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Everyday, I see a variety of rashes and skin issues in my clinic. For obvious reasons, patients want to know the underlying cause. For many skin disorders, I am able to give a very clear answer. Examples would include rashes caused by certain bacteria, fungi, viruses, or allergic reactions. For many other types of skin issues, the cause can be multifactorial without any clear underlying reason. One of the most common questions I get from patients is if their rash is caused by stress. Since this is such a frequent question in my clinic, I will attempt to answer it in this blog post below.
How Does Stress Affect the Skin?
There is no way around it, we are all going to be stressed at some point. Stress is part of our body's natural response to immediate threats, or our "fight or flight" system. While this response can be helpful for brief periods of time, when the stress is prolonged it can lead to negative affects. We all experience some of these stressors from school, work, financial difficulties, family issues, illnesses, deaths of loved ones, and many other situations.
When these stressful events happen, our bodies produce increased amounts of regulatory hormones such as cortisol and epinephrine. As long as the stress goes away in a short amount of time, no significant harm is done to the body or the skin. If the stressor doesn't resolve, these hormones create increased amounts of inflammation in our bodies. They also lead to the release of substances such as histamine that can cause numerous rashes and significant itching. Some of these hormones can lead to reductions in our immune response making us more prone to skin infections. Increased stress also causes our bodies to break down collagen and other vital building blocks in our skin. Stress even increases the amount of oil produced by our skin leading to acne breakouts and other skin issues. With all of these possible effects, it's no wonder stress can cause or worsen so many skin disorders.
Skin Disorders Worsened by Stress
While essentially any skin disorder can be due to stress, some of the most common ones are:
Eczema and Atopic dermatitis
Psoriasis
Hives
Acne and Rosacea
Skin Infections
Hair loss
Is There a Way to Tell if My Skin Problems are Due to Stress?
As you probably noticed when reading the list of disorders above, the conditions worsened by stress are some of the most common skin issues seen by dermatologists. Does that mean that every one of these disorders are mostly due to stress? I don't think so. I see plenty of people who are living happy and relatively stress-free lives who are still affected by all sorts of rashes and other skin issues. All of these skin disorders have many other potential causes including genetic predispositions, changes in weather, exposure to chemicals, or just the natural cycle of the condition. Trying to sort out which ones are due to stress and which were going to happen anyway is like trying to figure out which one of my five kids caused the latest mess in the kitchen. I can speculate based on evidence available, but just like my kids, stress doesn't fess up and admit that it was the one that caused the problem.
So, when a patient asks me if their current skin issue is due to stress, I unfortunately have to answer with a big "maybe". When patients ask this question, it typically means they recognize they are experiencing some significant stressor in their lives, otherwise they probably wouldn't be asking the question. To further investigate this, I will usually ask them about their stressors followed by a discussion of how they could be affecting their skin. I then discuss the fact that I see plenty of people with their same issue that may not be having any significant stress. Overall, one of my main goals is to ensure patients do not feel even more stressed about the fact that stress might be causing their skin issue. If I blame their rash on stress, that puts the burden on the patient to "fix" their rash by eliminating the stress. I like to emphasize that we are going to approach their skin issue as if it is entirely my job to figure out how to treat their skin issue independent of stress. I say this because there is a good chance they won't be able to eliminate or reduce the amount of stress in their life. At the same time, I absolutely encourage them to make any efforts to reduce stress because even if it doesn't help their skin, it will help make them happier, healthier, and overall feeling better in ways that go beyond good skin health.
Ways to Reduce Stress to Help Your Skin and Overall Health
I wish that I could say I am an expert on how to reduce stress in our lives, but unfortunately I am not. Throughout my dermatology residency, I received approximately zero training on how to help others reduce stress in their lives. The things I will suggest below are through personal experience and through listening to hundreds of hours of books and podcasts that are related to health and well being. I will provide links to some of my favorite ones that have helped me the most, and I encourage you to check them out.
Exercise - This is my go to strategy. I love to train for hard events like triathlons and long bike races. While it can be hard to motivate myself to wake up early enough to work out, I always feel better afterwards. For more information on the importance of exercise and all things health related, I highly recommend reading Peter Attia's new book entitled Outlive: The Science and Art of Longevity , or listen to his amazing podcast series.
Get Adequate Amounts of Sleep - For many years, I discounted the importance of sleep. I figured as long as I was sleeping enough to function, it was enough. After reading Matthew Walker's book entitled Why We Sleep, I became thoroughly convinced that sleep is essential to our overall health and well being. I still need to get more sleep than I do, but I am getting about an hour more than I used to. This has certainly helped me in many ways, including reducing my levels of stress.
Eat Healthy - While I won't get into any specifics as there are so many opinions on what type of diet is best, I will say we could all benefit from eating healthier. Some basic principles are to avoid processed foods and items high in sugar. Eating healthy can also lead to lower levels of inflammation in our bodies which can help with many skin disorders.
Build up Social Networks - Numerous studies show the benefits of having friends and those who can offer support. People who have and maintain friendships live longer and are happier. When we are stressed, it can be important to turn to others for support as they can help get us through hard times.
Seek Help When Needed - Asking for help is hard. Needing help doesn't mean we have failed, it just means we might not be able to do it all on our own. Sometimes the needed help may come through a therapist, other times it may come with medications for anxiety, depression, or other disorders. Whenever you need help, don't be afraid to seek it out.
Take Cold Showers or Use Other Forms of Deliberate Cold Exposure - I am still becoming a convert to this because it isn't very fun, but there are many studies showing the benefits of cold immersion therapy. This can be done in a cold plunge tub or with a cold shower. This unpleasant stimulus actually causes our bodies to release dopamine which can improve mood, lower stress and depression, and increase motivation. I try to spend at least 11 minutes split up through the week under the freezing cold water in my shower. Turning the shower from hot to cold is one of the hardest things I do most days, but I believe in its benefit for many aspects of our health including our mental health. For more information on this "fun" practice, listen to Andrew Huberman's podcast on Cold Exposure for Health and Performance.
There are numerous other ways to deal with and overcome stress including meditation, prayer, yoga, hobbies, providing service, etc. The key is to find the ones that work for you and to implement them as best as possible.
I hope your main takeaway from this blog post is to try not to stress about whether or not your rash or skin issue is mostly due to stress. All that is going to do is stress you out even more! Try to put your trust in your dermatologist to get your skin better, and focus on reducing stress in your life for its other health benefits. If these measures also help your skin rash, even better!