Can our skin and hair reflect the stress that we’re feeling? Are there any skin disorders which can reveal deep-rooted psychological anxieties and adjustment disorders? Learn more about skin ailments caused by or aggravated by stress.
There are a host of skin, hair and nail conditions- some major and some minor- which are either caused by stress or made worse by stress. A patient once told me “Oh come on Doc, when you guys don’t know the cause of a disease, you blame it on stress!” But jokes apart, certain skin ailments provide a clue to your secret anxieties, resentments and self-doubts.
Take dandruff and acne (pimples) for instance. There is a common misconception that dandruff causes acne. That’s not really true. However, both conditions have several commonalities. Both are caused by hormonal fluctuations and excessive sebum (oil) production on the skin. And they are both aggravated during stressful situations. There is nothing worse than a girl wanting to look her best on her wedding day but discovering a pimple on her big day simply because she was too anxious about getting a pimple!
Eczema is closely related to anxiety too. Eczema is a broad term for an exceedingly common allergic skin disorder and it appears in several different forms. It is typically aggravated in winters and yes, by stress. In fact textbooks have even come up with a description for an “eczema personality”. Long term eczema suffers are known to be more intelligent, timid, suspicious, anxious, depressive, have a conflicted relationship with their mothers, and show higher interests in power and social influence with less interest in money and affiliation. Having observed eczema patients for several years now, I would say that this description hits the nail straight on the head.
Hives and allergic wheals are red swollen raised areas on the skin which are intensely itchy and last for a few hours. Stress is one among a dozen different triggers which can set them off.
Alopecia Areata is a condition where one notices one or more bald patches on the scalp or any hair-bearing part of the body like the beard area. These patches are smooth and do not itch or burn. Most of the time, the hair regrows spontaneously without any treatment. And almost every patient can recall a stressful episode in his/her recent past.
Cold sores (also known as fever blisters) are painful and itchy blisters which occur periodically on the lip. Although they are worsened by anxiety, they also occur following fever, menstruation, respiratory infections or sun burns. They can be treated effectively with anti-viral medications, however the virus tends to linger in the body for several years in a latent state. Painful mouth ulcers are also linked to anxiety along with Vitamin B12 deficiency. Some of us respond to stress by sweating profusely, especially from the pits, palms and soles. Excessive sweating in turn causes a multitude of other skin ailments.
Some of us respond to stress by turning into skin pickers or nail biters. Picking or squeezing your zits is counter-productive. It does not make the pimple go away, and you will be left with ugly marks and scars which are hard to treat. Compulsive picking and pinching of the skin is a psychological disorder known as Dermatillomania, which is frequently misunderstood. Trichotillomania is a psychological disorder marked by compulsive hair pulling. These disorders generally afflict those with borderline personalities, who are unable to control themselves, and feel a great sense of relief when they pick at their skin. But the marks and scars leave them feeling ashamed and self-conscious. The guilt further aggravates their skin picking tendencies. A small subset of skin pickers complain of hallucinations or delusions where they see or believe that there are insects crawling underneath their skin. This is a severe psychosis which requires psychiatric attention. Drug abuse and certain medical conditions like Porphyrias can also bring on such hallucinations. A vigilant dermatologist can identify your correct diagnosis, and can refer you to a psychiatrist and behavioral therapist for treatment.
Hang nails are little slivers of torn skin by the sides of the nails. These are generally caused by dry skin or excessive washing, but made worse by biting or pulling. Snip it with a cuticle cutter, apply hand creams generously and do not pick on them, or they’ll get painful and infected.
Certain common ailments like hair loss, psoriasis and vitiligo (leukoderma) are also aggravated by stress. The irony is that the presence of a skin ailment itself causes stress due to social embarrassment, and this turns into a vicious cycle.
I have seen a number of patients who complain of non-specific itching, usually localized to one part of the body, like the legs or back of the neck. They do not have any specific skin ailment, and their skin only shows evidence of non-stop itching- like cuts, scratches and mild thickening of the skin. On further questioning, these patients admit to stress and an uncontrollable urge to itch when they’re feeling anxious. This condition is known as neurodermatitis. The treatment includes anti-depressants and anti-histamine medications to break the itch-scratch-itch cycle.
Why does stress have this effect on us? Our body responds to stress by releasing powerful hormones into our bloodstream. These hormones are meant to help our body cope with the stress, by increasing mental and physical alertness. However, hormones like cortisol (steroids), testosterone, adrenaline, insulin and thyroxine can play havoc on our skin and hair. When stress continues for a prolonged period of time, these hormones can alter the way our immune system works. Stressful events can also trigger an autoimmune process, where the immune cells of our body start attacking our own tissue. These immune cells are important to us as they fight against foreign invasion like infections and cancers. Stress can cause these cells to ‘misfire’ and start attacking our own skin and hair. Besides, a lot of nerve endings are connected to the skin, and stress can cause these nerve endings to release chemicals called neuropeptides, which makes the skin red and itchy. Thus the mind and skin are connected on multiple levels. In fact, ‘psychodermatology’ is now a fast growing medical field which addresses the impact of an individual’s emotions on their skin.
So if you have a child or a loved one who is suffering from a stress-related skin ailment, support them. Encourage them to speak. Get your family to counsel them. Maybe your child is being teased at school. Perhaps your friend is unable to cope with the stress of a bad relationship. Consult a counsellor if you feel the need. Hypnosis and biofeedback therapy can help in certain cases which are resistant to routine dermatological medications. Several patients have also tried acupuncture and massage therapy with moderate success. Although stress is rarely the sole culprit, it is a major ‘trigger’ for several skin ailments. Therefore these therapies are not a replacement for traditional skin treatment as they only focus on stress alleviation.Trichotillomania, dermatillomania and skin related hallucinations are severe psychological conditions which can only be addressed by a psychiatrist.
