Stressed out? If things in your life seem a bit unsettled, your skin may be paying the price. Out of whack hormones, emotional upheaval and even lifestyle excesses often leave their mark upon the skin.

How Does Stress Work?

A stressful situation triggers the release of a hormone, Corticotropin Releasing Factor (CRF) from the hypothalamus, located within the brain.

CRF sends 2 separate messages:

The first one goes to the adrenal glands, located high atop the kidneys. There CRF signals the production of adrenaline (epinephrine) and norepinephrine. These 2 hormones cause the classic "flight or fright" response. Increases in heart and breathing rate, quickened muscle reaction and general readiness for an emergency response occur in response to these hormones.

Next, CRF triggers the pituitary gland to produce Adrenocorticotropin Hormone (ACTH). ACTH affects the surface of the adrenal glands (the adrenal glands are multifunctional) and triggers the production and release of cortisol, increasing the body's metabolic rate.

Under normal circumstances, stress hormones tend to ebb and flow throughout the day. Chronic stress changes the body's biochemistry and converts progesterone into cortisol, blocking the production of estrogen. This switch-a-roo unmasks the effects of androgenic hormones that routinely take a "backseat" to estrogen in women, upsetting the delicate hormonal balance.

For example, estrogen normally helps suppress the availability of male hormones (androgens) in 2 ways. Higher levels of estrogen lead to higher levels of Sex Hormone Binding Globulin (SHBG), responsible for preventing the conversion of testosterone into its active form, DHT.

DHT is the undesirable testosterone metabolite responsible for triggering an increase in sebum production, enlargement of the sebaceous glands and generally flares acne, creates rosacea complications and exacerbates oily skin.

DHT also contributes to androgenic alopecia (balding) in both men and women.

DHT additionally is a leading factor in hirsuitism (excessive facial hair) as well.

By upsetting the balance, stress becomes a major flare factor for all of these dermatological concerns. Hence the explanation for why sudden onset of acne is often associated with wedding day jitters, prom, job interviews and school exams.

Uncontrolled stress can also trigger an increased rate of hair loss. It is not uncommon for my hair loss patients describe increased shedding during major emotional/health/life events. What should have been transient telogen effluvium inexplicably results in a lack of regrowth many months later. The reason: it wasn't simple telogen effluvium at all, but coincidental androgenic alopecia triggered by higher levels of circulating DHT. Coincidentally, this female or male pattern hair loss was likely in its infancy and was grossly sped along much to the chagrin of the unfortunate patient.

Treatments for such conditions rely upon the ability of the product to affect DHT levels that are focused upon sebaceous glands and hair follicles.

Birth control pills that are estrogen dominant (higher levels) and/or contain progesterone derivatives which are less likely to produce androgenic effects are one way to help control unsightly blemishes. Spironolactone, a diuretic, is structurally competitive with DHT, able to block its actions and reduce acne outbreaks.

DERMAdoctor Calm Cool & Corrected Anti-Redness Tranquility Cream contains nordihydroguaiaretic acid and oleanolic acid to effectively help blemishes triggered by stress while helping calm and soothe upset skin and simultaneously addresses skin rejuvenation. Consider trying it alone or as a syngergistic cosmeceutical option in your rosacea or acne prescription regimen.

For hair loss, Propecia is FDA approved for the treatment of androgenic alopecia in men. While effective for many women with this form of hair loss, the drug is capable of causing birth defects in unborn male child, so is restricted from being prescribed to women who are capable of child bearing.

What Does Stressed Skin Look Like?

When stress is unrelenting, your body's hormone and chemical levels can spike, adversely affecting the skin and how it functions. Oil production increases. Histamines trigger itchiness and inflammation. It becomes irritable, dull, clogged, prematurely wrinkled, prone to breakouts, itchy and flaky.

Some skincare products can help to reduce the detrimental effects of chronic stress on skin. Since stressed skin is damaged skin, what it needs most is to be soothed, healed and replenished to regain its natural health and radiance. Consider trying EI Solutions Allure Body Relaxing, a nice way to detoxify stressed out skin.

Atopic Dermatitis

Stress is not limited merely to affecting the balance of "sex hormones". An overwhelming 81% of patients with atopic dermatitis, a genetic form of eczema, blame stress as the major trigger for this condition and the discomfort associated with it.

Children with atopic dermatitis (AD) have been shown to be far more susceptible to stress-induced dermatitis because of a lowered responsiveness to the H-P-A (hypothalamus-pituitary-adrenal) axis. Inability or minimized ability to trigger the adrenals to produce cortisol prevents the body from suppressing stress-induced skin inflammation. Translated: a lack of therapeutic cortisol results in rash and itching. Cortisone based prescription creams are used to treat skin inflammation since they replace absent levels of this hormone within the skin squelching dermatitis and discomfort.

While itching is not fully understood in atopic dermatitis, it is known that it differs from hives and is not primarily the result of histamine release. This explains why oral and topical antihistamines like Zyrtec or topical prescription Zonolon are only palliative rather than healing.

Cortisone (supplementation of diminished levels of cortisol in AD), topical immune modulators (like prescription Protopic and Elidel), and UV light are the most commonly used beneficial therapies for gaining control over atopic dermatitis.

Other contributing AD factors can help reduce the effects that stressful situations may contrive to play out upon the skin. Restoring the ceramide barrier, typically disrupted in eczema with emollients such as TriCeram, avoidance of fragrance and dyes in skin care treatments, detergents and fabric softeners as well as rapid onset of therapy for infections and eczema recurrences can all help maintain overall skin health and comfort.

Stress & The Immune System

Factors essential to the immune system such as cytokines (protein message relayers), chemokines (chemical attractants for white blood cells) and growth factors as well as blood cells involved in immunity can all be affected by stress whether due to physiological or psychological causes.

Stress down-regulates the immune system, making patients far more susceptible to infection. Reduced immunity also factors into flare-ups of skin concerns such as psoriasis, eczema, shingles, cold sores, viral warts and aphthous ulcers.

Autoimmune skin diseases such as vitiligo (a form of skin color loss), alopecia areata (a form of hair loss), lupus and pemphigus foliaceous are all known to flare up during times of stress. Avoiding stress can actually be therapeutic for all of these patients.

Hives & Stress

Moving down the other branch of the chemical stress highway, adrenaline is the unlikely culprit of a specific form of hives called cholinergic urticaria (CU). While patients often blame stress for their garden-variety form of hives, it's CU that deserves this unique distinction.

Adrenaline, released from stress, heat or physical exertion can directly cause mast cells located within the skin to release their precious cargo of histamine. Histamine is the chemical responsible for causing the "wheal" seen in hives or mosquito bites.

Cholinergic urticaria has a specific appearance, multiple tiny pink or red bumps typically forming in areas of higher blood flow or sweat formation. Cholinergic urticaria tends to have an abrupt onset and is short-lived, perhaps only 30-60 minutes.

Anything that causes an increase in adrenaline (exercise, stress, heat exposure) can trigger this condition. Treatment with antihistamines, such as Zyrtec, can help control this condition. Concern that excessive amounts of histamine release might result in systemic shock makes it necessary that CU patients carry an Epi Pen (epinephrine) and be well versed in how to use it.

Living Happily Ever After

What can you do to insure a stress-free existence and gorgeous looking skin? Well, it's not easy, but taking the time to reduce your daily stress can pay off in healthier, happier skin. Try incorporating these steps into your routine:

• Take a deep breath and slow down.

  Type A personalities typically find themselves in a chronic state of stress, which places them at risk for hormonal imbalance. Try stress reduction techniques, practice deep breathing and if necessary, discuss prescription options with your physician.

• Maintain adequate nutrition.

  Excessive weight loss stresses the immune system, making it difficult for germ-fighting cells to function. This is particularly true if vital serum proteins and albumin become diminished. If you're a chronic dieter, picky eater or simply have a long-term goal, try following a diet under a physician's guidance and get blood testing to help avoid these risks.

• Avoid smoking.

  Smoking, particularly in anyone prone to depression, has been shown to reduce the natural killer (NK) germ-fighting white blood cells, thus reducing immunity. In turn, the body becomes more vulnerable to emotional and physiological stressors.

• Limit alcohol.

  Alcohol affects a variety of Immunological systems including reducing cytokines, inhibiting the function of white blood cells responsible for fighting infection and long term immunity.

• Limit caffeine.

  Caffeine elevates circulating levels of epinephrine, upping stress all day long. If you can't do without caffeine, try to limit your intake prior to 1 pm.

• Exercise.

  The benefits of exercise for reducing stress are legion. Practice a combination of aerobics with stress reducing routines like yoga or Pilates to maximize your benefits.

• Take a vacation.

  I simply can't tell you the number of times my eczema or psoriasis patients have returned from a vacation free of their skin disorder only to flare upon arrival home. Is it the job, the family interactions, or just the stimuli of normal daily living? Perhaps any combination of these is responsible. But take the time for yourself and get away. It'll do you a world of good.

• Take time for yourself.

  Every day can't be a holiday. But do try to schedule 15 to 30 minutes a day just for you. Read a book, practice meditation, go for a walkwhatever you want to do to take a moment for yourself and regroup.

Life is stressful but there's no need for it to show. So take a deep breath, smell the roses and check with your dermatologist if stress seems to be playing havoc with your skin.

Thank you for taking the time to read my newsletter. I hope you have found it informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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