Speaking at the American Academy of Dermatology's Skin academy (Academy), dermatologist Flor A. Mayoral, MD, FAAD, clinical instructor in the departments of dermatology and cutaneous surgery at the University of Miami's Miller School of Medicine in Miami, Fla., discussed the most common outward signs of stress on the skin, hair and nails, and offered stress management tips to control these symptoms.
"In treating hundreds of patients over the years with skin conditions such as eczema, rosacea, acne and psoriasis, I have seen firsthand how stress can aggravate the skin and trigger unexpected flare-ups that, in effect, create more stress for patients. Learning how to manage the effects of stress on your skin can help alleviate some of the anxiety and symptoms," Mayoral said.
Highlighting the effect of stress on skin, she noted that an increased level of the body's stress hormone (cortisol), causes a rise in oil production, which can lead to oily skin, acne and other related skin problems.
She cited a study in the January 2001 issue of the Archives of Dermatology entitled "Psychological Stress Perturbs Epidermal Permeability Barrier Homeostasis," which showed that stress has a negative effect on the barrier function of the skin, resulting in water loss that inhibits the skin's ability to repair itself after an injury.
Dr. Mayoral further explained that stress may be the primary reason for unexplained hair loss. When someone is under stress, hair can go into the telogen (fall-out) phase. Telogen effluvium is a very common hair loss problem that can occur up to three months after a stressful event. After the initial hair loss, hair usually grows back in six to nine months.
"Stress affects people differently - some may develop an ulcer, or have a heart attack, or lose their hair. Hair loss is a normal response to stress, but patients should see a dermatologist for a proper evaluation to rule out other medical causes. I also advise patients to avoid any strange diets where only one or two foods are allowed, as improper nutrition and extreme or rapid weight loss can result in hair loss," said Dr. Mayoral.
Nails are not immune to showing outward signs of stress, and some people develop the nervous habit of biting their nails or picking at them when they feel stressed, she said.
Another stress-related nail habit that Dr. Mayoral discussed is people who rub their fingers over their thumb nail, which can create a ridge across the nail. This rubbing causes a distortion of the nail plate, and when the nail grows, a raised ridge forms in the middle of the nail. In addition, physical or emotional stress, certain diseases, and chemotherapy can cause white horizontal lines to appear across the nails. Brittle, peeling nails also are a common side effect of stress.
"Sometimes patients with nail problems are not aware that their habits or tics from being stressed out or nervous are at the root of their problem. There are instances where patients self-inflict skin, hair or nail problems that go beyond what we normally expect from stress, and these patients often need psychological help to modify their behaviour," she said.
In her practice, Dr. Mayoral finds it beneficial to give patients the tools to help themselves cope with stress-related skin flares, particularly patients with eczema, acne, psoriasis, or seborrheic dermatitis where outward symptoms are obvious.
"Being in control of your situation can help relieve stress. For instance, I teach my acne patients who use a topical acne medication once a day how to safely use the medication more frequently to counter the effects of stress. If this doesn't work, they know to call me or come in to the office so we can make further adjustments in their treatment. I find that initially giving them the power to fix the problem is very empowering to them," she said.