Dermatologists routinely see patients with stress-induced skin problems such as a child with a flare of atopic dermatitis on the first day of school, a teenager with an acne flare before final exams, an adult who develops urticaria before public speaking or the patient who cannot stop scratching and picking at their skin. We also see patients with significant anxiety and depression related to their chronic skin conditions.
Usually, we do not routinely recommend psychotropic medications or suggest psychotherapy for all patients with stress-related cutaneous disorders, and many patients do not follow through with these recommendations even when they are made.1
Mind-body therapies (MBT)s offer an integrative care approach to these problems, which may be as effective and safer than other management options. Mind-body therapies include treatments administered by practitioners and selfdirected practices that patients do on their own. Examples of MBTs used to treat skin conditions include meditation, mindfulness, breathing techniques, biofeedback, progressive muscle relaxation, hypnotherapy, acupuncture, yoga and tai chi.
With recent advances in psychoneuroimmunology, we now have a greater understanding of how both acute and chronic stress can affect the skin and how MBTs can diminish some of the effects of the stress response. The effects of stress on the skin are primarily mediated by the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal medullary axis. Stress can trigger inflammation, dysregulate immune function, impair the skin’s barrier function, slow wound healing and alter blood flow to the skin.2
Mind-body therapies can mitigate many of these deleterious effects on the skin. The mechanisms by which they do this are complex and have not yet been fully investigated. However, it has been established that MBTs activate the parasympathetic nervous system and downregulate the sympathetic nervous system, which, in turn, can mitigate some aspects of the stress response. In addition, MBTs beneficially affect the areas of the brain that deal with emotional regulation and psychological response to stressors.3
Dr. Soutor is adjunct professor at University of Minnesota
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