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The relationship between eczema and stress is bidirectional, as eczema can be triggered by stress and, in turn, can cause stress.
Stress & Eczema
July 5, 2023
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, or atopic dermatitis (atopic eczema), is a common skin condition with many potential triggers. The symptoms of eczema typically include patches of skin that may be dry, itchy, cracked, and flaky. The condition tends to affect skin creases (fronts of elbows, behind knees, neck, fingers, and eyelids). It is a chronic condition that follows a relapsing-remitting course, with periods of eczema 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.
To understand the relationship, it's crucial to recognise that stress isn't solely a psychological experience but also a hormonal and chemical process that directly impacts multiple functions within the body. Stress is experienced as part of the body's fight-or-flight response, which aims to focus the body's resources to enable escape or avoidance of danger. This mechanism was beneficial during simpler hunter-gatherer lifestyles when threats were often tangible and therefore easy to escape, avoid, or overcome. However, in modern life, stress is often triggered by abstract threats that are difficult to escape from, leading to chronic periods of stress with significant negative consequences.
This post will cover the following:
- The link between stress and eczema
- The science behind stress-induced eczema
- Managing stress to improve eczema symptoms
- Stress and eczema FAQs
1. The link between stress and eczema
Many individuals with eczema report worsening symptoms during periods of psychological stress. This happens due to both the direct interaction between the body's stress response and the skin, which triggers inflammation and alters the skin barrier function, and the indirect effect stress has on heightening an individual's experience of sensory sensations, particularly itch. Therefore, both physical and emotional stress can drive the condition and exacerbate the experience of it. It's also important to recognise that poorly controlled severe eczema can significantly impact an individual's physical health and quality of life.
How stress impacts eczema symptoms
It is well established that during periods of stress, our experience of symptoms can increase. This is because stress induces a state of hyper-alertness, where the mind prioritises awareness of the immediate environment to swiftly recognise and react to potential threats. In individuals with eczema, this heightened awareness can lead the mind to focus on the physical symptoms of the condition, intensifying the sensation of itchy skin. Furthermore, research has shown that stress can cause spontaneous itching (itchiness in visibly healthy skin), which can result in scratching, skin damage, and trigger the itch-scratch cycle.
Stress triggers inflammation in the body
To comprehend the role of stress on the inflammatory response, it's essential to distinguish between the normal healthy stress response to acute stress and the dysregulated response observed in chronic stress.
In the acute pathway, the brain initiates the release of a stress hormone called cortisol from the adrenal glands via the hypothalamic-pituitary axis. Cortisol promotes the increased release of energy/glucose into the blood and also suppresses inflammation (topical steroids used in eczema management are derived from cortisol).
In the chronic setting, persistent activation of these pathways results in dysregulated cortisol release and desensitisation of cells to the hormone. This diminishes the suppressing effect of cortisol, leading to inflammation. Chronic stress can manifest in various forms, including physical exhaustion, sleep deprivation, and psychological/emotional stress.
Considering that atopic eczema typically manifests in early childhood when the condition is often more widespread and severe, individuals with eczema are frequently exposed to physical/chronic stress from eczema symptoms at 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
Research has demonstrated that stress can result in heightened water loss from the skin, an elevated risk of skin infections, and compromised skin barrier function by altering the integrity and cohesion of skin cells. Considering that one of the primary characteristics of eczema is a compromised skin barrier due to a genetic predisposition to dry skin, stress can exacerbate this fundamental feature.
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 aid in reducing eczema symptoms and flare-ups. Learning to manage stress has a dual benefit, as it can decrease the frequency of flares and lessen the intensity of symptoms.
The emotional toll of eczema is considerable, and if left unaddressed, individuals can become trapped in a negative cycle of escalating stress and worsening symptoms/flares. Developing a strategy to break this cycle can significantly improve 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?
Several factors can trigger eczema symptoms, with stress being a significant contributor, though it is often not the sole cause. Other eczema triggers include irritants, environmental factors, food allergies, and hormonal changes. The impact of stress on a person's skin varies depending on multiple factors, including the type of eczema. For example, dyshidrotic eczema, which typically affects the hands and feet, has a strong association with contact allergy (30%), suggesting that allergy may be a more influential factor in this case.
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 for eczema that can provoke flare-ups. It's important to recognise that separate factors drive different types of eczema. For a deeper dive into eczema triggers, you can explore our dedicated page on this topic.
