Dealing with Stressed Skin: A Dermatologist’s Guide

Well, 2020 was quite the year - and 2021 continues to challenge us in many ways, too. It’s no wonder that many people are experiencing high levels of stress, which manifests in lots of different ways. One of the ways stress affects us is by taking a toll on the skin, but don’t worry - there are ways we can fight back!

How Does Stress Directly Affect the Skin?

The “brain-skin connection” is something that has been discussed for centuries going right back to Ancient Greek physicians and traditional Chinese medicine as well as Ayurvedic practitioners. For far too long in the Western medical tradition we have separated body and mind and treated them as separate entities, thus losing that vital intimate connection between mind and body, brain and skin.

The relatively new field of psychodermatology is something that is really going to take off in the coming years as we develop more of an interest in how our mental state and emotions can affect our skin and vice versa. This will help us to holistically manage our patients better.

Stress, which can be acute or chronic, can have a major impact on someone’s wellbeing, and can cause really detrimental changes to the structure and function of our skin. I would say that stress can be physical, mental, emotional or indeed environmental, and in some ways the skin’s response is not dependent on the type of stressor.

An individual’s precise definition of stress and also their tolerance or threshold for stress can be quite variable. You could imagine stress as water boiling in a pot. When the water boils over and spills out of the pot the person’s adaptive capability to cope has been breached and stress ensues. For some people there may be more temperature on the pot (increasing responsibility at work, for instance), some people may have more water in the pot to begin with (history of depression/anxiety, lots of kids to look after, low finances, etc). Some people have larger pots than others and may be more resilient, for instance due to training or personality types.

Once stress does kick in, it induces certain survival and defence mechanisms in what is known as a “fight or flight” stress response, releasing stress hormones which cause physiological responses such as changes in heart rate and breathing, as well as blood flow to the skin. Most people are already aware of how stress can affect their skin, especially if they already have an inflammatory skin condition such as eczema, psoriasis or acne, as stress can trigger a flare up or exacerbate an existing skin issue. In fact, a lot of my patients report to me that stress, such as exams during their teenage years, was the cause of their first ever flare of a skin condition.

What are the Effects of Stress on the Skin?

Skin has multiple layers and levels of macro and micro structure as well as a myriad of functions such as barrier function, sensory function, homeostasis and immune function. Stress responses of any type can really impact on all of these.

The impact of stress hormones such as cortisol can depress your immune system and trigger an increased state of inflammation which makes it more likely that you will have a flare up. Cortisol can also cause increased activity of sebaceous glands in your skin, which results in an increase in production of sebum which can clog pores, cause spots, exacerbate acne, and cause an oily scalp and hair.

Stress can impact your immune system and make you more prone to infections in general, so during these Covid-19 times it really is best to stay calm. Stress can make you more prone to skin infections as well as autoimmune conditions such as vitiligo where you get hypopigmented (lighter) patches of skin.

Stress can cause dry skin by increasing your transepidermal water loss (the amount of moisture you lose through your skin) and decreasing its ability to hold on to water. This can make your skin prone to cracking and fissuring which can be painful and impair your skin barrier function, making you more prone to local and systemic infection as well as allow irritants and allergens to penetrate more easily.

Stress can cause a flare up of seborrhoeic dermatitis which is caused by a common yeast infection on the skin. This results in red flaky skin particularly in the “T-Zone” of the face and the scalp and hairline. Stress hormones can also really impair how well your skin heals as well as cause your nails to become brittle or to peel easily.

Another effect of stress hormones is adrenergic urticaria, where you get itchy bumps, hives, and even blisters. These stress hormone chemical triggers can cause your skin to become more sensitive and easily irritated so you may start to notice random rashes, breakouts and itching.

In addition to this, stress can cause fine lines and wrinkles to appear or worsen. This is due to stress hormones such as cortisol causing the breakdown of proteins such as collagen and elastin in the dermis layer (deeper layer) of your skin. Collagen provides the scaffolding in your skin giving it structure, support and strength as well as a degree of flexibility; it allows other skin components something to hold on to for their function and stability. Collagen gives skin its youthful firmness and bounce, while elastin provides the rubber band qualities of elastic rebound and springiness that you see in young skin as well. Combine this destruction with the inflammation caused by stress including oxidative stress and it can really accelerate skin aging and the formation of lines and wrinkles as well as hollow sunken eyes, dark circles, saggy eyes and jowls, irregular pigmentation - all of these are natural changes, but may be considered aesthetically unpleasant.

And it’s not just the skin that suffers - stress can also make your hair thin, dry and brittle; in more severe cases, it can cause your hair to fall out. This kind of hair loss is usually associated with a major life event such as loss or bereavement, and is called Telogen Effluvium. There is also recent evidence that the sympathetic nervous system drive from stress hormones can affect the pigment cells via stem cells in your hair making your hair lose its colour. So it’s true after all that stress makes you go grey!

The true picture of how stress affects the skin is going to be highly complicated and is currently not fully understood. It involves the close interaction of many organs and body systems, such as the skin, the brain, nervous system, multiple endocrine systems, the immune system, pharmacological factors, and the gut. For example one of the things stress can do is cause a “leaky gut” as well as disrupt the gut microbiome (bacteria and microbes) which might lead to skin problems. When all our systems are working in sync we are like a well oiled race car - but stress can cause us to break down into an old banger!

When is it Too Late to Treat Stressed Skin?

The good news is there is always time to deal with the physical symptoms of stressed skin - it’s never too late! However, please bear in mind that there may be an overlap with natural aging processes in terms of some of the symptoms.

It’s a tricky issue, as stress can be a difficult trigger to avoid completely. The best treatment is prevention, so I would suggest working out your risk for becoming chronically stressed and reducing this, if possible. In terms of acute stress, some studies suggest that some forms of acute stress can potentially even be positive. If you are briefly stressed about something you love doing, such as taking your child to their first day of school or playing a tennis match, this so-called “positive” stress may release oxytocin. This is actually the hormone that makes you fall in love, and it can act as a counterbalance against the effects of stress hormones such as cortisol.

If you are really concerned about your stress levels, please see your doctor to make sure you don’t have something such as an anxiety disorder. The same goes if you have real concerns about your skin. Cortisol in excess over time can cause thinning of the skin, and may be a sign that you have Cushing’s syndrome.

How to Treat Stressed Skin

Remember that long term or chronic stress in general is bad for many of your vital systems such as your cardiovascular system, your immune system and your mental health. Trying to remove the stressful situation or trigger(s) will help. Coping strategies can include exercise, music, spending time and talking with family and friends (thanks to the wonders of Facetime, Zoom, Skype and others!), exploring nature, taking up a new hobby, practising meditation or taking up mindfulness. You might want to consider counselling, Cognitive Behavioural Therapy (CBT), or Resilience training. Improving your sleep hygiene may be highly beneficial, too.

Try to stay away from coping mechanisms that may be harmful to you in the long run. This can include unhealthy eating, smoking, excess alcohol, illicit drugs, gambling, and excessive retail therapy. That’s not to say a little of something to take the edge off some stress and create a bit of respite is inherently bad - having that slice of cake, enjoying a glass of wine, or buying that jumper you’ve been coveting can all bring a little joy. Importantly, it is about staying positive and looking after your mental health.

Look out for habits that you might have got into. These are usually repetitive body movements such as hair pulling, scratching or picking your skin. These sort of habits activate “reward” centres in your brain and can be hard to get rid of.

From the skin point of view you should avoid too much sugary foods. Sugar can damage skin components such as collagen and can lead to signs of premature aging on the skin. When you are stressed it can be easy to forget about self care including skincare. Try to keep up with your regular skin care routines and simplify them if needed. This includes cleaning your skin with a gentle cleanser twice a day, and using any serums such as Vitamin C and retinol or bakuchiol, which features in the Maxerum serum.

You should moisturise well with something non-comedogenic, and use the best sun protection you can during the day. Check to make sure you are getting decent UVA protection as well as UVB protection. UVA levels are constant all year round and cannot be filtered by clouds and windows unlike UVB. They penetrate deeper into the skin and are the main cause of photodamage and photoaging, and also cause some skin cancers. UVB causes sunburn as well as most types of skin cancer.

If in doubt about that new mole or changes in an existing one, get it checked - better safe than sorry. Patients often apologise to me in the clinic if I tell them a skin lesion is benign, but I always tell them there is no need to be sorry, I am much happier to tell them it’s all fine as opposed to some people who are unfortunate enough to have developed skin cancer.

Sometimes stress can be a vicious cycle. Your existing skin condition, such as psoriasis, can make you stressed or even cause mental health issues. This in turn can make the skin worse, which can make your stress or mood worse and so it goes on. This can be serious, so we should take it seriously. Break the cycle. Seek help. Speak to your doctor who can help you or if they feel you need further input they can refer you appropriately to a dermatologist, a psychiatrist or for psychological counselling.

Can Collagen Help with Stressed Skin?

The skin is made up of two layers. The top layer - the epidermis - is mostly providing a barrier function. The bottom layer is called the dermis, and provides structure as well as containing organs and systems such as blood vessels, nerves, lymphatics, and immune cells.

Collagen is a large protein molecule and it is also what the bulk of the dermis is composed of. It is the scaffolding that provides strength and a support structure to your skin as well as a degree of flexural integrity. It is the structure of the skin that contains or allows other vital things to hold on to for support. In practical terms, it keeps your skin plump, bouncy and firm. Collagen levels decline from the age of 25 or so, and stress may accelerate this. This decrease is what leads to the classic signs of aging, including lines and wrinkles which can deepen over time.

Taking a high quality liquid collagen peptide such as Absolute Collagen will help to replenish collagen levels, helping counteract the effects of stress and aging on the skin. Marine collagen peptides are broken down molecules that are designed for maximum absorption in your gut without putting any extra strain on it. Once absorbed, they are then readily available for your body to utilise in making new collagen. It can take up to 12 weeks for the fibroblasts in your body to make new collagen, which is why it is recommended that you take collagen daily to keep your levels up.

The best way to take collagen is as a liquid collagen peptide supplement from a high grade marine source such as contained in Absolute Collagen. It is important to take it daily and to combine it with a good skincare routine. People take it in various ways - some add it to their breakfast, some add it to their shakes or drinks, and some take it straight from the sachet. Mixing it in with food or drink will not affect the benefits of it at all - which is why it’s so great, as it can fit in with your everyday lifestyle and routine. Personally, I prefer to take it last thing at night straight from the sachet. This means it doesn’t have to compete with anything else for absorption from my gut. Also, importantly, most collagen synthesis occurs when we are asleep. Absolute Collagen also contains Vitamin C, which is required for collagen synthesis.

In conclusion, stress can be very debilitating and detrimental to a person’s wellbeing including their skin. But crucially, there are steps you can take. I would like to say please look after yourselves and others if you can. Stay safe, be positive and try to keep happy - and please get in touch with myself or the team should need to.