How Stress Affects Skin

We all experience various stress levels in our daily life. Busy work schedules, deadlines, taking care of loved ones and keeping pace with the daily routine are just some of the stress factors that can, sometimes, overwhelm us. Chronic mental, physical, or emotional stress can have a series of consequences on our overall health and may lead to heart disease, worsening of neurological problems, weakened immune system, migraines and depression, to name a few. Further, chronic stress can have a severe and even irreversible impact on our skin. Here is why and how stress affects our skin: 

Why does stress affect our skin?

The stress response is regulated through a system called the hypothalamic-pituitary-adrenal axis. This path is triggered by stress and starts in our brain by producing a series of hormones that further stimulate glands in our body to secrete glucocorticoids, including cortisol and epinephrine (adrenaline). These hormones are secreted so that our body can adapt and survive stressful situations of all types.

Cortisol is one of the most important stress hormones impacting skin health. Normally, during the day, cortisol level is regulated by our internal clock, or the circadian system, peaking in the early morning and decreasing at the lowest point at midnight. During stressful situations, this regulating system is disrupted, resulting in oscillating and high cortisol levels.

Moreover, the skin is the first sensing organ to interact with external stress factors such as intense heat or cold, pain and tension. As such, the skin has its own built-in stress response system, equipped with specialized cells that can produce a series of chemicals and hormones in response to stress factors.

Chronic stress can evolve with inadequate adaptation response and excess hormone secretion, leading to a series of unwanted and, in some cases, irreversible skin changes [Chen, Ying, and John Lyga 2014, Chen, Ying, et al. 2015, Orion, Edith, and Ronni Wolf ].

 

Some of the most frequent skin conditions that can be triggered or aggravated by stress include:

 

Acne:

- Cortisol excess weakens the immune system allowing pathogenic bacteria on our skin to multiply and cause moderate to severe acne;

- Stress hormones stimulate sebum production, which can clog pores, create a favorable environment for pathogenic microorganisms. This process makes the skin on the face, upper chest and back, which is denser in sebaceous glands, more prone to breakouts;

- Increased stress hormone levels promote inflammatory processes at the skin level and stimulate hyper-keratinization or thickening of the skin.

 

Atopic dermatitis:

- Impaired immune system response, often encountered in chronic stress, can contribute to the occurrence or aggravation of atopic dermatitis;

- Stress can disrupt the skin permeability barrier and homeostasis, making it more sensitive to allergens and bacteria, more prone to excess water loss, dehydration and pruritus;

- During stress, specialized skin cells can secrete local enzymes that act as mediators of inflammation and triggers of allergic reactions.

 

Psoriasis:

- People who have psoriasis suffer from the stress of living with this condition, and, at the same time, psoriatic lesions are aggravated by stress;

- Disruptions in skin healthy lipidic barrier and permeability can lead to flaky or dry skin, altered lipidic composition and triggering of psoriasis lesions [Evers, A.W.M., et al.].

 

Alopecia areata:

Also known as non-scarring hair loss, this condition can occur due to autoimmunity and genetic predisposition, but it is also often diagnosed in people suffering from chronic stress. While the exact causes for this skin condition are unknown, stress hormones, particularly glucocorticoids, can cause hair loss and delayed hair regrowth. 

 

Pruritus and erythema

Skin itchiness and redness occur due to the enzymes and hormones released during chronic stress, depleting the skin from its protective lipidic barrier, exacerbating dehydration, and promoting inflammation.

 

Other effects of chronic stress on skin:

Wrinkle formation:

- In the long term, glucocorticoids can cause skin thinning and atrophy, impact cell renewal, lead to a higher predisposition to injuries, collagen loss, and premature skin aging;

- Wrinkle formation is also promoted by a higher transepidermal water loss, lower water retention, impaired barrier function, exfoliation and a decrease in lipid molecules, also known as ceramides found in cell membranes;

- Stress can and decrease lipid synthesis, making wrinkles more evident.

 

Impaired wound healing:

- Wound healing requires a series of processes that include mediation of inflammatory processes, protection against infection, production of new cells and remodeling of the wound. Stress hormones make the skin more vulnerable to infection because of the decreased immune response. Also, high cortisol levels stimulate local inflammation and interfere with the production of new healthy repairing cells [Chen, Ying, and John Lyga 2014, Chen, Ying, et al. 2015, Orion, Edith, and Ronni Wolf].

 

Ways to ease the effects of chronic stress on skin: 

- Avoid exposure to direct sunlight without high SPF sunscreen. Exposure to UV lights is perceived as stress by our brain and can increase stress hormones, further promoting skin aging. This process is called "photoaging," or aging caused by UV light;

- Quitting smoking can significantly help prevent wrinkle formation and premature aging. Cigarette smoke is also perceived as a stress factor by our body and can decrease skin oxygenation and increase skin temperature. Further, lack of tissue oxygen interferes with cellular renewal and contributes directly to wrinkle formation;

- Leading an active lifestyle can efficiently reduce stress hormones, reduce physical and even emotional tension, improve skin oxygenation and strengthen the immune system;

- Eat a healthy diet to prevent and keep inflammatory processes under control;

- Avoid excess alcohol consumption as it can increase anxiety and emotional stress;

- Daily relaxation exercises and meditation can help you keep your mind off the daily hazard and manage stressful situations more efficiently. 

People suffering from chronic stress and skin conditions, either pre-existent or secondary to stress hormones, enter a vicious cycle often difficult to break. Stress hormones aggravate skin conditions and skin conditions make people self-contious, leading to chronic stress and impaired quality of life [Prie, Beatrice, et al., Green, Liz.].

What you need to know is that trying to avoid stress altogether is impossible. Instead, make sure you eat a healthy diet, have enough physical activity and make daily time for yourself to meditate and reflect, even if it is just for five minutes.

 

REFERENCES:

Chen, Ying, and John Lyga. "Brain-Skin Connection: Stress, Inflammation and Skin Aging." Inflammation & Allergy-Drug Targets, vol. 13, no. 3, 2014, pp. 177–190., doi:10.2174/1871528113666140522104422.

Chen, Ying, et al. "Brain-Skin Connection: Impact of Psychological Stress on Skin." Textbook of Aging Skin, 2015, pp. 1–22., doi:10.1007/978-3-642-27814-3_153-1.

Evers, A.W.M., et al. "How Stress Gets Under the Skin: Cortisol and Stress Reactivity in Psoriasis." British Journal of Dermatology, vol. 163, no. 5, 2010, pp. 986–991., doi:10.1111/j.1365-2133.2010.09984.x.

Green, Liz. "The Effect of Skin Conditions on Patients' QoL." Nursing Standard, vol. 25, no. 9, 2010, pp. 48–56., doi:10.7748/ns.25.9.48.s52.

Orion, Edith, and Ronni Wolf. "Psychological Factors in Skin Diseases: Stress and Skin: Facts and Controversies." Clinics in Dermat, vol. 31, no. 6, 2013, pp. 707–711., doi:10.1016/j.clindermatol.2013.05.006.

Prie, Beatrice, et al. "Oxidative stress and alopecia areata." Journal of Medicine and Life, vol. 8, 2015, pp. 43-46., PMID: 26361510; PMCID: PMC4564047.

Saif, Ghada A., et al. "Association of Psychological Stress with Skin Symptoms among Medical Students." Saudi Medical Journal, vol. 39, no. 1, 2018, pp. 59–66., doi:10.15537/smj.2018.1.21231.