How to diagnose and treat ‘stressed’ skin
November 1 is International Stress Awareness Day. Dr Maryam Zamani looks at how to spot stressed-out skin, and discusses how to treat it.
Aesthetic Medicine (AM): How does stress display on the skin?
Dr Maryam Zamai (MZ)“Stress has multiple and wide impacts on skin and skin disease. The body’s stress response creates a cascade of events which result in the release of cortisol, catecholamines, and neuropeptides. Together, this has been shown to increase skin inflammation, itching, impair skin barrier function and wound healing, and suppress immunity. Specifically in skin, multiple neuroinflammatory conditions can be triggered or aggravated by stress, such as psoriasis, atopic dermatitis, acne, contact dermatitis, alopecia areata, itch or pruritus, and erythema.”
AM: Does stress age patients?
MZ: “Stress can cause detrimental physiological and functional consequences in the skin. Skin ageing is characterised by the formation of lines and wrinkles, increased pigmentation, loss of elasticity and firmness, and dull skin; This can be caused by both intrinsic and extrinsic factors. While the exact mechanism of how stress impacts skin ageing is still being studied, we do know that epinephrine, norepinephrine, and cortisol increase DNA damage, interfere with DNA repair, and alter transcriptional regulation of the cell cycle. UV irradiation, smoking and air pollution have been confirmed as critical chronic stressors that impact skin ageing significantly. Telomere shortening has emerged as another possible cellular mechanism linking chronic psychological stress and ageing. Various chronic stress situations have been associated with shorter telomere length, including caregiving for a family member with chronic conditions or elderly dementia patients, major depression, childhood adversity, and exposure to intimate partner violence. Recent studies have also shown the negative effect of sleep deprivation on skin ageing. Lack of sleep creates increased signs of intrinsic skin ageing like fine lines, uneven pigmentation, and reduced elasticity. Skin also recovers more slowly after skin barrier disruption.”
AM: What treatments can help with the imprint stress leaves on the skin?
MZ: “Mind-body therapies have been shown to ameliorate some of the harmful physiological changes attributed to stress or to reduce harmful behaviours. Treatments such as meditation, biofeedback, hypnosis, guided imagery and more have been evaluated in the treatment of skin disease and have shown some benefits. Interventions have had beneficial outcomes in diseases such as atopic dermatitis, psoriasis, trichotillomania, and others. There are treatments that can be used to help diminish the negative effects of stress. Creating a consistent and simple skincare routine to reveal, enhance and protect the skin is an effective foundation. Repairing the skin barrier is essential, a healthy and functional skin barrier is important against dehydration and penetration of allergens and irritants. Stay away from aggressive treatments. Invest in gentle exfoliation to create an inviting environment for nutrients to enhance the skin. Go for antioxidants and skin nourishers - think of Vitamin C, E and A to protect and enhance collagen and elastin production. Find products rich in ceramides to lock in hydration and hydrators like glycerine, hyaluronic acid, and squalene. LED can also help reduce skin inflammation, improve skin health, and help reduce stress. In-office treatments, can be applied to target effects such as fine line, wrinkles, and pigmentation.”