Stress and Skin: Why do my skin issues keep coming back?

By Dr Melissa Lee 李嘉琳醫生 (ND)

Your skin is the largest detox organ in your body, and a reflection of both your inner health and emotional state. Eczema, psoriasis, acne and other skin conditions often signal an imbalance in gastrointestinal health, immune dysfunction, hormone dysregulation, emotional overwhelm, environmental pollutants, infection, and/or nutrient deficiencies. When your toxic bucket fills up more quickly than it can be emptied, symptoms often overflow onto your skin.

Stress is commonly that last drop before everything spills over!

How stress affects your skin

Does your skin seem to take forever to heal? If so, your body is likely in a stressed state. Physiologically, your body is made to react to acute stressors or threats. For example, if a bear is coming after you, you’ll need to either run away or fight it off.  This triggers your ‘fight and flight mode’ – a natural stress response prompted by the release of the adrenaline and cortisol hormones.

These stress hormones will up-regulate the functions that help you survive the threat, which is why you may notice an increase in heart rate, blood sugar, blood pressure and sweating – all of which fuel immediate survival. At the same time, your stress hormones will down-regulate functions like healing and digestion that are non-essential to getting you away from your flighty situation.

With minimal support and few resources directed towards nourishing and healing, it can take weeks for your skin to repair properly. When you finally get away from the bear, your body will naturally attempt to restart the functions that were turned off. However, some of your functions may struggle to restart.

In modern day society, we have bears of all kinds coming after us at every moment: work, deadlines, e-mails, bosses, children, partners, parents, in-laws and more. Added to these emotional pressures, we have excessive background stressors like environmental pollution, poor sleep, nutrient-poor diets and, in this last year, COVID-19. These pressures and stressors can further hamper your body’s ability to restart its healing function.

Over time, the loss of functions can accumulate, making your body less and less resilient. In addition, the functions that were up-regulated due to stress, stay operating at higher levels and further damage the system. Because everything in your body is interconnected, this can lead to a cycle of further functions being turned off.  Some functions may never go back online unless they receive appropriate support.

Skin and topical steroid creams: why a quick-fix is not a long-term solution

Inflammation is generally thought of as a terrible evil, but it’s actually a natural part of the healing cycle. This is why it isn’t promoted during an acute ‘fight or flight’ situation.  As the stress hormone cortisol is anti-inflammatory, topical corticosteroids are often prescribed to calm skin inflammation. These can work well initially, but extended periods of cortisol exposure can cause side-effects and undesirable alterations in the body’s function that may become permanent.

When topical steroid creams are stopped, you may experience a ‘rebound reaction,’ where the inflammatory skin condition becomes worse than before. With repeated application of topical corticosteroids, you may experience thinning of the skin as well as easier bruising, enlarged blood vessels, and increased hair thickness in the area.

With chronic flare-ups and inflammation, the integrity of your skin is implicated. With repeated breaks in your skin’s barrier, the area becomes more susceptible to allergens, infections, and water loss – all of which can make your skin condition worse. Thus, the vicious cycle continues. There is a time and a place for quick fixes, but if your skin issues are reoccurring, we recommend you dig deeper to discover the root causes.

The underlying causes of skin conditions

Chronic stress or unrelenting stressors maintain the activation of your stress-response system, leading to disruption of almost all of your body’s processes. When that system is activated long-term, the way your body reacts to stress hormones can change, making cortisol pro-inflammatory instead. That’s why treating stress in addition to finding the root causes of your skin disease is so important. Whether it be increased physiological demands, psychological pressures or environmental factors, stress can exacerbate the root causes of your skin disease.

Causes of skin issues may include:

  • Leaky gut. Digestion is one of the functions down-regulated during stress, leaving your GI tract more susceptible to recurrent infections, inflammation, and food sensitivities. These can damage your gut lining and lead to a ‘leaky gut.’ When the tight junctions between cells in your digestive tract are compromised, permeability between cells is increased. Allergens and bacterial antigens can easily pass through where they shouldn’t, leading to more inflammation, heightened immune response and infection. Internal inflammation often manifests on the outside too, due to the many signaling connections between your digestive tract and your skin.
  • Immune system. Your skin is full of immune components that are important for protecting your body as a barrier, and for fighting off infectious pathogens. Normally, inflammation plays a large role in the healing and defense of your body since it brings the necessary factors and cells to the site. But, when there’s an imbalance in the regulatory cells and change in the binding of cortisol due to chronic stress, the inflammation signal is unable to be turned off, which leads to uncontrolled inflammation. Often with skin rashes, dysregulation in the balance between the types of immune actions protecting the body occurs, as one side is too stimulated, and the other side suppressed, leading to provocation at the slightest stimulus.
  • Hormonal imbalance. Your cortisol hormone naturally increases during puberty, menopause/andropause, pregnancy and menstruation due to the high physiological demands of enacting the many changes needed in the entire body. This is why regulation of the actions and production of these hormones needs to be controlled and precise. Any additional stressors during those periods can make the skin especially susceptible to issues. When reacting to high levels of stress, your body can choose to create cortisol over the sex hormones. This can lead to a deficiency of the necessary hormones at the appropriate times, and dysregulation of the entire cycle. The intricately regulated process of inflammation can become stuck at uncontrolled inflammation.
  • Toxic overload. Your body’s ability to detox is also impaired during the fight and flight state. Your liver plays a central role in metabolic, digestive and hormonal processing, so when these functions are down-regulated, it cannot function optimally. Often, skin disorders occur because there’s too much input for your down-regulated detox system to handle, causing it to overflow. When your body is overloaded with environmental pollutants, toxins from food or medication, stressful events, negative emotions and more, the healing process is stalled and becomes part of the problem. As your skin is one of the organs that helps clear waste, recurrent skin rashes can be a sign there’s a blockage in the detox system.
  • Emotional health. Chronic stress has detrimental effects on mental and emotional health. Long periods of cortisol imbalance can increase your risk of anxiety, depression and mood swings. Imbalances in your physical body are often a reflection of imbalances in other realms of your health, so there is almost always a deep emotional component to skin issues. When there is no way to express suppressed emotions and pain, skin can be one of the facets your body chooses to manifest these feelings. Your emotional and psychological well-being are not only connected to physical symptoms, but also healing outcomes.

Skin problems: how to improve skin long-term

Test, don’t guess. Testing for basic physiological imbalances, hormone levels, infections and food sensitivities can help to pinpoint the exact causes of your skin issues. Once we know the culprits, we can put in place a holistic, sustainable solution to re-balance your body for long-lasting health and rash-free skin. While the road to recovery can take a few months, patients often report healthier, clearer skin in just a few weeks after starting treatment.


  1. Fukaya M, Sato K, Sato M. Topical steroid addiction in atopic dermatitis. Drug HealthcPatient Saf. 2014;6:131-138.
  2. van den Elsen LW, Poyntz HC, Weyrich LS, et al. Embracing the gut microbiota: the new frontier for inflammatory and infectious diseases. Clin Transl Immunology. 2017;6(1):e125.
  3. Parodi A, Paolini S, Greco A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol. 2008;6(7):759–764.
  4. Al-Ghazzewi FH, Tester RF. Impact of prebiotics and probiotics on skin health. Benef Microbes. 2014;5(2):99–107.
  5. Quaresma, J.A.S. Organization of the Skin Immune System and Compartmentalized Immune Responses in Infectious Diseases. Clinical Microbiology Reviews. 2019: 32(4): 1-34


Share via
Copy link
Powered by Social Snap