With the Covid pandemic, 2020 has been a very stressful year for most people in the world. In South Africa, particularly, we have had to deal with a number of stresses over the years including political uncertainty, unemployment, severe drought with water shortages, as well as electricity constraints with load-shedding.
With acute and chronic stress, the body produces more cortisol as well as adrenaline. In the unstressed state with a normal circadian rhythm, we get a peak of cortisol production in the morning, with the least amount of cortisol being produced at midnight. With stress, this normal circadian clock is disrupted and more cortisol and adrenaline is produced throughout the day and the night. As a result of this increased, erratic production of cortisol as well as adrenaline, certain skin conditions may flare. I will deal with each condition below:
As a result of the increased cortisol production, the sebaceous gland produces more sebum and this tends to cause acne to flare. With stress, many people tend to fiddle, pick or squeeze acne lesions and this is called Acne Excorie. With the fiddling and picking the person will spread bacteria over their face and body, again worsening the acne. Because the skin has been scratched open, these people will often be more intolerant of topical products. Those with Acne Excorie may have to use more gentle cream cleansers, avoid toners and scrubs and may have to use Benzoyl Peroxide as a spot treatment only.
If the person has many large, deep excoriated, infected acne lesions an oral Tetracycline antibiotic may need to be prescribed.
Stress and anxiety are well-known triggers for Rosacea. Facial redness and flushing, in itself, may cause embarrassment and self-esteem issues leading to further stress and anxiety and it can become a vicious cycle. Treatment includes the avoidance of extremes i.e. hot or cold environments, spicy foods, excessive alcohol and potent ingredients in skincare. It is recommended that you use very mild cleansers such as Micellar water and specific skincare products specially formulated for the Rosacea-prone skin.
Chronic stress has been shown to disrupt the epidermal barrier function and as a result, most types of eczema will get worse with acute and chronic stress. Stress also lowers your itch threshold. As a result, the scratch/itch/scratch cycle in Atopic Eczema will be more difficult to break.
In Seborrhoeic Dermatitis, one gets an overgrowth of the yeast Pityrosporum Ovale on the scalp, face and trunk. With stress, the immune system is lowered and this yeast multiplies further and as a result, this skin condition will flare.
Stress can cause a particular type of eczema called Lichen Simplex Chronicus (Scratch Patch) or pickers nodules. This is where you get into the habit of scratching a particular spot when feeling stressed or anxious. Common sites for pickers nodules are on the side of the neck or scalp or on the side of the leg, usually the same side as the dominant hand.
With the Covid pandemic, we are washing our hands more frequently and using hand sanitisers that contain alcohol. With the frequent use of these products as well as stress, you are set up to develop an irritant contact hand dermatitis. Once it has become established, the barrier function of the skin is disrupted further making it more susceptible to irritation by household cleansers, detergents etc.
With all types of eczema or dermatitis, it is imperative to only cleanse or wash your skin with the mildest of products and with a pH as close to 5.5 as possible (the skin’s natural pH) and the frequent use of moisturisers to help restore the skin’s epidermal barrier function.
Chronic stress can accelerate skin ageing resulting in more fine lines, wrinkles and sagging around the eyes. You, therefore, may need to tweak your skincare regimen by using a more powerful antioxidant in the morning and possibly adding a retinol and/or growth factors or peptides at night time.
Many people who are stressed tend to drink more alcohol or eat more sugary treats and these can also help to cause skin ageing. Excessive alcohol can cause dehydration which impacts on the skin. Too much sugar in the diet can increase a process called glycation whereby too much glucose causes sugar molecules to adhere to proteins collagen and elastin in the skin. The skin develops a type of crepiness due to glycation.
Acute and chronic stress can cause what we call Acute Telogen Effluvium. Large clumps of hair fall out in a small space of time often causing great alarm to the individual affected by this. As humans, we do not normally moult at the change of seasons like animals. Human hair grows and falls out in cycles. However, stress and a severe viral infection such as Covid can cause hairs to move en-masse from the anagen phase to the telogen phase (like an animal moulting).
The good news that each hair that falls out is being replaced by another hair and your hair might become temporarily thinner for a while post-viral infection but eventually, the hair will regrow back again. There are other causes of hair loss (Alopecia) so if your hair does not regrow again, there may be an underlying iron deficiency or thyroid problem and therefore you would need to consult a Dermatologist.
I have dealt with specific skin conditions that can be aggravated by stress. You can obviously adopt some general measures that will help like a healthy balanced diet, cutting back on alcohol, stopping smoking, increase exercise, getting a good nights sleep, practising mindfulness and meditation.