Is Stress Triggering Your Skin?

Learn how to better identify and manage your stress triggers

Stress is a well-documented trigger AND comorbidity of many skin conditions including psoriasis, eczema, rosacea and acne.  But stress is very much a subjective term.  Learning what it is that your mind and/or body finds stressful is the key to managing your flares and the answer might surprise you…

The skin is innervated by a network of cutaneous nerves and research has discovered that certain neurochemicals play a significant role in many skin conditions by modulating inflammation, cellular growth, immune response and wound repair.  Certain characteristics of chronic skin conditions such as symmetrical distribution, sparing of de-nervated skin and initiation of a flare after stress indicates nerves may play a significant role in the pathogenesis of multiple chronic skin conditions, including psoriasis, eczema, rosacea, acne and more.

What types of stress can flare the skin?

There are 3 stages of stress to be aware of when it comes to skin flares, as different stages can have a different effect on the health of your skin.

  1. Alarm – This stage is also known as fight or flight.  It is the acute stage of stress where your cortisol, heart rate and blood pressure increase as a protective mechanism.  Due to the anti-inflammatory nature of cortisol, you may not experience any symptoms during this phase.
  2. Resistance – During this stage, the body attempts to adapt to the stressful situation.  If the stressful event ceases, the body returns to normal.  If not, the body continues to produce stress hormones, creating imbalances in the endocrine, immune and nervous systems.  This is where symptoms may begin, often with new lesions appearing in new places.
  3. Exhaustion – After extended periods of stress, the body becomes exhausted from trying to maintain a balance in stress hormones.  Your immune system can becomes vulnerable to infection, fatigue and lack of concentration set in and feelings of anxiety and depression are common.  This is where a skin flare can become chronic.

Identifying your stress:

Many of us associate stress with a negative emotional experience, such as a relationship break up, argument, loss of job, financial difficulty and so on.  These are certainly stressful events, but they have something more than negative emotions in common….CHANGE.

As a practitioner of many years, I have found that change is a major driver of skin flares, and what we consider a “Primary” or “Initiating” Trigger.  The interesting part is that the change may even be a positive one, such as taking on a promotion, giving birth to your first child, buying your new home or getting married.  Patients with chronic skin conditions are often very sensitive to changes in their environment.  Even simple changes in weather or temperature can be enough to initiate a flare. 

However, once the patient has adapted to the change, the skin should clear, right?

If it doesn’t clear, this indicates that “Secondary” or “Exacerbating” triggers are still present.  This can include everyday stressors such as being busy, poor sleep, poor diet, nutrient deficiencies, obesity and so on.  These place not only a mental but a physical stress on the body, again exhausting its defense mechanisms. 

So how can you manage your stress, even if you don’t feel stressed?

The answer is ROUTINE!  The nervous system loves routine.  Creating a pattern around when you go to bed, when you wake up, when you eat, what you eat and when you exercise, takes a lot of pressure off your nervous system and the stress response, allowing it to adapt, rather than stay in a constant state of alarm.  Of course, if your routine is not so unhealthy, you may need to make some initial dietary and lifestyle changes, such as less caffeine, less technology, more time outdoors, more vegetables, less processed foods, more water and less alcohol (Read more here).  But once you have, keeping them consistent enough to create a new habit, will give your nervous system the rest it needs, in order to start healing. 

If you are suffering from depression or anxiety and need support, please follow this link for more information.

Jessica Simonis

Clinical Skin Nutritionist

Practitioner Integrative Dermatology

Circadian Rhythm and Chronic Skin Conditions – What’s the link?

Keeping a chronic skin condition stable when your hormones are running wild can feel like a constant uphill battle.  Not only do we have fluctuating male and female hormones to contend with, but there are stress hormones, sleep hormones and glucose regulating hormones to name a few, all of which work together to create our natural internal rhythm or “circadian clock”.

When we are in balance, our circadian rhythm responds to external cues appropriately.  For example, we are energetic during the day light, sleepy at sun down, hungry during the middle of the day and if female, menstruating in a 4 weekly pattern.   In modern day life, where blue lit screens are often the last thing we see before bed, gyms are open 24/7 and the working day starts and finishes in the dark, it’s no wonder our rhythms go awry. 

So how does this affect the skin?

 Like many organs, the skin is regulated by a central clock known as the suprachiasmatic nucleus which receives light through the retina and passes messages along to other internal clocks via neural and hormonal pathways. It also has its own internal clock system which regulates changes in activity according to the time of day.  For instance, research has shown skin to do the majority of DNA and cellular repair work during the night time.  Skin cells also divide and proliferate more at night, are less hydrated, more acidic and at a slightly higher temperature than during the day, often setting the scene for an uncomfortable night’s sleep for many eczema and psoriasis sufferers.

What can you do to regulate your circadian rhythm and improve your skin?

It’s all in the timing:  Research has shown that the application of topical skin treatments is best timed at night to not only help alleviate the symptoms but to also help optimize repair at a time where the skin needs it most.

Routine, routine, routine:  A regular routine is essential to a healthy circadian and hormonal rhythm.  Chronic disruption to routine such as through shift work, irregular eating patterns or frequent travel can contribute towards flares.  Do your best to time activities within your control, such as regular meal times, breathing exercises, and limiting blue light exposure and/or caffeine before sleep.

Rise with the sun:  The best way to reset your rhythm is to rise with the sun.  Get your 15 minutes of vitamin D exposure and enjoy what nature has to offer before – there’s no better way to start your day. =2

Heart Health – The Importance of Omega 3 fatty acids in Cardiovascular Health

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Omega 3 fatty acids have long been associated with a reduced risk of cardiovascular disease. They are a type of unsaturated fatty acid, found most commonly in fish.

When a diet high in saturated fatty acids, such as those in meat, is substituted for unsaturated fatty acids, such as those found in fish, we see several benefits in the cardio vascular system. Omega-3 fatty acids may decrease triglycerides, lower blood pressure slightly, reduce blood clotting, decrease stroke and heart failure risk and reduce irregular heartbeats. Eating at least one to two servings a week of fish, particularly fish that’s rich in omega-3 fatty acids, appears to reduce the risk of heart disease, particularly sudden cardiac death. Omega-3 fatty acids may also reduce inflammation, which is associated with damage to blood vessels and, if left unchecked, may lead to heart disease and strokes.

Which types of fish are most beneficial?

Fatty fish, such as salmon, trout, mackerel, herring, sardines and tuna contain the most omega-3 fatty acids and therefore the most benefit, but many types of seafood contain small amounts of omega-3 fatty acids.

Not all types of fish are equal

Fish that do not contain as high levels of omega 3 and those which contain higher levels of unhealthy fatty acids are not as beneficial for heart health, examples include tilapia and catfish. Also pay attention to where your fish comes from- fish from countries known for their bad pollution is not a good idea. Some fish are also higher in dangerous toxins, for example mercury is found in higher concentrations in larger predatory fish, such as swordfish. Farmed fish may contain antibiotics and other chemicals so pay careful attention where you source your fish from. In addition, fish is not be that healthy if it is prepared in an unhealthy way, for example fried fish opposed to steamed or baked fish.

How much fish should you eat?

For adults, at least two servings of omega-3-rich fish a week are recommended. A serving size is about 100 grams, or about the size of a deck of cards. Women who are pregnant or plan to become pregnant and young children should limit the amount of fish they eat because they’re most susceptible to the potential effects of toxins in fish.

Are there other options if I dislike fish?

Researchers are divided as to the health benefits of taking omega-3 supplements, however, they are an option if for any reason foods high in omega-3’s cannot be included in the diet. Good non-fish sources of omega-3’ oils include flaxseed, flaxseed oil, walnuts, canola oil, soybeans and soybean oil. Bear in mind the evidence of heart-health benefits from eating these foods isn’t as strong as it is from eating fish.

Senior Practitioner- Phillip Bayer- Psoriasis Eczema Clinic

How to deal with the post-festive season slump?

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A how to list from our Integrative Dermatology Specialists at Psoriasis Eczema Clinic.

This time of year, many people may feel overwhelmed and exhausted following the build up to Christmas and New Year festivities. Facing the prospect of returning to very busy, high demand lives can be unnerving.   If you are feeling unwell, fatigued and having trouble getting back into the swing of things you’re not alone!

Here are some tips to regain your energy and feel ready to tackle the year ahead:

  1. Take a break from alcohol – Holiday time can mean more consumption of alcohol, which sometimes can become a regular part of dinnertime. Alcohol consumption can lead to excess weight gain, headaches, and difficulty in sleeping, so try and limit this to weekends or eliminate altogether.
  2. Invest in some vitamins to support adrenal glands– Vitamins C, and B complex, as well as Magnesium. These supplements will support the nervous system as well as helping adrenal glands in meeting more physical and mental demands.
  3. Get back into exercise – you may not feel like you have the energy, but start small and build up to at least 30 mins exercise 3-4 times a week, even if this is just an evening walk. The key is raising your heart rate and getting more aerobically fit, you will soon see that your energy improves.
  4. Eat well – This requires planning so make sure that you have an organised approach to the weekly shop so that you have enough to cover healthy lunches and snacks while at work / home. If you are a busy person buy snacks that you can eat on the go such as nuts, seeds, fruit, dark chocolate. Try making your own trail mix with your favorite raw nuts and seeds with a small amount of dried fruit of your choice. Make dinners easy with grilled fish or meat and salad, or veggies.

Would you like to know more about how to manage your Chronic Skin Condition? Our team of Integrative Dermatologists would enjoy showing you how!

The Psoriasis Eczema Team.

Christmas and the Holiday Season with Skin Conditions

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So now the Christmas and New Year holiday season is upon us and for those of you who suffer from a skin condition, this time of the year can be challenging.

We all know that the intake of alcohol can be a trigger for many skin conditions such as psoriasis, eczema, urticaria etc. It is dehydrating and dehydration impairs the skin barrier. Alcohol also has the potential to weaken one’s immune system, this makes people with skin conditions more susceptible to bacterial infections and injuries, which in turn can trigger and exacerbate their condition.

For those of you who are yeast sensitive, the intake of drinks such as beer and champagne, both of which contain yeast, most certainly will aggravate their skin condition and could cause a major flare up. Those that are gluten sensitive or suffer from Celiac disease also have to be careful with their alcohol intake as some types of liquors e.g. vodka, bourbon etc. may use a starch-source for fermentation and these starch sources e.g. barley contain gluten.

This time of the year can be emotionally challenging, if you are experiencing family or relationship difficulties, you may be experiencing considerable emotional distress, depression and even social isolation. Try to reach out to friends and support groups for support during this time. It is important that you do not isolate yourself and allow your stress levels to escalate.

If tasks such as shopping or getting the house ready cause you stress, then make sure you plan ahead and allow yourself extra time.

Food of course is a big deal at this time of the year. Catching up with friends for barbecues, lunches, dinners at restaurants or at homes is an important tradition and catch up time for all of us.

 Control on what is on the menu is often out of your hands, therefore it is important to choose your food wisely. So avoid all spicy foods or at least keep it to a minimum – if you eat spicy food at one sitting try to avoid another serve for a few days.

Avoid or at least keep to a minimum intake of tomatoes (including chutneys), smoked foods, red and processed meats. Try to select green vegetables, chicken, turkey, fish and moderate all other intake. Remember if you do have a food sensitivity, be it seafood, gluten, yeast, sugar then try to avoid it as much as possible. The golden rule is “If you ate it during one meal wait a few days before having it again”  if you can’t avoid eating it then moderation is key.

If you are eating at the home of family member or friend then don’t be afraid to tell them of your eating requirements. Most people will be only too happy to oblige by either offering an alternative that you can eat or by modifying the dishes that they are preparing.

As mentioned earlier dehydration impairs the skin barrier so drink plenty of water. It is important to try to drink between one and a half litres to two litres of water a day and critical if you are drinking alcohol.  

The most important thing is to try to enjoy your time with family and friends, don’t overdo the alcohol or food intake. Remember moderation and alternatives, drink your water, get plenty of rest. If you find yourself feeling stressed, make some time to chill out, meditate or listen to music.

 So Check List:

  • Drink water
  • Eat Greens, chicken, turkey, fish
  • Avoid tomatoes, spicy, red and processed meats, smoked foods, sugar
  • Avoid your trigger foods
  • Moderate alcohol intake 
  • Keep stress to a minimum, plan ahead & get support 

HEALTHY SKIN and WATER INTAKE- PART 2

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There are a number of challenges in trying to link chronic dehydration and fluid consumption to various diseases and health outcomes:-

Only a limited number of good studies have been  conducted to date. More long-term studies are needed.  Larger patient numbers need to be included in future studies. 

There are difficulties in assessing patient daily fluid  intake and compliance is difficult to monitor. Hydration status constantly changes and hydration can be difficult to measure in some patients especially when daily fluid requirements vary widely from patient to patient.

The diseases that can be complicated or worsened by dehydration are multi-factorial and there are many differences among these diseases. 1

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There is, however, increasing evidence that even mild dehydration can play a role in the development of various morbidities (diseases) or conditions. The medical evidence for good hydration shows that it can assist in preventing or treating ailments such as:

  • Pressure ulcers   – Dehydration is a known risk factor for PU development because of its effect on blood volume and circulation and skin turgor and has been shown to be associated with an increased risk of developing pressure ulcers in 42% of residents in long-term care facilities, home care patients, and elderly patients.2                           
  • Wound healing – Fluid intake to correct impaired hydration, increases levels of  tissue oxygen and enhances ulcer healing.3
  •  Constipation – Studies have confirmed the recommendation to simply increase intake of fluids such as water to prevent constipation.4
  • Urinary infections – Urinary tract infections result from a bacterial contamination of      the genitourinary tract [35]. They are highly prevalent in both men and women of all age groups, but their frequency is about 50 times higher in adult women. More than half (50–60%)  present with at least one UTI at some stage during their lives. Increasing fluid intake and thereby increasing diuresis (the production of urine) has a diluting effect on contaminating bacteria and virulence factors. Secondly, consecutive to increased diuresis, is the flushing effect that occurs with each void, washing out contaminants and cleaning the epithelia. Also, increasing the frequency of voiding has a shrinking effect on the bladder, effectively reducing the available surface area on which bacteria can thrive.5
  • Chronic kidney disease – CKD is an inevitably progressive, serious condition     associated with impaired quality of life and early mortality, and its prevalence is increasing constantly. CKD is more common among women, men with CKD are 50% more likely than women to progress to end-stage renal disease (ESRD), defined as kidney failure requiring dialysis or transplantation. 44% of people with ESRD have a primary diagnosis of diabetes and 28% of hypertension. Some studies have suggested that increased fluid intake/urine output is associated with a delay in the onset or progression of CKD.6
  • Kidney stones – It is predicted that, based on the effects of global warming, the percentage of people living in areas designated as high risk for kidney stone formation would increase from 40% in 2000 to 56% by 2050, and up to 70% by 2095. This would result in a significant “climate-related” increase in kidney stone events.14  Drinking sufficient levels of fluid on a daily basis is an important part of kidney health. Dehydration, especially chronic dehydration, results in the production of urine which has a higher concentration of minerals and waste products. This can lead to the formation of crystals which can affect kidney function and contribute to certain kidney diseases, such as kidney stones. By moderately increasing water intake, to around two litres per day, you may reduce the risk of decline in kidney function 7
  • Stokes – Stroke conditions worsened or stayed the same in 42 percent of dehydrated patients, compared to only 17 percent of hydrated patients. Dehydrated stroke patients also had about a four times higher risk of their conditions worsening than hydrated patients.8
  • Low blood pressure – Even mild cases of dehydration can cause low blood pressure. Patients with mild dehydration may experience only thirst and dry mouth. Moderate dehydration may cause orthostatic hypotension –  a form of low blood pressure in which a person’s blood pressure falls when suddenly standing up or stretching, and severe dehydration                                             (hypovolemia) can lead to shock, kidney failure, confusion, acidosis, coma, and even death.
  • Diabetes – Hypernatremia dehydration is the most devastating type of dehydration because it can result in severe neurological damage from haemorrhage. Normally, an increased osmolality results in water conservation. This does not occur in central Diabetes Insipidus due to a malfunctioning hypothalamus. In hypernatremic dehydration, extracellular osmolality increases and water moves ou of the brain cells. This movement of water causes brain cells to shrink and the blood vessels tear as the brain is pulled away from the skull and the meninges. The tearing of blood vessels results in haemorrhaging and potential for thrombus formation.10
  • Cognitive impairment – Delirium is a common manifestation of dehydration that  clearly reflects the global impact of dehydration on cerebral function. However, the three areas of the brain most vulnerable to the effects of dehydration are the reticular activating system, which subserves attention and wakefulness; the autonomic structures that regulate psychomotor and regulatory functions; and the cortical and mid-brain structures that are responsible for thought, memory and erception.11
  • Dizziness – Dizziness, vertigo or light headedness can occur simply by changing positions, or moving your head or it can occur at the time of or during strenuous exercise.
  • Xerostomia –  also known as “dry mouth,” is a common but frequently overlooked condition that is typically associated with salivary gland hypofunction. It is estimated that 12-47% of the elderly and 10-19.3% of people in their early 30’s have been suffering from dry  mouth. Whilst dehydration may not be the single cause of this condition it can certainly aggravate or worsen the condition.12
  • Skin conditions – once the body becomes dehydrated and the skin dries out there is   a dysfunction in the skin barrier with an increase in water loss from the body and, subsequently, increased penetration of harmful substances from the environment. This causes the development of sensitization and initiates immune responses resulting in the inflammation of the skin. Skin barrier function depends on several factors including the level of hydration, cellular properties of corneocytes (skin cells), association of these cells in the stratum corneum and speed of changes (turnover) of these cells, amount and composition of intercellular lipids (oils), and skin surface pH (6-20). Water content of the stratum corneum and surface lipids form a balance, which is very important for the function and appearance of the skin, any disturbance of this balance leads to clinical manifestations in the form of dryness and pruritus (itch).13

Recommended daily fluid intake

Approximate adequate daily intakes of fluids (including plain water, milk and other drinks) in litres per day include:

  • infants 0–6 months – 0.7 (from breastmilk or formula)
  • infants 7–12 months – 0.9 (from breastmilk, formula and other foods and drinks)
  • children 1–3 years – 1.0 (about 4 cups)
  • children 4–8 years – 1.2 (about 5 cups)
  • girls 9–13 years – 1.4 (about 5-6 cups)
  • boys 9–13 years          – 1.6 (about 6 cups)
  • girls 14–18 years – 1.6 (about 6 cups)
  • boys 14–18 years – 1.9 (about 7-8 cups)
  • Adult women – 2.1 (about 8 cups)
  • Adult men – 2.6 (about 10 cups).

These adequate intakes include all fluids, but it is preferable that the majority of intake is from plain water (except for infants where fluid intake is met by breastmilk or infant formula).

Sedentary people, people in cold environments, or people who eat a lot of high-water content foods (such as fruits and vegetables) may need less water. 14

Those working in heated environments or who do heavy work and sports players may also need to increase their water intake.

Care should be taken not to overhydrate.

Also read our blog “HEALTHY SKIN and WATER INTAKE – PART 1”

 

REFERENCES

  • Armstrong LE. Challenges of linking chronic dehydration and fluid consumption to health outcomes. J Amer Coll Nutr 70(11): S121-S127, 2012.
  • Horn Sd. Et al.; The National Pressure Ulcer Long-Term Care Study: Pressure Ulcer Development in Long-Term Care Residents; Journal of the American Geriatrics Society
  • Stotts NA, Hopf HW. The link between tissue oxygen and hydration in nursing home residents with pressure ulcers: preliminary data. Journal of Wound, Ostomy & Continence Nursing 2003;30:184-90
  • Arnaud MJ.; Mild dehydration: a risk factor of constipation?; European Journal of Clinical Nutrition (2003) 57, Suppl 2, S88–S95
  • Lotan Y. et al.; Impact of fluid intake in the prevention of urinary system diseases: a brief review; Curr Opin Nephrol Hypertens 2013, 22 (Suppl 1):S1–S10
  • Romero V. et al.; Kidney Stones: A Global Picture of Prevalence, Incidence, and Associated Risk Factors; Rev Urol. 2010 Spring-Summer; 12(2-3): e86–e96.
  • HYDRATION AND KIDNEY HEALTH; Natural Hydration Council UK:http://www.naturalhydrationcouncil.org.uk/wp-content/uploads/2015/03/NHC_hydration_and_kidney_health_FINAL.pdf
  • Bahouth MN. et al.; A Prospective Study of the Effect of Dehydration on Stroke Severity and Short Term Outcome; Abstract T MP86:2015; International Stroke Conference Moderated Poster Abstracts – Session Title: In-hospital Treatment Moderated Poster Tour:
  • Manouchehr Saljoughian; Hypotension: A Clinical Care Review; US Pharm. 2014;39(2):2-4
  • https://www.uspharmacist.com/article/hypotension-a-clinical-care-review#sthash.1Ku9Afv2.dpuf
  • Hospital Hydration Best Practice Toolkit The health and economic benefits of providing water; https://www2.rcn.org.uk/__data/assets/pdf_file/0003/70374/Hydration_Toolkit_-_Entire_and_In_Order.pdf
  • Hudson MJ.; Complications of Diabetes Insipidus: The Significance of Headache; Pediatric Nursing
  • Wilson MG. and Morley JE.; Impaired cognitive function and mental performance in mild dehydration; European Journal of Clinical Nutrition (2003) 57, Suppl 2, S24–S29
  • Mortazavi, H et al. “Xerostomia Due to Systemic Disease: A Review of 20 Conditions and Mechanisms.”Annals of Medical and Health Sciences Research 4 (2014): 503–510. PMC. Web. 4 Aug. 2016.
  • Knor T. et al.; Stratum Corneum Hydration and Skin Surface pH in Patients with Atopic Dermatitis; Acta Dermatovenerol Croat 2011;19(4):242-247
  • https://www.betterhealth.vic.gov.au/health/healthyliving/water-a-vital-nutrient

HEALTHY SKIN and WATER INTAKE – PART 1

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Water is an essential element for our existence as it performs a number of vital functions in the body.  It is a key component of the fluid that forms the basis of saliva that helps us to swallow, of synovial fluids that cushion the joints and of the fluids that fill our eyeballs and lubricates our eyes. It provides the medium for by which most of the chemical reactions in the body occurs, it acts as a cushion for the nervous system (cerebrospinal fluid), allows us to get rid of waste products principally via the kidneys and urine production, and helps to regulate body temperature by the process of sweating. 1,2,3

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The body tightly controls its water volume and, under normal conditions, the volume fluctuates by less than 1% per day. Dehydration can be defined as a 1% or greater loss of body mass due to fluid loss e.g. urine, eye lubrication, sweating, breathing etc. 1,2,3

Research experiments using fluid restriction to induce dehydration, has shown that loss of body mass of about 1% can be seen after 13 hours, about 2% after 24 hours and nearly 3% after 37 hours when no fluids and only relatively dry foods are consumed. It was noted, however, that the subjects undergoing fluid restriction had a strong desire to drink and would have been unlikely to become dehydrated to such an extent accidentally. These experiments do show how quickly body fluid loss can occur and the importance of continued rehydration by the consumption of water. 1,2,3

 If water losses are not sufficiently replaced, dehydration will occur and extreme dehydration is very serious and can be fatal. More mild dehydration (about 2% loss of body weight) has been shown to result in headaches, fatigue, increased stress/anxiety, reduced physical performance and cognitive function. Some studies have refined the level of dehydration, where detectable symptoms and changes occurred, to the following: in males, dehydration of 1·59 % body weight loss and in females   1·39 % body weight loss. Such modest loss in body weight can occur in everyday activities, demonstrating the importance of maintaining optimal hydration. Taking into consideration various changes attributable to factors such as ambient temperature, physical activity, state of health, the European Food Safety Authority has recommended that the appropriate water intake should be approximately 2 litres per day for women and 3 litres per day for men. Higher water intake requirements will, of course, be higher for athletes and those that are physically active in hotter climates.4,5,6  

The Stratum Corneum (SC) of the skin consists of the essential barrier between the internal and external environment. Although most of the skin is between 2-3mm (0.10 inch)  thick, the SC plays a vital role in forming a protective barrier and helps to prevent percutaneous entry of harmful pathogens (e.g. germs) into the body. In addition to serving as a physical barrier, the SC has other important functions, including the regulation of body heat (thermoregulation), respiration and maintenance of the body’s water content – transepidermal water loss (TEWL)   Stratum Corneum properties and its protective function can be modified by various internal and external/environmental factors.7

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So what happens to human skin when the body becomes dehydrated?

Any change in the structure of the stratum corneum (SC) is potentially associated with alterations of both its barrier function and water holding capacity. Decreased hydration with reduced elasticity of the stratum corneum is responsible for cracks and fissures in the skin. The rate of TEWL is higher in dry skin than in normal skin where the integrity of the barrier function is not disturbed. The impaired barrier in skin conditions such as psoriasis and atopic eczema makes the SC less efficient in excluding substances that come in contact with the surface and patients with skin conditions e.g. atopic dermatitis are believed to be more prone to contact dermatitis than a normal population and those with psoriasis more susceptible to flare ups after exposure to chemicals.8 

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How can you tell if you are dehydrated?

One simple test is to gently pinch the skin on your hand …. hold for a few seconds and then release the skin. If the skin springs back you are not dehydrated, if the skin remains tented (turgor) then it is a sure sign that you are dehydrated and need to drink at least two glasses of water immediately. Another way of checking is the simple observation of the colour of your urine when you go to the toilet. Some charts have numerous colour options but the simple chart that the NSW Government Health Department has on their website “Beat the Heat” is probably the best and easiest to use:-

REMEMBER IF YOUR URINE IS DARKER THAN THAT INDICATED THEN YOU ARE SERIOUSLY DEHYDRATED AND SHOULD ATTEND YOUR NEAREST HOPSITAL EMERGENCY DEPARTMENT

URINE COLOUR CHART

This urine colour chart will give you an idea of whether you are drinking enough water or you are dehydrated (lost too much water from the body)

 Very Dehydrated ……. DRINK 1 litre of water 
 Dehydrated …….. DRINK 2 -3 glasses of water 
 Somewhat Dehydrated ……. Drink 1 glass of water 
 Hydrated, You are drinking enough, continue drinking as normal

http://www.health.nsw.gov.au/environment/beattheheat/Pages/urine-colour-chart.aspx

 

Also read our blog “HEALTHY SKIN and WATER INTAKE – PART 2

 

REFERENCES

  • Popkin B. M. et al.; Water, Hydration and Health; Nutr Rev. 2010 August ; 68(8): 439–458. doi:10.1111/j.1753-4887.2010.00304.x.
  • Benelam B. and Wyness L.; Hydration and health: a review; Journal compilation © 2010 British Nutrition Foundation Nutrition Bulletin, 35, 3–25
  • Je´quier E. and Constant ; Water as an essential nutrient: the physiological basis of hydration; European Journal of Clinical Nutrition (2010) 64, 115–123
  • Ganio M. S. et al.; Mild dehydration impairs cognitive performance and mood of men; British Journal of Nutrition (2011), 106, 1535–1543 doi:10.1017/S0007114511002005
  • Armstrong L. E. et al.; Mild Dehydration Affects Mood in Healthy Young Women; The Journal of Nutrition Ingestive Behavior and Neurosciences; First published online December 21, 2011; doi:10.3945/jn.111.142000
  • EFSA (2008). Draft dietary reference values for water. Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies, (agreed on 11 April 2008 for release for public consultation). (http://www.efsa. europa.eu/it/scdocs/doc/1459.pdf

PSORIASIS and ALCOHOL INTAKE

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The course of psoriasis is chronic and over a period of time the condition may be severe and commonly causes emotional problems, which in themselves may lead to relief drinking.1

Psoriasis Alcohol_1Patients with psoriasis experience considerable emotional distress, depression and social isolation due to the visibility of skin lesions, especially when the lesions are widespread and severe. Whilst it would be demeaning to state that all psoriasis patients with mild to severe psoriasis suffer from alcoholism, it has been confirmed in several Quality of Life studies that the percentage of psoriasis patients who admit to having a drinking problem may be as high as 32%. That said, the association between alcohol consumption and increased risk of psoriasis onset and psoriasis worsening has long been suspected.

Alcohol potentially weakens the immune response making psoriasis patients more susceptible to bacterial infections and injuries, which in turn can trigger and exacerbate psoriasis. Case studies have shown a definite connection between high consumption of alcohol and increased severity of psoriasis. Patients with severe psoriasis who misuse alcohol often show improvement after months of abstention or significant reduction in their alcohol intake. Patients who have abstained, improved and then gone on to have a binge drinking session, also experienced more severe flare-ups of their psoriasis upon resumption of drinking.1,2,3 It has also been shown that high alcohol intake is more problematic in the male population than in women.4

Alcohol_1Interestingly in a study of US women, researchers found that the risk for psoriasis varied according to the amount and type of alcoholic beverage consumed. “Non-light beer was the only alcoholic beverage that increased the risk for psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new onset psoriasis. One of these components may be the starch-source used in making beer. Beer is one of the few non-distilled alcoholic beverages that use a starch-source for fermentation, which is commonly barley. This differs from wine that uses a fruit-source (grapes) for fermentation. Some types of liquors such as vodka may use a starch-source for fermentation; however these starches are physically separated from the liquor during distillation. Starch sources such as barley contain gluten, which has been shown to be associated with psoriasis. For example, individuals with psoriasis have elevated levels of anti-gliadin antibodies (AgA) and may have a so called ‘latent-gluten sensitivity’ compared to individuals without psoriasis.” 5

This is not to say that other forms of alcohol are then, by default, safe as vodka and other spirits have been shown to increase the severity of psoriasis in other case studies. Alcohol also in general should not be consumed whilst taking various anti-psoriasis medications such as Methotrexate, Cyclosporine, and Acitretin.6

Alcohol also affects the pituitary gland, resulting in reduced secretions of the anti-diuretic hormone that maintains the body’s proper hydration level. More specifically, the kidneys are no longer able to reabsorb sufficient water from your urine, and your body ends up eliminating more water than it absorbs and the person becomes dehydrated. The symptoms of dehydration are fatigue, back and neck pain, increase itch and headaches.

There is still some controversy over safe levels of intake e.g. low and moderate, however, it is still considered prudent to restrict intake whilst on medication. It is certainly recommended for psoriasis patients to reduce or totally restrict alcohol intake, regardless of type, whilst their psoriasis is in a flare up. And when in remission to only consume low to moderate levels of alcohol. All forms of binge drinking should be abstained from.

f you are using alcohol as a crutch to cope with your emotional distress, general stress with work etc. or depression then please seek medical assistance. Also read our blog on “Psoriasis and Water Intake”, “Stress, Anxiety, Depression and Psoriasis” and “Stressed about Psoriasis – Identify Your Stressors and Yours Stress Responses”. Identifying and understanding your stress triggers and finding other ways to cope with your stress and anxiety can help you cut back on your alcohol intake.

REFERENCES

  1. Poikolainen K. Et Al.; Alcohol Intake: A Risk Factor For Psoriasis In Young And Middle Aged Men? ; Bmj Volume 300 24 March 1990
  2. Iva Dediol, Marija Buljan, Danijel Buljan, Vedrana Bulat, Maja Vurnek Živkovi? & Mirna Šitum: Association Of Psoriasis And Alcoholism: Psychodermatological Issue Psychiatria Danubina, 2009; Vol. 21, No. 1, Pp 9–13
  3. Captain G E Vincenti and Dr S M Blunden; Psoriasis and Alcohol Abuse; JR Army Med Corps 1987; 133: 77-78
  4. Zimmerman GM. Alcohol and Psoriasis: A Double Burden.Arch Dermatol.1999;135(12):1541-1542. doi:10.1001/archderm.135.12.1541.
  5. Qureshi AA, Dominguez PL, Choi HK, et al. Alcohol intake and risk of incident psoriasis in US women: a prospective study. Arch Dermatol146(12):1364–9 (2010 Dec).
  6. Vena GA. et al.;The effects of alcohol on the metabolism and toxicology of anti-psoriasis drugs.; Expert Opin. Drug Metab Toxicol. 2012 Aug;8(8):959-72. doi: 10.1517/17425255.2012.691166. Epub 2012 May 17.

 

Simple Mental/Mind Relaxation Techniques Part 2

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Are you having trouble controlling your thoughts and finding it difficult to let yourself float in the Full Body Scan Meditation or the Releasing Troubles and Worries Exercise?

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WELL DON’T WORRY!!!!!!!

Here is a “Thought-Stopping” Exercise that can be used during either the Full Body Scan Meditation or the Releasing Troubles and Worries Exercise or when trying to get to sleep.

In thought-stopping, you would do this exercise FIRST. So lie on a yoga bed for the exercises or in bed to get to sleep.

Think about something that you know is worrying you and will keep you awake …… something troubling you that you will know your mind will churn over and make it difficult to relax or go to sleep.  Force your mind to concentrate on that issue or person e.g. the project at work is in trouble and you know your boss is going to get angry at you and the team. Turn this over in your mind again and again and then suddenly in your mind “Shout Out” STOP!!!!!!. Breath easily and try to relax …… if you feel the issue creeping back into your mind ….. repeat the STOP exercise again and again until your mind releases the thought.

This STOP exercise basically is forcing your brain to recognize when to stop thinking about something …. It abruptly interrupts the thought process and makes the brain shift its focus … this is where the relaxation technique, that you have chosen should now be used.

A number of sites on the internet offer some wonderful guided meditations, and alternative Relaxation Techniques. Below we have listed some of the techniques and their links:-

SAFE HAVEN” – VISUALIZATION – Page 19 http://www.mirecc.va.gov/visn16/docs/Franklin_Relaxation_Therapist_Manual.pdf

QUICK RELAXATION STRATEGIES

https://www.k-state.edu/paccats/Contents/Stress/Quick%20Relaxation%20

Strategies.pdf

 

ABC GUIDED AUDIO MEDITATIONS

http://www.abc.net.au/radionational/programs/lifematters/features/meditation-toolkit/audio-practice/4326674

 

Also read our blog “Stress, Anxiety, Depression and Psoriasis, Stressed about Psoriasis – Identify Your Stressors and Yours Stress Responses, Simple Physical Relaxation Techniques for Psoriasis Patients, Simple Mental/Mind Relaxation Techniques Part 1 – For Psoriasis Patients, Simple Mental/Mind Relaxation

 

REFERENCES

  1. National Center for Health Promotion and Disease Prevention (NCP); Manage Stress Workbook; http://www.prevention.va.gov/mpt/2013/docs/managestressworkbook_dec2013.pdf
  2. Relaxation Techniques for Health: What You Need To Know; National Institutes of Health; U.S. Department of Health and Human Services; https://nccih.nih.gov/sites/nccam.nih.gov/files/Get_The_Facts_Relaxation_Techniques_02-06-2015.pdf
  3. Progressive Muscle Relaxation; http://www.cci.health.wa.gov.au/docs/ACF3944.pdf
  4. Manzoni G.M. et al.; Relaxation training for anxiety: a ten-years systematic review with meta-analysis ; BMC Psychiatry 2008, 8:41 doi:10.1186/1471-244X-8-41
  5. Franklin C.L. et al.: Relaxation Enhancement Therapist Manual; http://www.mirecc.va.gov/visn16/docs/Franklin_Relaxation_Therapist_Manual.pdf

Simple Mental/Mind Relaxation Techniques Part 1

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As we indicated in the Simple Physical Relaxation Techniques blog, it is important that you take control and find some relaxation techniques that best assist you to relax and to control your stress levels and increase your emotional resilience. Once you have mastered the 4 exercises that you found or will find in our Physical Relaxation Techniques blog it is time to combine any one of these with some simple Mental/Mind Relaxation Exercises and find the one that works for you:-

RELEASING YOUR TROUBLES AND WORRIES

 Create a Picture in Your Mind

Think of a view or a place or an object that you find simple, quiet and inspiring or use one of the following.

simple_mental_part1_2simple_mental_part1_1simple_mental_part1_3simple_mental_part1_4

Study every minute detail in your mind.

If you are sitting on the sand on the beach, feel the aetting sun warming your face, feel the breeze on your skin, smell the ocean air, taste the salty tang on the breeze, hear the waves washing right up to you and as you hear each and every wave, release all of your stress and throw it onto the waves to wash out into the ocean …… take a bad feeling and do the same with this feeling and just release it to the waves, repeat with a troubled thought, or a person who riles you or who has upset you … do it with everything that has angered, troubled, annoyed, worried or upset you until you are totally relaxed and free from all troubles and worries.

When using the sunset …. Do the same as you imaging the colour changing and fading until you are free from all troubles and worries and looking at a beautiful starry night.

When using the rainbow … do the same as you climb higher onto the rainbow ……. with each step leave another thing behind you. Climb right to the top of the rainbow and view the world free from all troubles and worries and as you begin to make your way down the rainbow know that you remain free from all of you troubles and worries as you step into a field of beautiful flowers and lush grass.

When using the garden …. Smell the flowers, hear the bees, watch the sun glint on dragon fly wings, and as you go through the gate leave all of your troubles behind you and imagine yourself walking along a golden path into beautiful warm, fern forest. Wind the path back to the garden but notice that when you walk back into the garden your troubles and worries have all gone and you a free to enjoy the garden with a feeling of peace and serenity.

RELEASING PAIN AND DISCOMFORT

Body Scan Meditation

To practice the Body Scan Meditation, get into a comfortable position, by lying on a yoga mat on the floor or on a bed. You can use a pillow under your head. You can also sit in a chair on in the Yoga position. Use the Controlled Breathing or the Progressive Relaxation exercise from our Simple Physical Relaxation Technique blog and gently bring your awareness to the present.

1. Concentrate on a specific body part, e.g. your right arm. As you breathe deeply, scan that part of your body for sensations – heat, pain or burning. Notice the sensations but try not to get lost in thought and feel the heat, pain or burning. Repeat in your mind – “ALL HEAT, PAIN, or BURNING IS GONE”…………. Repeat three times

Gradually let your focus move to different body parts—each leg, your hips, stomach, chest, hands, arms, and head. And do the same.

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2. Practice the Body Scan Meditation and do not worry if you become aware of your mind’s tendency to drift to other thoughts. When you notice this happening, just let the thought go and gently bring your attention back to your body. If you have any pain or discomfort, just notice it, accept it, and release it using the mantra and continue scanning

The more you do this exercise the greater control you will achieve over your pain or discomfort.

Also read our blog “Stress, Anxiety, Depression and Psoriasis, Stressed about Psoriasis – Identify Your Stressors and Yours Stress Responses, Simple Physical Relaxation Techniques for Psoriasis Patients, Simple Mental/Mind Relaxation Techniques Part 2 – For Psoriasis Patients, Simple Mental/Mind Relaxation

 

 

REFERENCES

  •  National Center for Health Promotion and Disease Prevention (NCP); Manage Stress Workbook; http://www.prevention.va.gov/mpt/2013/docs/managestressworkbook_dec2013.pdf
  • Relaxation Techniques for Health: What You Need To Know; National Institutes of Health; U.S. Department of Health and Human Services; https://nccih.nih.gov/sites/nccam.nih.gov/files/Get_The_Facts_Relaxation_Techniques_02-06-2015.pdf
  • Progressive Muscle Relaxation; http://www.cci.health.wa.gov.au/docs/ACF3944.pdf
  • Manzoni G.M. et al.; Relaxation training for anxiety: a ten-years systematic review with meta-analysis ; BMC Psychiatry 2008, 8:41 doi:10.1186/1471-244X-8-41
  • Franklin C.L. et al.: Relaxation Enhancement Therapist Manual; http://www.mirecc.va.gov/visn16/docs/Franklin_Relaxation_Therapist_Manual.pdf