Stress is an inevitable occurrence in the life of all individuals. It takes many forms, such as social, mental and physical to name a few. Anything from work deadlines, commuting burdens, financial obstacles to raising a kid – stress doesn’t stop at anyone’s behest. Whilst some personalities take it with ease and find means of dealing with it, others crumble to states of depression and even resort to suicide – the obvious winner here being stress itself.

The amount of stress we wish to take in is in our hands as is the amount we wish to neglect. Apart from the various sizes and shapes, stress comes in as mentioned above, stress can be an important external indicator of internal health. One such indicator is the largest organ of our body, the skin. The skin & hair are generally referred to as mirror images of internal body system functioning and are often the first indicator/sign of disease activity originating from within. We dedicate this write-up to our skin & hair, for, they are our shining armour in the fight against a merciless opponent- stress. 

EFFECTS OF STRESS ON THE SKIN

When we are stressed, our body releases a hormone known as cortisol. The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones— can disrupt almost all body processes. This puts an individual at increased risk of numerous health problems, including anxiety, depression, digestive problems, headaches, heart disease, sleep problems, weight gain, memory and concentration impairment. The mind and skin are connected at many intricate levels. One theory is the “target organ” theory: some people get ulcers, some people get migraines and other people get skin rashes as the skin is their target organ to channelize stress. As the skin is exposed to view, skin conditions elicit reactions from the patient's environment and the easy accessibility of the skin allows patients to interact directly with their rashes, adding further to emotional and mechanical stress. So, a skin disorder in itself can be a cause of concern and thus lead to stress, while on the other hand, stress can be considered as a triggering/perpetuating/aggravating factor in the causation of various skin diseases.  

1. General conditions:

  • Dryness: Periods of chronic stress will release the hormone cortisol that in turn damages the skin’s ability to retain water leading to dryness. One must drink plenty of water throughout the day. Application of a non-allergenic, fragrance-free moisturizer while the skin is slightly damp traps moisture, thereby protecting the skin from dryness. 
  • Sleep: Poor quality sleepers have increased signs of intrinsic skin aging including fine lines, uneven pigmentation and reduced elasticity and hollowness in the under-eye region. On an average 6-8 hours of sleep is warranted along with plenty of fluid intake. There are a multitude of under-eye creams in the market with moderate benefits. Dermal fillers can be injected into the tear trough, a hollow groove in the under-eye region, which thereby replenishes the sparse hyaluronic acid there. “Early to bed, early to rise makes the skin healthy, worthy and nice”- is the mantra here for sure. 
  • Fine lines: Constant use of the muscles of facial expression, like frowning and pursuing one’s lips when one is stressed or angry can lead to deeper wrinkles in these areas over time. Topical retinoid creams, Botox injections and platelet-rich plasma therapy are some of the useful modalities to target fine lines and wrinkles. 
  • Immune system: Chronic stress usually suppresses the immune system, increases susceptibility to infections and exacerbates some allergic and inflammatory diseases. A balanced and healthy diet rich in fruits and vegetables, oral antioxidants along with a proper exercise regime will definitely give a boost to one’s immune syStem. 
  • Others: Smoking and air pollution have been confirmed as critical chronic stressors that impact skin aging significantly. Air-borne particle exposure from traffic is associated with significant increase in pigment spots and facial wrinkles. Avoiding smoking and using sunscreens on a regular basis along with physical sun protection can go a long way. 

2. Skin conditions:       

  • Acne: The exact cause by which stress worsens acne is not known but a possible explanation is that during periods of stress, stress hormones are activated. The cells that produce sebum have receptors for stress hormones. Sebum is the oily substance that mixes with dead skin cells and bacteria to clog the hair follicles, leading to a pimple or acne cyst.
  • Acné excoriée: It is a skin condition seen particularly in adolescent girls under emotional stress, who pick and squeeze pimples leaving behind an unsightly dark, pigmented scabbed wounds. Such patients are the ones who usually spend hours in front of the mirror trying to correct any self-perceived body dysmorphisms. Treatment of the wounded areas is essential with topical antibiotics and wound healing agents. Similarly, anti-acne therapy may be initiated.
  • Rosacea: Stress increases blood flow to the skin that causes capillaries to expand. Stress also triggers flushing, a condition known as rosacea wherein the skin of the cheeks, chin, nose and forehead becomes persistently red and with possible development of red bumps similar to acne. Sometime small blood vessels can also become visible in such patients. It may be affiliated with a weakened immune system and temperature changes. Topical and oral antibiotics, sunscreens of SPF 30 or above, topical retinoids, topical azelaic acid cream etc. are all helpful in the treatment of rosacea.  
  • Psoriasis is a chronic recurrent autoimmune skin disorder, the cause of which is unknown wherein the skin cells multiply very rapidly leading to red, rough hard plaques surmounted with silvery scales, commonly seen on elbows, knees, palms,soles, nails and/or scalp. Stress is a very well known trigger factor for psoriasis. Chronic psoriasis in itself also leads to psychological difficulties, including poor self-esteem, sexual dysfunction, anxiety, depression and suicidal ideation. It is of utmost importance to moisturize the skin as frequently as possible along with the prescribed medication given by the dermatologist (which may consist of omega-3 fatty acid capsules, antihistamines, topical corticosteroid / topical vitamin D analogues or oral medicines, etc.).
  • Atopic eczema/dermatitis: A condition is commonly seen in childhood, appears as oozing red rashes on cheeks (usually in infants), elbows or elbow folds and behind the knees to name a few. The condition is severely itchy at times. Children with atopic dermatitis have higher levels of emotional distress and more behavioral problems than healthy children. Teasing and bullying by children at school along with the social stigma of visible skin rashes can cause social isolation adding to further stress. The onset or exacerbation of atopic dermatitis often follows stressful life events. A treatment plan often includes medicines (topical corticosteroids / topical tacrolimus, topical antibiotics oral antihistamines, etc.), skin care (regular and frequent moisturizer use), and lifestyle changes. Skin care and lifestyle changes can help prevent flare-ups.  
  • Severe emotional stress may exacerbate pre-existing urticaria, a condition more commonly referred to as “hives”. Hives are red itchy swellings that can occur anywhere on the body. Due to the severity of itching and visibility of the rashes, patients feel embarrassed when the rashes crop up during important meetings and this can further lead to a state of depression. The dermatologist usually prescribes oral antihistamines and topical calamine-based lotions.  
  • Vitiligo: It is an autoimmune condition wherein in white patches develop on the skin. Stress and pre-existing thyroid disorder are common triggering events. Social stigma is very highly connected with vitiligo as patients get marriage proposal rejections and social isolation from friends and family alike. Such individuals are very depressed and have very low self-esteem. There are a host of treatment modalities available to stop further progression of the disease and also to get normal color back (topical and oral medicines, phototherapy, surgical skin grafting, etc.).

Effects of stress on the hair: 

  • Graying of hair is very common due to the stressful lifestyle and nutrient-poor foods individuals consume these days, yet the exact cause remains unknown. Usually topical solutions and B-complex vitamins / Biotin based tablets may be prescribed for the same. 
  • Telogen effluvium is a condition wherein a person sheds more than 100 hair per day (shedding 50-100 telogen hairs per day is considered normal). It occurs when an increased number of hair (i.e., more than one in ten) are in the telogen stage (shedding stage) of the hair growth cycle. This abrupt shift of anagen (growth phase) hair into telogen results in increased shedding several (approximately three) months later since that is the length of time hair stay in the telogen stage prior to falling out. Stress, childbirth or the cessation of oral contraceptives, surgery with general anaesthesia, severe systemic illness including fever, thyroid disease and inadequate nutrition (especially lack protein intake), ferritin and vitamin D3 deficiency, any and all of which may trigger the onset of hair fall. Along with hair fall, the hair starts getting thinned in such states. Treatment is dictated by its cause whenever known. Generally, a healthy protein powder, topical hair growth serums and minoxidil solution, oral multivitamin tablets (containing biotin and other supplements) and platelet-rich plasma therapy all play a vital role in hair fall reduction. 
  • Trichotillomania is a condition wherein a person pulls out his or her own hair with an obsessive-compulsion, which occurs as a result of stress, anxiety, depression, behavioural disorder, mental retardation and delusions. Children who engage in such hair pulling usually are ones that are neglected by parents or friends at school, those who undergo child abuse, have broken relationships etc. Behavior modification therapy along with medications may be prescribed by the treating dermatologist or psychiatrist. 
  • Stress is a very well known aggravating factor in a condition known as alopecia areata. In this condition, there are circular circumscribed patches of hair loss commonly on the scalp or beard areas. Sometimes hair regrowth may occur without any medicinal intervention. Dermatologists recommend medical therapy in the form of topical minoxidil solution, topical corticosteroids, hair growth serums, zinc based tablets and injectable corticosteroids all aid in hair regrowth.