Model Cara Delevingne has said she may quit the catwalk after suffering stress induced psoriasis at Paris Fashion Week, which made her legs break out in itchy red patches. Now experts recognize the huge role stress plays in skin conditions such as psoriasis, eczema and acne and recommend soul therapy alongside medical help
You’ve probably known for years that stress makes your pimples or eczema worse, but convincing your doctor may have been a different story. Not anymore, thanks to a growing area of medicine called ‘psychodermatology’. Dermatologists now work together with psychiatrists and psychologists to soothe skin problems and the stress issues that may be exacerbating them. In fact, recently the American Association of Dermatology said ‘traditional dermatologic therapies should be used in conjunction with stress management therapies to treat stress-related skin conditions.’
According to dermatologist Dr Nicholas Lowe, of London’s Cranley Clinic, ‘The stress connection has been proven in the group of skin diseases that dermatologists refer as ‘the big three’ – acne, eczema and psoriasis,’ he says. ‘Patients I see who get the best response from medical treatments are those who deal with the key stressors in their lives at the same time.’
‘We don’t know which comes first, the stress or the skin problem,’ says Dr Anthony Bewley, consultant dermatologist at Bart’s and the London NHS Hospital and co-chair of the expert group, Psychodermatology UK. ‘There is probably a cycle that forms where stressful events lead to skin problems such as eczema, psoriasis or acne, having the condition is stressful and that exacerbates it further.’ It’s believed between 30 and 60 per cent of people who have been referred to hospitals for skin conditions have emotional factors affecting their skin’. Here are three skin conditions aggravated by stress:
It affects one in 50 people and for three quarters, it will start before their 40th birthdays, most commonly women like Cara Delevingne in their early 20s. Unlike eczema though, psoriasis is not an allergic reaction but a disorder of the immune system. Though it’s usually inherited from parents, the very first attack which can involve severe skin thickening, scaling and flaking, is almost always triggered by either a throat infection or a stressful event. ‘The most common exacerbator for psoriasis is stress,’ says Dr Chris Griffiths, Professor of Dermatology at the University of Manchester and a world authority on psoriasis. ‘In people who have the genetic susceptibility, we find a big, stressful event usually brings on the first episode and subsequent stress and pressure may trigger subsequent attacks.’
Over the Counter Help Mild topical steroid creams such as Eumovate from the pharmacy could help if the disease is mild, says Professor Griffiths. ‘As soap can dry the skin and make flaking worse, emollient washes and unperfumed moisturisers such as those from E45 can keep it moisturized,’ he says.
Medical Help ‘People often get told by their GPs that nothing can be done for psoriasis,’ says Professor Griffiths. ‘But in the last few years treatments have improved dramatically and some, such as a new group of injectable drugs called ‘biologics’ for severe psoriasis, are revolutionizing patients’ lives.’ For mild or moderate psoriasis your doctor or specialist can prescribe Vitamin D containing ointments and creams as well as light therapy known as Narrow Band UVB, always done in a controlled hospital environment. ‘Though there is still no cure for psoriasis, we have more than ever to keep it under control,’ says Professor Griffiths.
Stress Solution Studies looking at the brain/skin axis – that’s how stress levels affect the surface of the skin – have found through brain scans that the way people with psoriasis process stress could be different to those without the disease. ‘We know that CBT, when it’s used in conjunction with treatments such as prescription creams and light therapies, can help people with psoriasis deal with stress in less damaging ways and make treatment more effective than the medical option on its own,’ says Professor Griffiths. Meanwhile, researchers at the University of Massachusetts Medical School found patients listening to meditation tapes while receiving their UVB therapy saw their skin clear up four times faster than those that had the light treatment alone. ‘Alcohol and smoking are known to exacerbate psoriasis too,’ says Professor Griffiths. ‘If you use these as stress crutches, try and seek help to stop or cut down’.
‘In the last three years there has been an increase in acne in women in their 20s, 30s and 40s,’ says Dr Samantha Hunt, consultant dermatologist and Medical Director of Sk:n Clinic, Portsmouth. ‘The main theory is that more women than ever are in stressful jobs and it’s affecting their skin.’ All acne is triggered by an excess of male or ‘androgenic’ hormones that over-stimulate skin’s oil glands causing it to become blocked and inflamed. ‘Stress causes an over-production of the hormone cortisol,’ says Dr Lowe. ‘That leads to increased androgens, oil production and acne. Controlling stress is a key step in controlling spots.’
Over the counter help ‘Look for cleansers and spot gels containing salicylic acid, which helps dry pimples,’ says Dr Lowe. ‘Don’t be afraid to dab spot gels on up to five times a day at the first sign of a spot.’
Medical Help ‘Topical and oral antibiotics taken for up to six months and certain contraceptives pills (such as Yasmin) can help clear acne,’ says Dr Lowe. ‘We can also prescribe Vitamin A creams to treat both wrinkles and spots.’ If that fails, a dermatologist may put you on a course of Roaccutane. ‘We now use lower doses which minimize side effects people may have read about such as mood changes, hair loss and dry skin,’ says Dr Lowe. Therapies such as Intense Pulsed Light (IPL) therapy and new coloured light laser treatment (one type is called Isolaz from Sk:n Clinics nationwide) can help with surface spots.
Stress Solution Talk to your GP about a course of Cognitive Behavioural Therapy (CBT) which can help you deal with stress-causing thought patterns or compulsive picking – you may be entitled to it through the NHS. Or try Biofeedback therapy, in which you systematically learn to relax by observing your body’s physical responses. A study published in the Journal of Psychosomatic Research found that 12 sessions over six weeks significantly reduced acne.
There are many types of eczema (also called dermatitis) which refers to allergic, inflamed skin causing redness, chronic itching, blistering and flaking. ‘While typical triggers include wool against the skin, harsh soaps, perfumes and allergies to certain metals, feeling stressed or overtired can play a key part in flare-ups’, says Professor Hywel Williams, Director of the Centre for Evidence-Based Dermatology and a leading authority on eczema.
Over the counter Replace harsh soaps with emollient washes and if the skin is dry make sure you use moisturizer – lots of it. ‘Alternatively, you can use your moisturizer as soap in the shower,’ says Dr Williams. ‘Aqueous creams, or those made by Aveno, Cetraben, Hydromol or Diprobase are effective for eczema. If gardening or hot and cold weather bring on hand flare-ups, use a barrier cream on the hands such as white soft paraffin,’ says Professor Williams.
Medical Help ‘GPs often trivialize eczema but there is plenty that we can do,’ he says. ‘If he/she is not taking your problem seriously, even if it’s mild, when the eczema is affecting your quality of life you can ask for a referral to a dermatologist who can prescribe topical steroid creams to be used in the right strength and for the right period of time. 95 per cent of eczema can be controlled through clear advice on how to use treatments, good support and recognizing triggers,’ advises Professor Williams. ‘For the other five per cent, there are new topical creams that can help with severe cases.’
Stress Solution ‘Keep a diary to help you record the feelings and pressures that might lead to flare-ups,’ suggests Professor Williams. ‘This can help you identify whether stress or over-tiredness is one of your triggers.’ According to Professor Williams, there is some evidence showing that regular massage therapy can help control the symptoms of eczema. If chronic itching is making your eczema worse, a therapy called Habit Reversal Training is being successfully used in psychodermatology clinics across the country. ‘Habit Reversal Training helps patients realize how much they’re scratching and teaches them how to break the habit over time,’ says Dr Christopher Bridgett, a consultant psychiatrist at London’s Chelsea and Westminster Hospital who has worked in dermatology for 20 years and practices the therapy on patients in his private clinic. ‘Used alongside medical treatment, patients’ eczema often clears completely,’ he says.
How your doc can help ‘In the past, most doctors’ priority in treating skin problems has been dealing with the surface problem alone,’ says Dr Bewley. ‘Now psychodermatology and the impact of stress on skin is being recognized by more and more GPs,’ he asserts. ‘But still, many people get told things like ‘oh it’s just your skin.’ Patients should never put up with their condition being trivialized.’ All GPs have access to talk therapies such as CBT which they can prescribe alongside medical treatment.
How about a specialist? ‘There are a small number of psychodermatology clinics throughout the UK,’ says Dr Bewley. Your GP can also refer you to a dermatologist who may advise you on seeking the appropriate form of stress reduction or therapy for your skin problem. Or you can find a dermatologist through the British Association of Dermatologists bad.org.uk
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