Can stress cause eczema?

We explore the relationship between stress and eczema, with the latest research findings and tips for managing stress-related eczema.

Eczema is a common inflammatory skin condition that has many potential triggers. The symptoms of eczema typically include dry, itchy, cracked, and flaky patches of skin, it tends to affect skin creases (flexural areas) and follows a relapsing-remitting course with periods of flare-ups followed by calmer periods where symptoms may fully resolve.

The link between stress and eczema has been studied closely and is multifaceted. Stress impacts eczema through multiple separate pathways, including predisposing individuals to developing the condition, and both directly and indirectly triggering future flares. The relationship between eczema and stress can be considered bidirectional as eczema can be triggered by stress and is a cause of stress.

In order to understand the relationship, we need to appreciate that stress isn’t solely a psychological experience but a hormonal and chemical process that directly impacts multiple functions within the body. We experience stress as part of the body's fight or flight response, the purpose of this mechanism is to focus the body's resources to allow us to escape or avoid danger. This was helpful when we lived simpler hunter-gatherer lifestyles as the threat was often tangible and therefore easy to escape/avoid/overcome. In modern life, stress is often triggered by abstract threats that are hard to escape from leading to chronic periods of stress with significant negative consequences. 

‍

This post will cover the following:

1. The link between stress and eczema

2. The science behind stress-induced eczema

3. Managing stress to improve eczema symptoms

4. Stress and eczema FAQs

‍

1. The link between stress and eczema 

Many individuals report worsening eczema during periods of psychological stress. This occurs due to both the direct interplay between the body's stress response and the skin (triggering inflammation, altering the skin barrier function) and the indirect action stress has on heightening an individual's experience of sensory sensation (namely itch). Therefore, stress can both drive the condition and make the experience of the condition worse.

How stress impacts eczema symptoms 

It is well established that during periods of stress, our experience of symptoms can increase. This is due to stress leading to a state of hyper-alertness, where the mind focuses on its local environment in order to rapidly recognise danger and react. In individuals suffering from eczema, this can lead to the mind focusing on the physical symptoms of the condition increasing the experience of both itchiness and pain. Furthermore, it has been shown that stress can lead to spontaneous itch (itchiness in visibly healthy skin), leading to scratching, skin damage and triggering the itch-scratch cycle.

Stress triggers inflammation in the body 

To understand the role of stress on inflammation in the body, we must separate the normal healthy stress response to acute stress and the dysregulated response seen in chronic stress. 

In the acute pathway, the hypothalamic-pituitary axis leads to the release of cortisol from the adrenal glands, cortisol leads to the increased release of energy/glucose into the blood and also suppresses inflammation (cortisol is the body's natural equivalent of topical steroids used in eczema management).

In the chronic setting constant firing of these pathways leads to dysregulated cortisol release and desensitisation of cells to the hormone. This leads to a reduction in the suppressing effect of cortisol leading to inflammation. Individuals with AD often develop the condition in early childhood and are therefore exposed to chronic physical stress from a young age, predisposing them to this dysregulated stress response.

‍

2. The science behind stress-induced eczema

Stress plays multiple direct roles on the skin, including impacting the skin barrier, triggering inflammation and interacting with immune cells in the skin. 

How stress affects the skin

Studies have shown that stress leads to increased water loss from the skin, increased risk of infections and weakening of the skin barrier function through altering the integrity and cohesion of cells in the skin. 

Role of the immune system and inflammation in eczema 

As mentioned previously prolonged periods of stress leads to reduced cell responsiveness to cortisol and inflammatory dysregulation. Stress can also trigger other neuroendocrine pathways in the skin, stimulating the release of stress signals in the skin, leading to localised inflammation. 

Impact of stress management on eczema symptoms 

Minimising stress and other potential triggers can help to reduce eczema symptoms and flares. Learning to manage your stress has a double benefit as it can help reduce the frequency of your flares and reduce the intensity of your symptoms.

The emotional impact of eczema is significant, and if not addressed, individuals can get caught in a negative cycle of increasing stress and worsening symptoms/flares. Developing a strategy to break this cycle can your day-to-day life. 

‍

3. Managing stress to improve eczema symptoms 

Managing stress is important for managing eczema, but when it feels like you are trapped in a vicious circle, it can be hard to know where to start. Here are some ways you can reduce stress to treat eczema. 

Mindfulness meditation 

Mindful meditation has the power to relieve eczema symptoms and help calm stress-related pathways in the body. Meditation works by training the mind to let go of sources of psychological stress, switching the mind's focus onto the breath and being present. In practice this calms the body's fight or flight response, reducing cortisol release and can lessen the experience of eczema-associated symptoms. It takes regular practice to build this skill but over time it will become easier and more effective.

Exercise

Another way to lower your stress levels and improve eczema symptoms is through exercise and physical activity. Your body experiences exercise as physical stress, which it subsequently reacts to through similar pathways as described earlier. The difference is that when you stop exercising you remove the stress allowing your body to settle to a lower level of baseline stress.

Aromatherapy

Aromatherapy is used by some individuals to help manage stress. The evidence for this is limited, but it is thought that strong pleasurable scents can help calm the sympathetic nervous system (fight and flight) and increase the parasympathetic nervous system (rest and digest). Common essential oils used for this include lavender oil.

Yoga

Yoga can be an ideal form of exercise as it combines both physical exercises with mindfulness/meditation techniques. It can also be helpful for those whose eczema flares with intense exercise due to its low-impact nature.

Cognitive Behavioural Therapy

Therapy can also be used to reduce stress, such as Cognitive behavioural Therapy (CBT). CBT is a powerful tool which hijacks the brain's natural learning processes to break down negative habits and or build positive ones. CBT is usually delivered over short 6-8 week courses with fixed goals and outcomes. Examples of how CBT can be used in eczema include building new habits for managing itchiness and scratch prevention. 

Importance of stress management for eczema 

Stress-related eczema can be hard to overcome but by gaining better control of your condition by optimising your treatment plan and developing stress management techniques, you may be able to significantly improve your symptoms and reduce the frequency and intensity of your flares.

‍

4. Stress and eczema FAQs 

‍

How can I manage my stress levels to reduce my eczema symptoms?

There is a wide range of treatments and techniques available to help manage stress levels to reduce eczema symptoms. Mindful meditation, exercise, aromatherapy, yoga, and cognitive behavioural therapy are all common techniques used to manage stress. 

Is stress the main cause of eczema?

There are a number of things that can trigger eczema symptoms. Stress is a significant contributor to eczema though it is often not the sole cause. Other eczema triggers include irritants, environmental factors, food allergies, and hormonal changes. 

What are some other triggers that can cause eczema to flare up bedside stress? 

Irritants, environmental factors, food allergies, hormonal changes, and fabric are common triggers that can provoke eczema flare-ups, alongside stress. For a deeper dive into eczema triggers, feel free to explore our dedicated page on this topic.