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Feeling Stressed?
Pending job cuts at the office.
Back-to-back final exams. A messy divorce. An unexpected surgery. What do
they all have in common? In a word -- stress. While everyone knows that
stress can take a toll on a person physically and psychologically, it also
can lead to dermatologic problems, such as acne, brittle nails or even hair
loss.
Speaking today 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," said Dr. Mayoral. "Learning how
to manage the effects of stress on your skin can help alleviate some of the
anxiety and symptoms."
Stress and the Skin
When a person becomes stressed, the level of the body's stress hormone
(cortisol) rises. This in turn causes an increase in oil production, which
can lead to oily skin, acne and other related skin problems. Dr. Mayoral
noted that even patients with skin that is not affected by acne tend to
develop temporary stress-related acne due to increased oil production.
In fact, a study in the January 2001 issue of the Archives of
Dermatology entitled "Psychological Stress Perturbs Epidermal Permeability
Barrier Homeostasis," found 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. Specifically, the study
involving 27 medical, dental and pharmacy students examined how periods of
higher stress (in this case, during final examinations) impacted the skin's
response to repeated stripping of cellophane tape on the subjects' forearms
vs. periods of lower stress (such as after returning from winter vacation).
Researchers found that it took longer for the skin to recover from the
minimally invasive tape stripping during periods of perceived higher stress
than during less stressful periods.
"This study was the first of its kind to suggest what dermatologists
anecdotally have known for years -- that psychological stress adversely
affects the normal functions of the skin," said Dr. Mayoral. "While the
subjects in this study did not have any pre-existing skin conditions, I
would suspect that people with skin conditions such as eczema or psoriasis
would have been even more adversely affected by this experiment."
Stressed-Out Hair
There are many reasons why men and women lose their hair, but Dr.
Mayoral believes 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.
Life-changing events such as childbirth or surgery also can cause hair
loss. Dr. Mayoral explained that during these times, the body takes a
"time-out" from growing hair to concentrate on recovery and healing. As
such, hair does not grow as much and some could shed and not grow back
right away.
"Stress affects people differently -- some may develop an ulcer, or
have a heart attack, or lose their hair," said Dr. Mayoral. "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."
Effects of Stress on Nails
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. 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," said Dr. Mayoral. "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 behavior."
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. For example, Dr. Mayoral teaches her acne
patients how to modify their treatment regimen to deal with flare-ups from
stress -- which gives them control to help themselves during stressful
periods.
"Being in control of your situation can help relieve stress," said Dr.
Mayoral. "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."
In addition, Dr. Mayoral offered tips to curb the effects of stress
both internally and externally:
-- Learn to recognize the underlying problem that is triggering your
symptoms and develop skills to help minimize the stress.
-- Exercise helps release endorphins in the body that can reduce stress.
-- Avoid very hot showers or baths and use detergent-free soaps.
Moisturize as soon as possible after bathing.
-- Wear a broad-spectrum sunscreen with an SPF of 15 or higher daily to
protect your skin from sun exposure.
For more information on skin, hair and nail conditions that can be
affected by stress, visit http://www.skincarephysicians.com, a Web site
developed by dermatologists that provides patients with up-to-date
information on the treatment and management of disorders of the skin, hair
and nails.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology
(Academy), founded in 1938, is the largest, most influential, and most
representative of all dermatologic associations. With a membership of more
than 15,000 physicians worldwide, the Academy is committed to: advancing
the diagnosis and medical, surgical and cosmetic treatment of the skin,
hair and nails; advocating high standards in clinical practice, education,
and research in dermatology; and supporting and enhancing patient care for
a lifetime of healthier skin, hair and nails.
American Academy of Dermatology
http://www.aad.org
Feeling subliniat? - Feeling Stressed? - articole medicale engleza - startsanatate