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

By Dr Melissa Lee 李嘉琳醫生 (ND)

Chinese version 跳至中文版

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.

References

  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

 

壓力和皮膚:為什麼我的皮膚問題一次再一次的出現?

皮膚是你身體最大的排毒器官,也反映你內體健康和情緒的狀態。 濕疹、銀屑病、痤瘡和其他皮膚病通常是胃腸健康失衡、免疫功能障礙、激素失調、情緒失控、環境污染物、感染或營養缺乏的信號。 如果你身體的毒素滿的快過它能排除的速度,癥狀通常會溢出到你的皮膚上。

壓力通常是一切溢出之前的最後一滴!

壓力如何影響你的皮膚

你的皮膚好像永遠都不癒合嗎? 如果是這樣,你的身體很可能處於壓力狀態。 生理上,你的身體會對急性壓力或威脅做出反應。 例如,如果一隻老虎在追你,在生死存亡的一刻,你要選擇逃跑,還是要擊退牠。 這觸發了你的”戰鬥或逃跑反應”,一種由腎上腺素和皮質醇激素釋放引起對壓力的自然反應。

這些荷爾蒙會在危急時上調來應付在威脅中生存的功能,所以會出現心率、血糖、血壓增高和出汗這些反應來保擭生身。 與此同時,你的應激激素和消化和癒合功能等相應會下調,因為這些功能對於你在擺脫危難時並不重要。

當你最終離開老虎時,你的身體自然會試圖重新啟動被關閉的功能。由於身體要供給大量資源應付存亡危機,用於滋養和癒合的資源也很少,你的皮膚需要幾周才能正常修復。 但是在某些情況下,你身體的一些功能可能很難重新啟動。

在現代社會,我們每時每刻都有各種各樣的老虎追著我們:工作、電子郵件、老闆、孩子、伴侶、父母、姻親,財務,人濟關係等等。 除了這些情緒壓力,我們還有過度的背景壓力,比如污染,睡眠不足,情緒壓力,營養不良,食無定時,還有去年的新冠肺炎。 這些壓力和刺激會阻礙你的身體重新開始康復功能。

隨著時間,久而復始,身體功能的喪失會積累起來,使你的身體越來越沒有彈性。 此外,由於壓力而被上調的功能保持在更高的水平上運行,更加損害身體。 身體是一個相互連接的系統,當必要的資源缺乏時,進而令其它的功能被關閉。 除非得到適當的支援,否則有些功能可能永遠無法恢復啟動。

皮膚和外用類固醇面霜:為何速戰速決不是長久之計

炎症通常被認為是一種可怕的邪惡,但炎症實際上是癒合週期的自然現象。 所以在激烈的”戰鬥或逃跑”的情況下,癒合的功能是暫時關閉。由於激素皮質醇具有抗炎的作用,很多時都會開一些局部皮質類固醇來緩解皮膚炎症。 最初,這些藥可能很有效,但是長時間接觸皮質醇會導致副作用和身體功能的不良改變,這可能會變成永久性的問题。

當局部類固醇霜停止使用時,你可能會經歷”反彈反應”-炎症性皮膚狀況變得比以前更差。 重複使用局部皮質類固醇的話,你可能會經歷皮膚變薄以及更容易形成淤血、血管擴大和在該區域的毛髮增加。

隨著慢性炎症,你皮膚的功能受到影響。 皮膚屏障的反覆破壞,該區域會變得更容易受到過敏原、感染和水分流失的徵象——這些都會使你的皮膚狀況惡化。 因此,惡性循環仍在繼續。

用皮質類固醇快速修復有它的作用,但如果你的皮膚問題經常出現,我們建議你深入地追根尋原。

皮膚病的根本原因

慢性壓力或持續不斷的壓令你的壓力反應系統開動,導致你身體幾乎所有其他的過程中斷。 當這個系統被長期啟動時,你的身體對壓力荷爾蒙的反應方式會發生變化,反而會使皮質醇促進炎症。 這就是為什麼除了找到你皮膚病的根本原因之外,治療壓力是如此重要。 無論是生理需求的增加、心理壓力還是環境因素,壓力都會加劇你皮膚病的根本原因。

皮膚問題的原因可能包括:

  • 腸漏。 消化系統是會因壓力而下調的功能之一,這更使你的胃腸道容易反覆感染、炎症和食物過敏。 這些會損害你的腸壁,導致”腸漏”。當消化道細胞之間的緊密連接受到損害時,細胞之間的滲透性就會增加。 過敏原和細菌抗原可以很容易地通過它們不應該通過的地方,導致更多的炎症,和感染,又促使免疫的反應。 由於消化道和皮膚之間的許多信號連接,內部炎症也經常在外部表現出來。
  • 免疫系統。 你的皮膚充滿了免疫成分,這些成分對保護你的身體和抵抗傳染性病原體是很重要的屏障。 通常,當有感染時,身體便會産生炎症而將必要的因素和細胞帶到了這個部位,在身體的癒合和防禦中起著很大的作用。 但是,當調節細胞失衡,皮質醇因慢性壓力而改變時,炎症信號無法關閉,從而導致炎症失控。 保護身體的免疫能力平衡失調時,一側受到太多的刺激,而另一側受到抑制,導致在最輕微的刺激下受到極大的反應。
  • 荷爾蒙失衡。 你的皮質醇激素在青春期、更年期/男性更年期、懷孕和月經期間會自然增加,來應付很高的生理需求和整個身體所需的變化。在此期間, 這些激素的運用和生產及調節是需要身體精準的控制。 在這期間遇到任何額外的壓力都會使皮膚特別容易受出問題。 在高度壓力的情況下,你的身體可以選擇產生皮質醇而不是性激素的反應。 這可能導致在適當的時候缺乏必要的激素,以及整個周期的失調。 錯綜複雜的炎症調節過程可能會陷入無法控制的炎症。
  • 毒素超載。 在’戰鬥和逃跑狀態’下,你身體的排毒能力也會受到損害。 你的肝臟在新代謝、消化和激素處理中擔仼著核心的作用,所以當這些功能被下調時,它就不能發揮最佳功能。 通常,皮膚病的發生是因為你的昇降調節排毒系統有太多的輸入問題要處理而導致它忙不過來。 當你的身體被環境污染物、食物或藥物中的毒素、壓力事件、負面情緒等所困擾時,康復過程就會停滯不前,成為問題的一部分。 由於你的皮膚是説明清除廢物的器官之一,復發性皮疹可能是排毒系統堵塞的跡象。
  • 情緒健康。 長期壓力對精神和心理健康有不利影響。 皮質醇長期失衡會增加你焦慮、抑鬱和情緒波動的風險。 你身體的不平衡,往往是反映著你其他領域的不平衡,所以皮膚問題幾乎總是有深層的情感因素。 當沒有辦法表達被壓抑的情緒和痛苦時,皮膚可能是你身體選擇來表達這些感覺的一個渠道。 你的情緒和心理健康不僅與身體癥狀有關,還對治愈的成功率有關。

皮膚問題:如何長期改善皮膚

不要猜,去檢查。 測試基本的生理失衡、激素水準、感染和食物敏感性都有助於確定皮膚問題的確切原因。 一旦我們知道了罪魁禍首,我們就可以制定一個整體的、可持續的解決方案來重新平衡你的身體,實現持久的健康和無皮疹的皮膚。 雖然康復之路可能需要幾個月,但患者通常報告說,在開始治療後的幾周內,皮膚會更健康、更清潔。

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