Whether you are bogged down at work or struggling with a relationship, your excess stress could be impact your health and your skin. We’re exploring the link

If you’ve been living with a skin condition like psoriasis or chronic spontaneous urticaria (CSU) for some time, then you’ve probably learned the hard way about certain things that trigger your flare-ups. Maybe it’s the expensive shampoo you splurged on that left your scalp so itchy you wanted to shave your head. Perhaps it’s that woolly jumper that looked great on you, but caused your skin to break out. 

But while you can avoid that shampoo and try a different jumper, one trigger few people can avoid is stress. Whether we like it or not, stress is a fact of everyday life – and sadly one that can have a huge impact on our skin. 

Stress has been indicated as a trigger in a number of skin conditions, including acne,1 psoriasis2 and CSU.3 One study, for example, found that around 40% of people with psoriasis say stress exacerbates their condition,4 and another study reported that many people ranked stress as a higher trigger than infections, trauma, medications, diet, and weather.5 

Similarly, a study of people with CSU found a significant number had experienced stressful life events preceding their symptoms4. Some people find their skin condition first appears during a particularly stressful period in their life, while others notice their symptoms worsen when they’re going through a tough time. So is there a way that you can avoid this? 

Itching to know more 

The problem is that stress isn’t just in our heads – it triggers very real physical changes throughout the body. Thanks to the field of psychoneuroimmunology – the study of the link between the mind, nervous and immune systems (and impossible to say 3x fast…try it) – scientists are beginning to understand a little better why exactly this happens. 

When we’re stressed, the brain stimulates the adrenal glands to produce the stress hormones cortisol and adrenaline. In the short-term, these hormones prepare the body to respond to a particular threat.6 This was useful back in the day when we needed to run away from saber-toothed tigers. But since that doesn’t happen anymore, our body turns it on when you need to “run” from a threatening situation like giving a big presentation at work (which for some of us is equally as frightening as the saber-toothed tiger). 

Research suggests that when it comes to skin conditions like psoriasis, it could be the cortisol that’s the problem. Cortisol helps to dampen the immune response.7 However, in people with skin conditions, it appears this stress reaction could be slightly askew. Some studies have shown that in stressful situations, people with psoriasis have lower cortisol levels in their blood and higher levels of adrenaline than those without psoriasis.8 In the absence of cortisol, the immune system appears to go into overdrive, triggering the release of inflammatory compounds called cytokines, which may stimulate the skin cells to replicate faster.9,10 The cells build up, and before you know it you have an annoying flaky patch that itches like crazy. 

In the case of CSU, emotional stress can potentially make symptoms worse.11 

Calm your body, spirit – and skin 

So now that you know the what and why, here’s how to work with it: 

Stock up on beauty sleep: There already appears to be a link between CSU and lack of sleep3. So if stress is keeping you awake at night, you’ve got a double whammy on your hands. Try to tackle the source of your insomnia. Whether that’s reviewing your workload, scaling back on other commitments or just saying no to binge-watching your favorite show at night, aim to get at least 8 hours of shut eye. Time to put some hours in that old sleep bank! You should also consider the importance of ‘sleep hygiene’—try turning off your computers and phone before going to bed in order to promote relaxation and fall asleep faster. 

We all need somebody to lean on: Reach out online, speak to close friends or seek the help of a counsellor. Talking through your anxieties can help you to feel calmer which will be reflected in the state of your skin. A review published in the British Journal of Dermatology found that interventions like habit reversal and cognitive behavioral therapy are particularly beneficial in the management of skin conditions . Be sure to talk with your dermatologist about local psoriasis or CSU support groups as well as other health care professionals trained to help people deal with stress. 

Ditch those stress habits: Sometimes it’s the way we deal with the stress in our lives that ironically cause more stress. Drinking12 and smoking13 can both aggravate skin conditions, for example, as can bingeing on junk food. Try to find healthier ways to blow off steam like spending time with loved ones, or taking an uplifting stroll around your neighborhood. 

So now you know how bad stress is for your skin, hopefully you’ll get better at dealing with it. Yes, it’s annoying when someone tells you to relax and stop stressing, but you know, what? They could have a point. Because ultimately, the happier you are, the happier your skin will be. In fact, a chill pill could be the best medicine of all.


1The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Chiu A, Chon SY, Kimball AB. Arch Dermatol. 2003 Jul;139(7):897-900. http://www.ncbi.nlm.nih.gov/pubmed/12873885

2Stress and quality of life in psoriasis: an update. Basavaraj KH, Navya MA, Rashmi R. Int J Dermatol. 2011 Jul;50(7):783-92. http://www.ncbi.nlm.nih.gov/pubmed/21699511

3Stress, insomnia, and chronic idiopathic urticaria--a case-control study. Yang HY, Sun CC, Wu YC, Wang JD. J Formos Med Assoc. 2005 Apr;104(4):254-63. http://www.ncbi.nlm.nih.gov/pubmed/?term=15909063

4A psychocutaneous profile of psoriasis patients who are stress reactors. A study of 127 patients. Gupta MA, Gupta AK, Kirkby S, Schork NJ, Gorr SK, Ellis CN, Voorhees JJ. Gen Hosp Psychiatry. 1989 May;11(3):166-73. http://www.ncbi.nlm.nih.gov/pubmed/?term=2721939

5Stress as an influencing factor in psoriasis. Heller MM, Lee ES, Koo JY. Skin Therapy Lett. 2011 May;16(5):1-4. http://www.ncbi.nlm.nih.gov/pubmed/?term=21611682 http://www.skintherapyletter.com/2011/16.5/1.html

6Website “Harvard Health Publications” – Understanding the stress response. Last accessed: 07.12.15. http://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

7Morey, J et al. Current Directions in Stress and Human Immune Function. Curr Opin Psychol. 2015 Oct 1; 5: 13–17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/

8Stress and psoriasis: psychoendocrine and metabolic reactions in psoriatic patients during standardized stressor exposure. Arnetz BB, Fjellner B, Eneroth P, Kallner A. Psychosom Med. 1985 Nov-Dec;47(6):528-41. http://www.ncbi.nlm.nih.gov/pubmed/?term=4070523

9Brain-skin connection: stress, inflammation and skin aging. Chen Y, Lyga J. Inflamm Allergy Drug Targets. 2014;13(3):177-90.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082169/

10Psychological Stress and the Cutaneous Immune Response: Roles of the HPA Axis and the Sympathetic Nervous System in Atopic Dermatitis and Psoriasis. Hall JM, Cruser D, Podawiltz A, Mummert DI, Jones H, Mummert ME. Dermatol Res Pract. 2012;2012:403908.  http://www.hindawi.com/journals/drp/2012/403908/

11Website “NHS Choices” – Urticaria (Hives). Last accessed: 18 July 2019. http://www.nhs.uk/conditions/Nettle-rash/Pages/Introduction.aspx

12Alcohol and skin disorders: with a focus on psoriasis. Kazakevich N, Moody MN, Landau JM, Goldberg LH. Skin Therapy Lett. 2011 Apr;16(4):5-6. http://www.ncbi.nlm.nih.gov/pubmed/21611681http://www.medscape.com/viewarticle/742538_3

13Smoking and skin disease. Thomsen SF1, Sørensen LT. Skin Therapy Lett. 2010 Jun;15(6):4-7. http://www.ncbi.nlm.nih.gov/pubmed/20532469

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