People with eczema can learn how to avoid stress-triggered flare-ups. The key is to try to manage your stress. Studies have found that managing the effects of emotional stress in your life might be one of the best ways to help control your eczema.
By Dr Lynn Chiam
How does stress trigger eczema?
Experts have known for years that stress can make eczema worse. While stress is known to be associated with atopic eczema, it is not fully understood how it affects the condition. Some people with eczema have worse symptoms when they are stressed. For other people, their symptoms cause them to feel stressed.
Many older children and adults with atopic dermatitis recognise a relationship between stressful occurrences in their lives and their atopic dermatitis flare-ups. Anger, frustration and embarrassment may cause flushing and itching. The resultant scratching can cascade into perpetual rash.
During times of stress, the inflammation in the skin increases, as a way to protect the skin from harm. If you already have inflammation in your skin, as with eczema, stress will worsen your condition
Evidence suggests that stress stimulates the ”master-gland “of our body ( the hypothalamic-pituitary-adrenal (HPA) axis) to release chemicals that induces the development and course of atopic dermatitis. It also causes dysfunction of the skin barrier and reduces itch threshold.
Some people react to stress by habit scratching. It is thought that scratching can make itch worse, which makes you want to scratch more, etc. This is called the itch-scratch cycle and can make eczema worse. Try as much as possible not to scratch the eczema.
In your experience, is there a difference between stress triggered eczema compared with stress triggered by allergens or diet?
There are many factors that can trigger eczema and most of the time, several factors act together to cause a flare in the rash, eg weather, sweating, stress. As such, it is difficult to pinpoint to a single cause.
How can you better protect your skin to prevent eczema flares especially during stressful times?
Moisturising the skin daily is an essential part of preventing eczema flare-up. Thus, it is important to continue to moisturise your skin even during stressful times.
Moisturisers are needed to replenish the Natural Moisturising Factors (NMF) found naturally in our skin. NMF are deficient in eczema patients and they will thus require long-term moisturisers. Moisturisers containing components of Natural Moisturising Factors will optimise the skin barrier function and this will lead to both improvement and prevention of eczema.
Gentle cleansing is of particular importance in atopic dermatitis patients and special attention must be paid to because of their dry, sensitive and often irritated skin.
Use a gentle cleanser and do not over-wash yourself as harsh soaps and prolonged contact with water can make your condition worse.
Conventional cleansing agents can expose the skin to irritants and may be too harsh for atopic skin. Gentle cleansers specially formulated for eczema skin that contain components of natural moisturising factors may complement treatment.
Some people react to stress by habitual scratching. It is thought that scratching can make itch worse, which makes you want to scratch more, etc. This is called the itch-scratch cycle and can make eczema worse. Try as much as possible not to scratch the eczema. Applying cold packs is more effective than applying hot packs.
How can a patient tell if stress is a factor in the triggering of eczema in his or her skin?
Some people with eczema have worse symptoms when they are stressed. If other factors like weather, environment, external irritants and allergens have remained constant, then stress is a possible cause of a flare of eczema. Many older atopic dermatitis children and adults recognise a relationship between stressful occurrences in their lives and their atopic dermatitis flare-ups. Anger, frustration and embarrassment all may cause flushing and itching. The resultant scratching can cascade into perpetual rash.
In Singapore, to what extent is psychodermatology used to treat skin conditions such as eczema? How do you see this developing in the future?
The connection between the mind and the body is well-known. Many skin conditions show a relationship to the state of mind. Stress and sleep deprivation can worsen the skin barrier function in atopic eczema. Stress can also worsen the itch-scratch cycle.
Psychodermatology refers to the treatment of skin diseases with psychological techniques like stress management, relaxation, biofeedback, hypnosis, mediation and medicines.
Although stress management techniques are commonly emphasised to patients, other aspects of psychodermatology like hypnosis, biofeedback and mediation are not widely practised. This is in part possibly due to the stigma associated with psychotherapy.
As more and more people understand about psychotherapy, it is likely to become a more common form of treatment in many different skin conditions, not just eczema.
What can a person do to deal with stress, so that it doesn’t cause eczema flare-ups?
Here are six tips to help manage the stress in your life:
1. Get Enough Sleep
Getting a good night’s sleep can help reduce stress. If eczema is keeping you up at night, talk with your doctor about controlling your symptoms. Antihistamines can help ease itching, and they have a sedating effect that may help with sleep.
2. Do something that you enjoy/ or help you relax
Listening to music, reading or doing deep breathing exercises may help.
3. Get Some Exercise
Exercising improves your physical and mental health. It also releases chemicals in your brain that can make you feel good. However, if sweat is a trigger for your eczema, make sure to take a cool or lukewarm shower soon after your workout to remove sweat.
4. Find Support
Talking with other people who have the same problem can help. You can find support groups for eczema such as the Eczema Support Group (Singapore).
5. Ask for Help
If nothing seems to work, see your doctor. He may be able to prescribe something to break the cycle.
6. Avoid scratching
Stress causes people to scratch more and habitual scratching in turn drives the vicious itch-scratch cycle.
To help with this, keep fingernails cut short so that any scratching is not so severe. Consider wearing cotton gloves at night if you tend to scratch in your sleep and use anti-scratch mittens for babies. If you need to relieve an itch, rub with fingers rather than scratching with nails. Apply cold packs rather than hot packs to relieve the itch.
Is it still important to strengthen and maintain the skin’s barrier function with the appropriate moisturisers and cleansers even when undergoing psychodermatology treatments? Why is this so?
Disruption of the skin barrier is the one of the most important factor in eczema. Many factors contribute to this disruption. They include genetics, environmental allergens and irritants, hormonal changes and stress.
Thus even when undergoing psychodermatology treatments, moisturisers are needed to replenish the Natural Moisturising Factors (NMF) found naturally in our skin. Natural Moisturising Factors are deficient in eczema patients and they will thus require long-term moisturisers. Moisturisers containing filaggrin breakdown products are essential for healthy skin which is lacking in the skin of those who have an impaired skin barrier function.
It is also important to avoid environmental irritants like harsh soaps to prevent triggering a flare.
Dr. Lynn Chiam is a dermatologist at the Children Adult Skin Hair and Laser Clinic. She is currently a Visiting Consultant at Kandang Kerbau Women’s and Children’s Hospital, Head of the Education Committee at the National Skin Centre, as well as the Medical Advisor to the Eczema Support Group (Singapore).
