to be overweight. One recent study found that those who reported less than 4 hours of sleep a night were 73% more likely to be obese. Note that in 1960, 1 in 4 adults was overweight; 1 in 9 was obese. Now, 2 out of 3 adults are overweight and nearly 1 out of 3 is obese.
These studies on stress from chronic sleep debt have now helped make the biochemical connection with the current trend towards obesity, hypertension, diabetes, even memory loss, and aging.
Stress, comorbitidies, and aging
“Comorbidities” is a relatively new term that refers to the presence of multiple diseases or disorders occurring together with a primary disease. For instance, patients with psoriasis (the primary disease) often develop diabetes, obesity, arthritis, and hypertension (the comorbid diseases). While these conditions are apparently unrelated, studies show that they have a common pathogenetic pathway, by which they are now thought to be inter-related.
One such pathway is stress. For years, dermatologists have anecdotally known that stress adversely affects the normal functions of the skin and aggravates such conditions as acne and other chronic skin diseases. From just the few studies mentioned above, we now know: first, that stress involves the stressor stimulus and stress perception by our brain. Second, there is such a thing as beneficial acute stress which warns us and helps us orchestrate physiologic responses for fight or flight. In this process, the skin is important as a first-organ system target, where white blood cells “traffic” (are re-distributed in large numbers) to increase immune surveillance and enhance immune function upon antigenic attack). Third, that, on the other hand, chronic stress can be harmful because it suppresses immune responses.
How to be in control:
Watch out for indicators of high stress levels: recurring skin lesions, infections, new itchy and dry skin rashes, persistently recurrent adult acne. If you start having hair and nail problems, accept that the damage could be self-inflicted (see a dermatologist for confirmation). Also remember that hair shedding is not due to shampoos, conditioners, or hair styling products but generally has an internal cause — with stress being one of the major ones.
How to chill out:
If you’re seeing any of these markers, start looking for the primary causes of your stress and commit to addressing them. Ask for more help from others. Delegate more work. Create alliances, re-connect with friends, see a therapist, join support groups, or take a stress-management class. Practice relaxation techniques such as daily meditation, prayer, or even just quiet time with a good book or music appreciation. Play with the kids (a 2-year-old toddling in can do wonders for one’s mood) or pets (studies show that time with animals can also relieve stress). Exercise regularly to help increase endorphin levels. Focus on a healthier, balanced diet with less processed foods (they’ve been shown to increase depressive tendencies). Sleep more: a minimum of 8 hours a night — your skin, body, and mind really need it.
The cause(s) of the stress may not disappear fast enough, or at all. But by developing effective coping mechanisms that efficiently help you relieve stress, you remain in control and can help your body (internally and externally) better regulate its health and its appearance.”
How Can VMV Help?
Articles contributed by doctors cannot contain product recommendations for ethical reasons, and VMV HYPOALLERGENICS® believes in protecting the skintegrity of our resource physicians. Below are some products that we at Skintelligencenter.com feel can be recommended based on the preceding article. They are our “skinformed” selections based on the information given above and not necessarily recommended by the medical author of the article.
Safer products reduce the risk of stress and injuries to the skin — like acne, rashes, irritations, dryness, inflammations, etc.. Concentrate on de-stressing and getting enough sleep. Then let products that are safer — based on their lack of allergens and irritants — take care of de-stressing your skin.An M.D.
Article Contribution. At Skintelligencenter.com, we include articles contributed by doctors who wish to provide helpful information to their patients and the public at large, or who respond to our requests to use them as professional resources. Doctors may or may not prefer to remain anonymous and we respect this preference. These resource articles do not in any way imply an endorsement by the physician of Skintelligencenter or VMV HYPOALLERGENICS®—they are intended for informational purposes only. While written by or with resource professionals, these articles should not be relied on for diagnostic accuracy or applicability to your particular skin, which requires an in-person ocular consultation with a qualified physician. For appropriate care for your skin, please consult your dermatologist.