This is an incredibly stressful and unpredictable time for all us at the moment. It is okay to feel a roller coaster of mixed emotions as we face the uncertainty and unpredictability this pandemic brings. We have little control over this unique situation, as well as over the many new challenges and concerns that it brings.
Stress is our body’s natural response to feeling under threat or pressure. It can also be motivating for short bursts of times, but what we’re facing right now due to the Covid-19 pandemic, is sustained, continuous and chronic.
We all know chronic stress can affect our body in many ways, but did you know stressors can also manifest in your skin, triggering or worsening a wide range of conditions such as acne, psoriasis, eczema, hives and even hair thinning.
Skin is the largest organ of the body and plays an important role in barrier and immune functions. To understand how stress can affect your skin, it’s imperative to focus on how our body responds to stress. It all comes down to the hypothalamus-pituitary-adrenal (HPA) axis, which is our body’s stress response system.
The HPA axis is essential for dealing with stress but when it is stimulated too much, it can lead to problems in our skin. Our body produces the hormone cortisol in response to the HPA axis being stimulated, which is often referred to as the “stress hormone”.
These increased levels of cortisol affect the integrity and protective function of the skin barrier, and the skin starts to lose hydration in a process known as transepidermal water loss (TEWL)[i]. This disruption of the skin barrier homeostasis and increased TEWL can aggravate conditions such as eczema and psoriasis, and also lower the threshold for itching[ii].
Cortisol also increases sebaceous gland activity which stimulates the overproduction of sebum (oil), which makes our skin more prone to flare ups of acne vulgaris. Stress has the ability to induce acne flares and this was recently confirmed in a well-controlled study[iii].
When we feel stressed over a longer period of time because of an ongoing situation, it can feel overwhelming and unpleasant. Chronic stress can affect your immune system and can cause your skin to be more reactive and sensitive, triggering hives, which is well documented in literature over the years[iv]. The effect on your immune system can also leave you vulnerable to infections such as flare ups of herpes simplex virus, which causes cold sores. It can lie dormant in your body but can be reactivated when your body is under stress.
During the pandemic, in my dermatology clinic, many patients have also been presenting with hair loss. Prolonged periods of stress can also result in hair loss. Telogen effluvium (TE) is a very common but temporary form of hair thinning that usually occurs about 3 months after a stressful event. Cases of Alopecia Areata (AA) have also risen as a result of stress. This is hair loss in clumps from an area rather than generalised thinning that is seen in TE. The important thing to remember with both types of hair loss is that your hair follicles have not been permanently damaged, and this is temporary shedding due to the presence of a stressor.
It is also assumed that increased levels of stress can increase DNA damage, interfere with DNA repair and lead to increased oxidative stress which can all contribute to skin aging. Furthermore, sleep deprivation due to stress can have a negative effect on our skin, resulting in fine lines, uneven pigmentation and reduced elasticity[v].
Stress is a completely normal response to life’s pressures and with your skin misbehaving and contributing to further anxiety around personal appearance, it may feel like your problems are adding up and you don’t know where to begin.
Our body relies on our daily routines through our sleeping patterns, eating patterns and daily activities, all of which contribute to our well-being. Our normal daily routines have been disrupted by the pandemic and has led to further stresses and strains for individuals who are already coping with a great deal.
I know that it is not possible to avoid how you are feeling at the moment, but trying to build the right routine with time for self-care, healthier eating, exercise and sleep may help reduce stress and in turn have a knock on positive effect on your skin.
I hope that these suggestions will help you. Pease do speak to your GP if you’re struggling. We are here to help!
Want to keep learning? Find out more about the author, Dr Sonakshi Khorana.
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