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Stress and the skin: Life's 'down' periods can manifest cutaneous effects


Stress, depression and anxiety can increase skin, hair or nail problems. Therefore, in some cases, dermatologic therapies should be used in conjunction with appropriate stress-management strategies.

Key Points

"There is, indeed, a reciprocal relationship between feelings and appearance, and how failing to address these concerns can affect how we look, feel and function," Dr. Fried says.

Dermatologists can advise patients to recognize these secondary symptoms of stress.

"Dermatologists can play a key role in helping patients not only alleviate these physical symptoms, but also help enhance their quality of life during a difficult time," he says.


Stress can manifest in many ways, primarily by making the skin more sensitive and more reactive.

For example, Dr. Fried says, stress can make rosacea more red, result in acne lesions that are more inflamed and more persistent, cause brittle nails and ridging of the nails, cause hair loss, cause or worsen hives, and cause excessive perspiration.

In addition, stress is a known trigger, or can be a worsening factor, for fever blisters, psoriasis and seborrheic dermatitis, and has even been shown to impair skin barrier function and dehydrate the skin - allowing more irritants, allergens and infectious agents to penetrate the skin and cause problems. Stressed skin often appears stressed, distressed and older.

"When it comes to treating patients who we suspect may be experiencing skin, hair or nail problems as a result of stress or other emotional factors, it is helpful to ask them whether their skin seems to look or feel worse when they are stressed," Dr. Fried says.

"Beyond the direct physiological effects of stress, patients under stress also tend to neglect or abuse their skin, lacking the energy and motivation to adhere to their skincare regimens," he says.

To successfully treat stress-related dermatologic conditions, Dr. Fried says dermatologic therapies should be used in conjunction with appropriate stress-management strategies.

For example, stress-reduction interventions and techniques, such as yoga, meditation and daily exercise, can reduce the culmination of negative events that can worsen many of these problems.


Studies show that people tend to be more distressed by skin, hair or nail problems, since they are so visible and uncomfortable, than by other serious medical conditions, such as heart disease or diabetes, Dr. Fried says.

"When dermatologists treat both the skin and the stress, the skin often clears more quickly and completely as the native influences of stress are diminished," he says.

Dr. Fried adds that stress reduction can decrease the release of pro-inflammatory stress hormones and chemicals.

For example, release of neuropeptides, the stress chemicals released from the nerve endings, can be reduced with stress-management techniques. Skin often looks and functions better as a result.

These interventions can reduce blood vessel overactivity, resulting in less blushing or flushing.

Decreasing stress allows the patient to focus more positive energy on good skincare rather than negative behaviors, he says.

"Often (when) people are under stress, they tend to 'fall off the wagon' in terms of practicing good skincare," Dr. Fried says.

With accurate diagnoses by a dermatologist, effective treatments improve the appearance and function of the skin. This alone can substantially reduce patients' stress and improve their skin, hair and nail conditions.

However, Dr. Fried says that if stress is clearly interfering with patients' overall well-being and ability to cope, simultaneous additional stress-management interventions are warranted.

In some instances, referral to a mental health professional who has an interest and understanding of skin problems might be warranted.

Disclosures: Dr. Fried reports no relevant financial interests.

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