Treating Stress And Skin Disease In Tandem

Stressed out? It may explain acne, a psoriasis outbreak or a case of the hives. Dermatologists at Columbia University Medical Center have reviewed all the studies on the relationship between stress and bouts of skin disorders.

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It turns out emotions can influence many skin disorders. NPR's Allison Aubrey reports that stressful events can cause a flare-up of psoriasis, as well as acne, hives or eczema.

ALLISON AUBREY: There's nothing pleasant about itchy, flaking skin, according to Kristen Palcisco. But she says for her, the worst thing about psoriasis is the sense that you're wearing your emotions on your skin.

Ms. KRISTEN PALCISCO: So you feel like everybody can see how you're feeling, and oh, my gosh, how embarrassing because this is not an attractive way to present, you know, what's going on the inside. So you just sort of feel exposed or unzipped, is how I used to call it.

AUBREY: Over the years, lots of patients have made the connection between stress and psoriasis. For Palcisco, it happened back in college. She'd had a mild case on and off for several years. But when her father died, she says her grief and depression seemed to make the condition much worse. Throughout her early 20s, she noticed the same pattern. The severity of her symptoms seemed to track her state of mind.

Ms. PALCISCO: And if I were to start exercising, eating well, feeling better about myself in general, I would notice a difference within two weeks.

AUBREY: Researchers are learning a lot about the mind-body connections and skin disease, and doctors are beginning to treat the two in tandem in cases where there's a clear connection with anxiety or depression.

Joseph Locala is a psychiatrist at the University Hospitals Case Medical Center in Cleveland. He sees patients at the Murdough Family Center for Psoriasis.

Dr. JOSEPH LOCALA (Psychiatrist, Murdough Family Center for Psoriasis): If you think of the skin, it's a barrier of defense for the body, and it's our main way of communicating with the outside world.

AUBREY: If we're embarrassed, we blush. If we're mad, we flush. And nervous -sweat. These are some of the emotional signals everyone can see, but there's a lot more going on. Locala explains that in the skin, all the systems of the body, including the nervous system and immune system, are talking to each other.

Dr. LOCALA: There's so many nerve endings that terminate in the skin, and there's such a strong influence of the hormones and the immune system in the skin in order to protect the body. So all these systems have to be functioning at a high level of the skin.

AUBREY: But when we get really stressed out, Locala says our bodies activate chemicals called cytokines. They're always there in our bodies, including in our skin.

Dr. LOCALA: And there are some that are actually used to decrease inflammation and decrease reactions in the skin, and others that would actually increase inflammation called proinflammatory cytokines.

AUBREY: When stress initiates a cascade of cytokines, researchers suspect it can help set off a flare up. Of course, not everyone develops psoriasis or hives or outbreaks of acne. There are genes and hormones that make some of us more vulnerable. As for patient Kristen Palcisco, she now meditates and walks regularly. She also uses UV light therapy and a topical cream to treat the few small patches of scaly skin that linger.

Ms. PALCISCO: I learned a lot of tools about, you know, managing stress, managing my emotions and the connection between my health and those things.

AUBREY: In treating skin disorders, the goal should be to treat the whole patient, says psychiatrist, Joe Locala. He says psoriasis sufferers tend to have higher rates of depression and anxiety, but many times they don't seek help beyond the skin issue. That's why he works as part of a team with dermatologists and psychologists.

Dr. LOCALA: Because the dermatologist can say this is a doctor who works with us in our clinic. We'd like you to see him, that there's less of a stigma attached to that and they're more willing to come to see me.

AUBREY: And he says in his experience, the collaboration often opens the door to helpful treatments.

Allison Aubrey, NPR News.

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