Eczema News: Are you steroid resistant?

Jessica Simonis, Practitioner Integrative Dermatology (BHScNutMed, AdDip WHM)

Chances are you are familiar with the term ‘antibiotic resistance’ but what about topical steroid resistance?  Yes, it is a thing, and here is what you need to know…

Topical steroids have been the basis of eczema treatment for over 50 years and can provide fast acting anti-inflammatory benefits.  Whilst short term use can be beneficial, long term use can be associated with various side effects, including a gradual reduction in effectiveness over time (aka topical steroid resistance).

One of the explanations for this resistance is related to the bacteria Staphylococcus aureus, a common bacteria which can become pathogenic in up to 90% of eczema cases.  Research has found S. aureus produces toxins (AKA Superantigens) which can be found in the lesions of eczema skin.  These toxins are responsible for the release of significant amounts of inflammatory cytokines which correlate with the severity of eczema, including symptoms of itch as well as a resistance to the anti-inflammatory effects of topical steroids.  Studies have shown that a combination of anti-inflammatory treatments with antibiotic therapy works better than just the anti-inflammatory on its own, suggesting that the Staphylococci bacteria and their toxins may play a role in suppressing the benefits of topical steroid treatments.  aren’t working,

So if antibiotics and steroids stop working, what’s left?

The answer lies in nature of course! New research has found that herbal bioactive ingredients, including thymol and farnesol, have demonstrated a direct action on S. aureus bacteria and superantigens, including antibiotic resistant strains.  These ingredients are found in extracts of herbs such as thyme and the peel of citrus fruits.  Topical application of these ingredients has shown great benefit in the treatment of chronic eczema presentations. Read more here

The Psoriasis Eczema Clinic specializes in the treatment of chronic skin conditions resistant to conventional therapies. Our topical treatments contain a unique combination of herbal bioactive ingredients, shown to be effective in the treatment of superantigen associated skin conditions, including eczema and psoriasis. For more information on PEC Founder, Professor Tirant’s research into Superantigens and Skin conditions, see here

How can gut health affect your immunity?

Immune health plays a key role in multiple skin diseases, including psoriasis and eczema, but what does gut health have to do with your immune system? 

The health of our gut plays a significant role in determining the health of our immune system.  Gut associated lymph tissue (GALT) is the largest immune organ in the body, and the primary route of exposure to pathogens.  Essentially GALT acts as the gate keeper, keeping the balance between health promoting microbes (eg.probiotics) and disease promoting microbes (eg. pathogenic bacteria, fungi, yeasts and viruses).   When we are healthy, the gate keeper is fairly tolerant, ignoring a certain amount of nasty microbes as long as the balance is in favour of probiotics.

When we experience an imbalance in the gut microbes, the gate keeper becomes intolerant and hyper responsive leading to imbalances in the immune system, including chronic inflammation, allergy, autoimmunity and vulnerability to infection.

How will I know if my gut is out of balance?

Research has shown that those with chronic skin conditions such as eczema, psoriasis and acne, demonstrate alterations in their gut bacteria.  Symptoms of an imbalanced gut microbiome are not always expressed in digestive symptoms and therefore further investigations via stool testing may be required. 

So, how can you keep your gut in balance?

Frequent exposure to a diverse range of probiotics is important in order to keep the nasty microbes in check but also to help maintain the health of the gate itself (aka the gut barrier).  Ways to increase your microbial diversity include:

  • Increase consumption of plant based, fibrous foods (fruit, vegetables, nuts and seeds)
  • Include fermented foods, such as yoghurt and kefir (these are best kept to small amounts for those with inflammatory skin conditions due to histamine content)
  • Spend plenty of times outdoors immersed in nature (get your hands dirty!)
  • Avoid unnecessary antibiotics and opt for antibiotic-free/organic  meat and dairy products where possible
  • Avoid high sugar and high fat diets, which promote inflammation and growth of pathogenic microbes

If you would like to know more about how your gut health could be affecting your immune system, contact the Psoriasis Eczema Clinic today.

PROBIOTICS AND ECZEMA

What do probiotics do?

A balanced microbiome plays an important role in maintaining our immune health, including regulating allergies, autoimmunity and reducing infection.  Certain gut microbes have also been shown to influence mental health and our appetites.  With research into the microbiome now the next big thing, it seems there is a specific probiotic for almost every condition you can think of, but what does the research say about using probiotics for eczema?

Probiotics are helpful bacteria which protect us against harmful bacteria.  They occur naturally all around us and are found in particularly high amounts in fermented foods such as yoghurts, pickled foods, kombucha, kefir, Sauer Kraut and more.  For the last few decades, modern medicine has relied on antibiotics as a main stay of treatment in skin disease, with the focus on ‘killing the bad guys’ so to speak.  More recently, in the face of increasing antibiotic resistance, science is turning its attention to increasing the ‘good guys’ instead. 

Patients with eczema, as with many other skin conditions such as acne, rosacea and psoriasis, have been found to have alterations in their gut microflora when compared to healthy controls.  It is also well established that an early exposure to diverse microbes via natural birth, breast feeding, early animal exposure, and avoiding a sterile home environment are protective factors against the onset of allergic diseases.  This understanding has highlighted the importance of microbes in the regulation of allergic disease and led to multiple studies which have investigated the use of oral supplementation of probiotic bacteria as a potential eczema treatment. 

Do probiotics work?

The strongest evidence to support probiotics in eczema was from a 2015 study which found that a specific strain of probiotic helped to reduce the incidence of eczema when given to pregnant mothers towards the end of pregnancy, and directly to the infant up to 1 year of age (Rather, I., et al, 2016)

A more recent 2017 study investigated the use of the same strain of probiotic combined with oral immunotherapy in reducing anaphylactic reactions to peanuts.  Results demonstrated a significant reduction in anaphylactic and other allergic reactions to peanuts, which were maintained for at least 4 years after treatment (Hsiao, K.C., 2017).  Again, this suggests a vital role in bacterial exposure and immune regulation.

However, evidence to support the use of probiotics as a treatment of established eczema in older age groups remains elusive.   It is important to note that certain probiotic strains may also make your symptoms worse through due to their effect on the release of histamine.  Therefore, it is important to choose the right probiotic for your age and your condition.

Can eczema patients take probiotics with other medications?

At the PEC our Integrative Practitioners are trained in the field of nutritional medicine and can help you find the right dietary/nutritional solutions for your eczema.

To book an appointment, contact us at info@psoriasiseczema.com.au or call 03) 9770 5337

References:

Hsiao, K.C., Ponsonby, A.L., Axelrad, C., Pitkin, S., Tang, M.L.K (2017).  Long-term clinical and immunological effects of probiotic and peanut oral immunotherapy after treatment cessation: 4-year follow-up of a randomized, double-blind, placebo-controlled trial.  The Lancel: Child & Adolescent Health, 1 (2), p97-105

Rather, I. A., Bajpai, V. K., Kumar, S., Lim, J., Paek, W. K., & Park, Y. H. (2016). Probiotics and Atopic Dermatitis: An Overview. Frontiers in microbiology7, 507. doi:10.3389/fmicb.2016.00507

Is ‘leaky gut’ or ‘leaky skin’ is the new culprit in eczema?

Many of us are now familiar with the term ‘leaky gut’ but have you heard of the term ‘leaky skin’?  Essentially both terms are referring to the same process which involves a break down in barrier function.   The function of the gut and skin barrier is to protect us against all sorts of nasties, including pathogens, chemicals, pollution and toxins.  When a break down occurs, the body is exposed to a plethora of insults, which can over-excite the immune system and cause inflammation.  

So is leaky gut or leaky skin the issue with eczema?

The answer is it can be both!  For many eczema patients, the skin becomes leaky due to a genetic trait which results in loss of function in the filaggrin (FLG) gene.  This gene is responsible for keeping skin cells tightly packed together.  When the FLG gene is not functioning, the skin becomes more permeable, not only letting water out but also letting uninvited guests in, including microbes and allergens.  Recent studies have shown that sensitization to allergens such as foods, dust mites and pollens may first occur through the broken skin barrier.  Furthermore, the itch-scratch cycle in Atopic dermatitis (AD) can also disturb the skin barrier due to the tears created in the skin.  This leads to a vicious cycle of re-flaring that AD sufferers are all too familiar with.

Having a leaky gut means that the intestinal barrier is compromised and substances that are not meant to penetrate the gut wall are able to, which can result in reactions to foods and immune over stimulation. Key markers of a ‘leaky gut’ have also been found in eczema sufferers and correlate with severity of the disease.  However, treatments targeting ‘leaky gut’, such as elimination diets and probiotic supplementation, have yet to demonstrate significant improvements in eczema skin. 

The good news is that treatments which target ‘leaky skin’, such as daily emollients, have shown benefit and can reduce the risk of allergen sensitization and water loss, helping to reduce inflammation and improve skin texture.

How will your PEC practitioner know if you have leaky skin or leaky gut?  Your practitioner is qualified to assess your skin condition and identify the underlying triggers causing your skin to flare.  Leaky skin can be effectively treated using our topical emollient formulations specifically compounded to suit your skin.  If leaky gut is suspected, your practitioner may refer you for further testing if required.

Practitioner – Jessica Simonis – Psoriasis Eczema Clinic

Choosing & Visiting an Integrative Dermatology Practitioner

Choosing an Integrative Dermatology Practitioner.

Why would it suit me?

Integrative Dermatology (ID) is a health profession concerned with whole person health care, with a focus on treating both the symptoms and underlying triggers of chronic skin conditions.  Integrated Dermatology treatments combine the best of both conventional and evidence-based natural medicines, treating from the inside and the outside.  Integrative Dermatology celebrates the important relationship between practitioner and patient, ensuring a positive experience and the best outcomes for your skin.

Visiting the Integrative Dermatology Practitioner

Your Integrative Dermatology Practitioner will need a longer consultation with you to address your skin concern. The extra time is needed to listen to your story about your skin, your concerns, and for you to gain a deeper understanding of your condition and how it affects your overall health. The longer consult is also needed for the practitioner to assess Comorbidities. These are conditions which are often associated with chronic skin conditions and need to be addressed if your treatment is to be successful. This Whole Body Approach is one of the hallmarks of Integrative Dermatology, where not only the skin but the whole person is considered to shape your treatment plan.

During the consultation, your practitioner will make a detailed assessment of your skin health and identify the triggers which drive your skin condition.  Based on this information, you will be provided with a customized treatment plan, which addresses both the symptoms and triggers of your condition. 

Education forms an important focus in Integrative Dermatology and helps to empower you to make the necessary changes to better manage your skin condition and any associated comorbidities which may affect your health, or which you may be at risk for.

The result of seeing an integrative dermatology practitioner is a long-term benefit to your overall health, and an effective way to manage your chronic skin condition.

A Holistic Approach

There are many ways to help manage a chronic skin condition beyond the conventional medicine approach.  For example, the relationship between psoriasis and diet and lifestyle is clear. Moderate changes to your daily routine can make a significant difference in the health of your skin.

Important factors to consider for example are stress levels and effective stress management, body weight, and comorbidities or health conditions associated with your skin condition.

Diet matters

Despite many patients being told that diet has nothing to do with their condition, the latest science says otherwise. For example, the link between psoriasis and metabolic diseases such as obesity and diabetes has led researchers to investigate the benefits of various dietary protocols.  Those shown to benefit psoriasis typically have a high vegetable and fruit content, are rich in polyunsaturated Omega 3 fatty acids and antioxidants and are low in calories.  Some examples include;

  • Mediterranean style diet
  • Vegetarian diet
  • Gluten Free diets (particularly in those gluten sensitive)
  • Intermittent fasting
  • Ketogenic diets

Your practitioner will guide you regarding nutrition and lifestyle adjustments which apply to your specific skin condition.

Senior Practitioner- Phillip Bayer- Psoriasis Eczema Clinic

Stress and its Effect on Nutrition

Stress and Nutrition 

In modern times, Stress has become our number one health enemy. Stress has become ubiquitous, and its effects often remain hidden, manifesting only in subtle symptoms at first. But, make no mistake; it can lead to enormous health issues down the line. 

Previously I discussed ways to help manage stress by improving exercise and more passive techniques such as breathing exercises. In this blog, I’d like to talk about stress and nutrition – its effects on nutrition and how we can utilize good nutrition to counteract stress and enable our bodies to better cope with the effects of it. 

Stress, anxiety, worry and overwork can lead to unhealthy lifestyle habits, which causes more stress, leading to a very harmful cycle.  Below is a list of common bad habits people sometimes indulge in when overwhelmed, tired and worried. 

Stress-Induced Habits 

  • Drinking Too Much Coffee: Usually increased stress means longer hours and pressure at work, so you may find yourself drinking more cups of coffee through the day to keep yourself going. 
  • Eating the Wrong Foods: Stress results in cravings for foods high in fat, sugar, and salt. This occurs due partially to increased levels of cortisol, the stress hormone. This may result in increased consumption of junk foods, sweets, and unhealthy snacks. 
  • Skipping Meals: Due to the time constraints which often come with periods of higher stress, eating a healthy meal tends to drop down on our list of priorities, and you might find yourself skipping breakfast or not eating lunch because there’s just too much on your to-do list. 
  • Mindless Munching: Emotional eating may also increase when stress is high, we eat when we are not hungry but because it feels comforting or chasing the “sugar high” 
  • Forgetting Water: as with skipping meals, drinking good amounts of water tends to decrease in priority, which may lead to dehydration. This is made even worse when the consumption of soda drinks, alcohol and coffee rises during times of stress. 
  • Fast Food: Because of the convenience of quick meals, stressed people often increase their consumption of fast foods, laden with anti-nutrients which negatively affect your health. 

The Impact of the wrong foods during stress 

  • Blood Sugar Imbalances: When your food demands are not met or when foods without needed nutrients are consumed, blood sugar fluctuations may result. In the short term, these fluctuations may lead to mood swings, fatigue, poor concentration and other negative consequences which will exacerbate stress. In the long term, greater health problems such as hyperglycemia and even diabetes may be the result. 
  • Side Effects of caffeine: Caffeine in excess can lead to poor concentration, anxiety, palpitations, lower levels of productivity, and problems with sleep. An even higher level of the stress hormone cortisol is often the outcome. 
  • Poor Health Outcomes: Chronic high stress and its effects on nutrition may have significant long term effects such as decreased immunity, worsening of an existing health issue or even the start of a new one, as is often seen in psoriasis and other skin conditions. 

Healthy choices during periods of stress 

In addition to having stress reduction techniques in place and ensuring enough quality sleep, it is vital to follow a healthy eating programme during times of stress. In this way, we can ensure that our bodies have a good supply of the nutrients it needs to counteract stress, and the body’s increased demands for nutrition is met. 

A fresh, clean diet is important – lots of fresh vegetables (not overcooked), fresh fruit, ample amounts of fresh water, good quality proteins, and healthy fats are essential. Limit anti-nutrients, such as refined carbohydrates & excessive sugar consumption, excessive caffeine intake, soda drinks, alcohol, processed and smoked foods and so on. 

The practitioners at Psoriasis Eczema Clinic are well-versed in helping you to manage the triggers of your skin condition. 

Phillip Bayer, Senior Practitioner 

Why is sleep so important?

Can’t fall asleep.. my mind is too active! Does this sound familiar? How about ‘I woke up and I can’t go back to sleep!’… or tossing and turning all night?.. or ‘scratching my itchy skin is keeping me awake!’

Sleep is a fickle thing. Vital for recovery and recharging of our vital energy, it all too often eludes us, eroding our energy levels, adding to our stress.

Why is sleep so important?

Sleep is the time where we allow the body to rest and recover and repair itself. Sleep is essential for overall wellbeing, stress management and skin health.

Many skin conditions adversely affect sleep, this may be due to persistent itching and scratching at night, burning and hot skin, discomfort due to dry skin and pain and so on.

Stress is a big enemy of sleep, and sleep quality is often a good indication of how well stress is managed. Typically, in times of high stress, we may have difficulty in falling asleep (sleep onset insomnia) or waking in the early hours of the morning and not being able to return to sleep (sleep-maintenance insomnia).

All too often these factors lead to a vicious cycle where stress results in poor sleep, which results in skin condition flares, which exacerbates poor sleep, which results in fatigue which results in higher stress and a worsening skin condition, which leads to even worse sleep and higher stress and so on.

So how do we tackle this conundrum?

Well, first we need to look at improving whatever is interfering with our sleep. If it’s a skin issue, it’s time to work on that problem and get the itch and discomfort down. If there’s stress, work on the stress using good stress management techniques and improving nutrition so we have the nutrients to counteract the effects of stress.

If sleep is just fickle for no reason, it’s time to look at sleep hygiene

Sleep hygiene

These are effective steps we can take to improve the quality of sleep.  As with all things, it is worthwhile to persist with these steps, and within a few weeks, they should be making a big difference.

  • Try to maintain regular sleep patterns, for example, go to bed at 10 and rise at 6, try not to deviate from this routine.
  • Use your bed for rest only – not eating, or watching TV, or using your phone
  • Avoid day naps as far as possible
  • Consistent night time routine – wind down before bed – switch off mobile devices an hour before bed, warm bath, dim lighting, read a book and so forth
  • Make sure the bedroom is quiet & decluttered bedroom, a calm space
  • Make sure the bed is comfortable, clothing is light and comfortable, pillows are comfortable
  • Regular exercise is important for health.  Exercise should be a few hours at least before bedtime to avoid overstimulation
  • Use relaxation techniques before bed
  • Avoid stimulants and diuretics – alcohol, drinking coffee in the afternoon, sugary snacks after dinner
  • Temperature control – keep the temperature cool in the bedroom, wear light comfortable clothing, and avoid heating/ spicy foods at dinner time.

Phillip Bayer

Senior Practitioner, Psoriasis Eczema Clinic

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Stress and its relationship to the Immune system

 Stress has very much become a part of life with most of us functioning under moderate to very high stress most of the time during our working lives. The impacts of significant stress are far-reaching and affect all aspects of human health. Chronic stress is a less intense, longer lasting form of stress than acute stress, which over time, is associated with increased ‘wear and tear’ on body systems and quality of life.

Since the dawn of mankind, through the process of evolution, the human body developed mechanisms to protect itself during periods of stress. Known as the ‘fight or flight’ response, these mechanisms are designed to save our lives in dangerous situations. The problem in modern times is that stress has become much more continuous and frequent, and therefore these normal physiological responses to stress are frequently or continuously affecting us, which results in health problems.

Often overlooked are the damaging effects of high stress on the immune system. Stress poses a significant risk to immune health, as it results in increased inflammation, decreased number and function of immune cells, and disrupted immune system balance.

The outcome of this impact may result in a health condition, such as cancer, skin conditions such as atopic eczema & psoriasis, recurrent infections, diabetes, cardiovascular disorders and auto-immune conditions.

In addition, chronic high stress or a sudden stressful event is also very often involved in a flare of an existing health condition.

Very often, your body will show physical signs of high stress when the threshold of acceptable stress has been crossed. These signs may include:

  • Fatigue
  • High blood pressure
  • Reduced libido
  • Sleeping difficulties – such as difficulty to fall or remain asleep
  • Weight gain around the middle
  • Cravings for caffeine or sugar
  • Muscle aches/pains/twitching
  • Frequent headaches
  • Frequent infections
  • Low moods/ feeling flat/ inability to enjoy life

If there is significant stress, it is vital that the stress is addressed and its effects decreased in order to reduce the effect of this enormous driver for health issues.  If the source of stress itself cannot be eliminated, and usually it cannot, then we need to consider ways to mitigate and reduce the effects of the stress on the body.

This is where effective stress management strategies need to be implemented and adhered to in order to help with your health concern.

In more serious cases of acute or chronic stress, such as abusive relationships, addiction, clinical depression, PTSD and anxiety, professional help is required. Helplines such as Lifeline (www.lifeline.org.au Tel: 131114) can offer support and guidance if needed.

The practitioners at Psoriasis Eczema Clinic can assess all the triggers for your skin condition and can advise you how to address these triggers.

 Phillip Bayer

Senior Practitioner, Psoriasis Eczema Clinic

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Stress Management

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The Importance of stress management

Stress is an intrinsic part of living in today’s world. There are times when we all go through acute phases of stress that are relatively short lived, and somewhat manageable as we know that it will pass. Living with chronic stress has an insidious effect on our overall health and can be responsible for many illnesses we experience today. Our mental and emotional wellbeing can also be affected as the stress begins to wear us down.

Learning how to look after yourself during times of stress is imperative in minimizing the overall negative effect it has on your system as a whole. This becomes extremely important when a pre-existing illness is present, as the additional stress can escalate symptoms and worsen the condition.

The next few blogs will discuss some easy to implement techniques for feeling less stressed, more relaxed and peaceful, as well as some dietary tips to increase your energy levels and prevent illness.

 

Recognising symptoms of stress

Short term or acute stress is fairly easy to recognise. These physiological responses come from the adrenal gland where adrenaline is released upon perception of a threatening situation.

Some of the symptoms you will want to be aware of are:

Rapid or shallow breathing

Increase in heart rate and blood pressure

Nausea – due to inhibition of digestion. Blood flow is redirected away from stomach, can also cause a nervous feeling in the pit of the stomach

Dry mouth

Trembling or shaking

Increased blood flow to skeletal muscles

Cerebral blood flow is reduced, and rational thought is compromised.

Increased alertness or agitation, “knee jerk” reactions and instinct become prevalent.

Dilation of pupils

When these sensations begin to be felt it is now time to take evasive action to minimize the elevation of the situation on an emotional and physiological level.

 

Chronic Stress and its consequences

Stress is a natural transient state for all human beings. We are designed to be able to activate survival mode whenever a perceived ‘life threatening’ event occurs. We are designed to be able to escape this event by utilising the enhanced physical capacity we temporarily have. What if there is a constant bombardment of perceived threats throughout the day, what happens to us physiologically when that energy isn’t utilised to physically fight or flight (run). Our nervous system isn’t designed to cope indefinitely with this pattern, so a different defence mechanism is utilised by the body and different hormones and effects will occur.

When we switch into a long term stress pattern, the main hormone the body utilises for ‘survival’ is cortisol. That is not to say that we no longer produce adrenaline, if the stress is bad enough, we can be pumping that out as well. Cortisol is designed to protect us in long term stress as the body’s wisdom dictates by this stage we must be injured or in some dire physical state.

So what does cortisol do to the body? Or in other words what are the signs of chronic stress?

It is now believed that Cortisol is responsible for immune dysregulation. What this means is that there are mixed messages for the body’s immune response – it may switch off the part of immunity that is responsible for monitoring and eliminating infections, which is why we can become sick more often or can’t seem to fight off a common cold. The immune system may go into a hyper state as well which means it can be so primed that it actually starts to attack even our own tissue which leads to inflammation. This is where if you have a chronic condition such as arthritis or any sort of autoimmune disease, the symptoms will worsen when you’re stressed.

Cortisol also increases insulin output under the assumption that if the body has been in a state of constant physical threat then the body must need more glucose in the cells to be able to have the energy to sustain itself. The net result of increased insulin is weight gain,(especially around the gut), sugar or carbohydrate cravings, and fatigue.

Cortisol is at its highest in the morning – one sign of long term stress or ‘adrenal fatigue’ is feeling absolutely wiped out and tired with difficulty getting out of bed first thing in the morning. As the day goes on you may notice a peak in energy around 5:00pm and then go to bed exhausted but unable to sleep. This is a common pattern.

Cortisol also increases risk of heart disease, and promotes premature ageing. CRH is the hormone that switches on Cortisol release. CRH also has an impact on the body such as increasing pain perception, and also affects bowel function.

The long term effect of elevated stress hormones will also have an effect on the brain, and reasoning and emotional control will also be affected. Many people that have been coping with stress long term will find their ability to focus and concentrate on tasks is diminished. They may also experience mood swings, frequent weeping, or poor anger control.

The above symptoms illustrate why it is so imperative to learn to recognize the symptoms of stress, and its progression into a chronic state. This needs to be addressed and corrective measures are put in place. Allow yourself some time to practice the suggestions in the followings blogs and be patient with the process.

Smiling Mind offers a free guided meditation app: https://www.smilingmind.com.au/smiling-mind-app/

Stress & The Effects on the Skin

stress

It has been established in recent years that the skin is a direct target of psychological stress via a cascade of hormones, neuropeptides, and neurogenic signals (causing nerve hypersensitivity and inflammation). The skin has been shown to be capable of launching its own local response to stress as well by producing many of the same substances that the brain produces, further enhancing the local effect at the skin level when someone is under acute or prolonged stress. It is no surprise that the skin can perceive and respond to stress similar to the brain and nervous system, since the two systems have evolved from the same germ layer during embryonic development.

The main skin cells (keratinocytes), mast cells (involved in allergy type reactions and inflammation), immune cells, and peripheral nerve endings all will have an effect on various cell behaviour and processes within the skin under stress that can lead to skin disruption, premature ageing and disease development.

The skin is rich in nerve endings, so when an individual is stressed the peripheral nerve endings secrete numerous substances such as Substance P and Nerve growth factor that contribute to hypersensitivity, inflammation, and allergic reactions.

Due to the impact of stress related hormones and peptides, and growth factors on the skin, stress can play a role in the development and exacerbation of skin disorders such as Eczema, Acne, Psoriasis, and Rosacea.

Psychological stress activates the autonomic nervous system to trigger release of catecholamines [e.g. epinephrine and norepinephrine] from the adrenal glands, and in situations of chronic stress corticotrophin releasing hormone [CRH] and ACTH (adrenocorticotropic hormone), mediate a release of glucocorticoids (Cortisol) from the adrenal cortex.

Here is a brief outline of some key stress mediators and the effect that they have on the skin:

Glucocorticoids:

Excess levels can cause atrophy and impaired wound healing by interfering with keratinocyte and fibroblast function. Keratinocytes are the primary skin cells that form the epidermis of the skin, and fibroblasts are responsible for collagen and elastin formation.

This manifests as atrophy and thinning of the skin, increased trans-epidermal water loss related to disruption to the skin permeability barrier, and easy bruising with impaired wound healing.

The skin barrier is also negatively impacted by excess cortisol as this effects the lamellar bodies in the skin cells which are responsible for lipid synthesis; the lack of essential lipids weakens the barrier resulting in dry skin, allergies and sensitivity, delayed healing and infections.

Insulin:

Excess glucocorticoids stimulate Insulin production and lead to insulin excess and Insulin resistance. Elevated Insulin stimulates IGF2 (Insulin growth factor) which increases growth of keratinocytes, and stimulates abnormal keratinocyte growth, (exacerbates Psoriasis and Acne) and increases androgens and testosterone release.

Substance P:

This is neuropeptide released in times of stress. Substance P stimulates sebaceous germinative cells and proliferation of sebaceous glands which results in excess oil production and blockage of the oil ducts and the development of acne. Substance P also activates mast cells, increasing histamine release and itch sensation. Substance P induces vascular permeability and inflammation, which aggravates conditions like Eczema and Rosacea.

Corticotropin Releasing Hormone (CRH):

CRH stimulates release of MSH (melanocyte stimulating hormone) causing hyperpigmentation and blotchy skin.

Catecholamines (Adrenaline, Noradrenaline)

Decrease blood perfusion to skin reducing availability of oxygen and nutrients resulting in poor texture and sallow / pallor. Catecholamines have also been shown to cause immune suppression, interfere with DNA repair and contribute to ageing.

Managing stress

While the effects of stress on the skin are only briefly outlined above, it illustrates the significant impact this can have on individuals predisposed to skin conditions. It is therefore imperative to minimise stress where possible in order to avoid any exacerbation of skin disorders.

There are some straight forward tips to reduce stress such as getting a good night’s sleep, exercising and following some simple dietary guidelines (listed below).

stress_2

Reduce salt intake

Avoid alcohol

Avoid caffeine

Avoid skipping meals

Avoid refined, processed foods.

Avoid high fat foods

Do eat high fibre, low glycaemic index diet

In the following blogs we will present some relaxation techniques that are easy to implement and will have a direct effect in reducing the side effects of stress.

 

References

  1. Dunn, Jeffrey HKoo, John; Psychological Stress and skin aging: A review of possible mechanisms and potential therapies; Dermatology Online Journal 19 (6): 1 University of Colorado, School of
  2. Medicine, 2 University of California, San Francisco, Department of Dermatology 2013 Permalink: http://escholarship.org/uc/item/3j0766hs
  3. Jessica M. F. Hall, desAnges Cruser, Alan Podawiltz, Diana I. Mummert, Harlan Jones, Mark E. Mummert; Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis; Dermatology Research and Practice Volume 2012, Article ID 403908, doi:10.1155/2012/403908
  4. Ying Chen, John Lyga; Brain – Skin Connection: Stress, Inflammation and Skin Aging; Inflammation & Allergy – Drug Targets, 2014, 13, 177-190
  5. Theoharis C. Theoharides, Jill M. Donelan, Nikoletta Papadopoulou, Jing Cao, Duraisamy Kempuraj, Pio Conti; Mast cells as targets of corticotropin releasing factor and related peptides; TRENDS in Pharmacological Sciences Vol.25 No.11 November 2004