Is eczema stress related?

Eczema and Emotional Wellness

Note: Mood changes, including anxiety and depression are side effect of the asthma medication montelukast. If you are taking montelukast and experiencing symptoms of depression/anxiety contact your health care provider right away.

Watch our webinar with information and advice on how to be well even when you don’t feel well.

Using relaxation to manage eczema stress

When it comes to relaxation and self-care, what works for one person might not work for another. Thankfully there are many options to explore. Practice deep breathing while listening to soothing music or nature sounds. Download a guided meditation app. Enroll in a yoga or tai chi class. Allot a certain amount of time each day to reading a book or cuddling with your pet. Make it a daily habit to stroll along a nature trail. Distract your mind from negative thinking with creative activities to do with your hands, such as writing, painting, knitting, baking or playing video games or chess.

Learn more about using meditation to ease eczema’s itch.

The importance of sleep when you have eczema

Easier said than done, right? People living with eczema know how difficult it is to sleep when your skin is itchy and uncomfortable. If eczema is keeping you or your child awake at night, talk with your doctor about how to get a better handle on your symptoms. Taking an antihistamine before bed can help you become drowsy. Enjoying warm, relaxing baths or showers and lathering on the moisturizer before bed can induce sleepiness and stave off itch. It also helps to turn your bedroom into a sleep sanctuary by keeping the room dark, cool and clean, and limiting the use of electronics an hour or two before bedtime.

Learn more about how to get a good night’s sleep even when your eczema is flaring.

Find an eczema support group

Even though eczema is a common disease affecting more than 31 million Americans, many people say they are too embarrassed or ashamed to talk about it. Oftentimes, they report covering up their skin and thus go through life not knowing if the person standing in line next to them also has eczema. It’s human nature to want to talk with others who have the same problem and know what you’re going through. The National Eczema Association can help. Connect with us on Facebook and Twitter to discuss the latest news and research with others in the eczema community. Join Eczema Wise, an online support group where people living with or affected by eczema can post discussion topics, exchange ideas and make new friends.

Exercise and eczema

Exercise is one of the most effective ways to combat stress, anxiety, depression and other negative emotions. Whether you prefer walking, running, swimming, boxing or playing tennis, exercise is believed to trigger certain neurotransmitters and hormones that can dramatically improve your mood. The Department of Health and Human Services recommends that adults get a minimum of 150 minutes of moderate-intensity physical activity each week, in addition to muscle-strengthening activities. However, if sweat is a trigger for your eczema, remember to take a cool or lukewarm shower soon after your workout and change clothes.

Learn more about what you need to know when exercising with eczema.

Diet and eczema

Although there is little scientific evidence connecting diet to eczema flares, or diet to stress, it’s common for people with eczema to experience allergic reactions to foods such as dairy, gluten, nuts or fish. On the other hand, some people have found success eating a “Mediterranean diet” containing anti-inflammatory foods, such as fish and other sources of omega-3 fatty acids, or probiotic-rich foods such as kefir or yogurt. Others have said consuming sugar, caffeine, alcohol, processed foods or foods high in trans fats tends to exacerbate or worsen their eczema symptoms. While it’s common sense to stick to a healthy, well-balanced diet, it’s also important to remember that what is helpful to some may be harmful to others. Always consult with your doctor before making any changes to your or your child’s diet.

Read more about the role of food allergies in eczema symptoms.

Can eczema really be affected by stress?

Can stress cause eczema?

This is often a source of confusion as stress has become so interwoven with eczema that some actually believe that it could be an underlying cause. Eczema is even sometimes known as a pscyhodermatologic disorder, which is a fancy way of saying that it is a physical disorder that is tied to your emotional health.1

However, this doesn’t mean that stress is the actual cause of eczema; it simply means that stress can inspire a flare-up of a pre-existing skin condition. It won’t cause eczema to manifest if you have never suffered from the disorder before, but, if you do suffer from eczema, you may notice that your symptoms seem to get increasingly worse during times of emotional stress.

1http://www.livestrong.com/article/154329-stress-induced-eczema/

How does stress affect eczema?

So stress might not cause eczema but how exactly does it affect your symptoms? In order to answer this question, you first have to understand how stress can affect your body as a whole. When you experience stress, your primordial flight-or-fight reflexes will kick in as your body will instinctively believe that you are in a life-or-death situation.

When this happens, your sympathetic nervous system will prioritise short-term survival over long-term survival and nutrients will be redirected to other areas of your body, such as your muscles. Stress hormones such as cortisol and adrenaline will be released to prepare you for a fight or flight scenario. During this period, certain biological functions will be suppressed such as digestion and your reproductive system.

Your parasympathetic nervous system, sometimes known as the ‘rest and digest’ system is slower to respond but it can help to calm your body down, shifting focus from short-term survival back to long-term survival.

If episodes of stress are infrequent, there shouldn’t be any lasting consequences; however, if you find yourself under emotional stress on a regular basis, this process will keep happening, placing a lot of pressure on your sympathetic nervous system and affecting your immune function, digestive health and more.

So what does this all have to do with stress? Well, one study concluded that stress was a “significant contributor to AD disease course through its direct and indirect effects on immune response, cutaneous neuropeptide expression and skin barrier function.” In other words, stress affects eczema due to its impact on other parts of the body.

Immune system

So how does stress affect the immune system and why does this have an impact on eczema? Eczema is considered to be an autoimmune disease, which is why immunosuppressant medicines such as steroids are often prescribed by doctors. However, ideally you don’t want your immune function too low either, as this can make you more vulnerable to pathogens that may irritate your skin.

In cases of chronic stress, your immune system will eventually become weakened, as our mental wellbeing adviser, Marianna Kilburn, explores in her blog ‘Why stress is the enemy of your immune system.’ Repeated exposure to stress hormones such as cortisol can start to affect how your immune cells respond to threats, making your more exposed to pathogens and viruses.

The immune system can also instigate an inflammatory reaction, which it may continue to do when you experience stress. Inflammation, as you may be aware, is not good news for your eczema symptoms! Interestingly, one study also revealed that the immune system also helps to regulate what microbes inhabit your skin, and, if your immune system is weak, sometimes unhealthy microbes can make a home for themselves there too, uninhibited!2

You also have to consider the affect that cortisol can have. This stress hormone has a lot to answer for – under normal circumstances, it can be very useful, helping to regulate your metabolism and reduce inflammation. However, when chronic stress occurs, over time your immune system will become more insensitive to cortisol’s effect on inflammation, not to mention cortisol can also work to supress your immune function.

The result of all this stress is that you are left with a fatigued immune system that’s unable to fight off invasive pathogens and keeps releasing inflammatory chemicals to upset your skin.

Gut health

Gut health is something that I often mention in relation to skin conditions like acne, however, it’s also applicable to eczema too! It’s estimated that over 70% of our immune cells are located in our gut, so what happens in this area of the body can be surprisingly relevant for your skin.

As I remarked earlier, when you experience stress, it’s not unusual to also experience a bout of constipation or diarrhoea. This is because your sympathetic nervous system does not prioritise breaking down your food, so it will either attempt to evacuate your bowels or cause you to retain waste products.

I’m sure you can imagine the effect this will have on your gut if it is a regular occurrence. Frequent bouts of diarrhoea can cause your body to lose fluids while constipation means that all those toxins are trapped in your body, which can cause further instances of inflammation. For more information, please take a look at our stress advisor Marianna’s blog, ‘How does stress impact our digestive system?’

All of this can have implications for your gut flora too, which feeds into the idea of the gut-brain-skin axis. Gut dysbiosis, also known as an imbalance with your gut flora, can occur as a result of chronic stress which again, can stimulate inflammation. Not to mention, gut dysbiosis can also cause toxic by-products to be released within the body and sometimes, these impurities are eliminated through the skin, causing further irritation.3

Often eczema is associated with a food intolerance too, so it might be worth exploring certain aspects of your diet, as what you eat can also affect your gut flora and digestive tract! Please check out my blog, ‘Change your diet to help control eczema’ for further details.

Skin barrier

Finally, stress can have a direct effect on your skin barrier. In one study it was found that stress can inhibit your skin’s ability to retain moisture, causing it to lose valuable fluids, making you more inclined to bouts of dry skin.

In addition to this unfortunate issue, stress can even impact your skin’s ability to repair itself, making it more vulnerable to irritation by invasive pathogens, stimulating symptoms such as itchiness. Stress can also affect your mood which may make you more predisposed to destructive behaviours, such as scratching or overeating.

What can you do to eliminate stress?

It’s all very well telling you that stress is bad, not only for your skin, but your entire body as a whole, but eliminating stress is a lot easier said than done. There could be multiple factors affecting your stress levels – financial issues, sleep deprivation, illness, or relationship worries – and none of them are going to disappear overnight.

Even if you can’t eliminate the source of your stress, you may still be able to help yourself cope better with the ordeal. That’s why I’d recommend starting with your diet.

As I mentioned earlier, food intolerances can play a role in eczema, not to mentioned that certain food products such as refined sugar, can impact the overall health of your skin – please check out my blog ‘The bitter truth about sugar and your skin,’ if you want to learn more.

Your diet can also play a role in affecting your stress levels too, so instead of bingeing on processed foods and caffeine, focus first on getting plenty of fresh fruit and veg into your meals.

Not only will these types of food be rich in skin-boosting antioxidants, they may also contain magnesium and other nutrients that can help to benefit your mood. You could try Biotta’s Carrot Juice, which is a great source of vitamin A, a really important nutrient for your skin!

It may even help to consider a prebiotic and probiotic combination to help support healthy gut flora. Molkosan is our gentle prebiotic which can help to create a healthy environment for your gut flora to flourish in, while a probiotic like Optibac’s For Every Day Capsules, is available from our sister company, Jan de Vries.

Once you have your diet under control, you could look at your lifestyle. If your day-to-day routine is busy and hectic, it’s important that you try and set aside some time for yourself every day, at least 30 minutes. It’s also essential that you get plenty of good-quality sleep as this can have a huge impact on your overall happiness and wellbeing, as our sleep advisor Marianna details in her blog, ‘Is a good night’s sleep the key to happiness?’

Getting plenty of exercise can also help to lower your stress levels. If you are new to working out, I would recommend starting with a low-impact form of exercise such as yoga, which can teach you deep breathing techniques, enabling you to cope with stress better. If you are more used to exercise, though, you could try running or cycling, which can be great for getting you outdoors and exposing you to more vitamin D!

Finally, if you feel that stress is really starting to take over your life, you could try our natural, gentle stress remedy, AvenaCalm, which works gradually to ease the symptoms of mild stress and anxiety, restoring a sense of balance and calm. Prepared using extracts of organic oat herb, this remedy is very popular with our customers and can also be used to help you drift off into a natural sleep.

Eczema

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What Is Eczema?

What Are the Signs & Symptoms of Eczema?

The symptoms of eczema:

  • are mainly dry, itchy skin
  • also include redness, scales, and fluid-filled bumps that become moist and then crust over
  • can vary quite a bit from person to person
  • can be on any part of the body. But in teens, the itchy patches usually happen where the elbow bends; on the backs of the knees; on the inner wrists and ankles; and on the face, neck, and upper chest.
  • tend to come and go. When they get worse, it is called a flare-up.

Some people who have eczema scratch their skin so much it becomes thick, darker, and almost leathery in texture (called lichenification).

What Causes Eczema?

Doctors don’t know exactly what causes eczema, but they think it could be a difference in the way a person’s immune system reacts to things. Skin allergies may be involved in some forms of eczema.

Who Gets Eczema?

Many people with eczema have family members with the condition. Experts think it passes from parents to kids through the genes. Eczema is fairly common.

People with eczema also may have asthma and some types of allergies, such as hay fever. Eczema, asthma, and hay fever are known as “atopic” conditions. These affect people who are overly sensitive to allergens in the environment. For some, food allergies may bring these on or make them worse. For others, allergies to animal dander, dust, pollen or other things might be the triggers.

Eczema is not contagious.

How Is Eczema Diagnosed?

There is no specific test used to diagnose eczema. A doctor will look at the rash and ask about your symptoms and past health, as well as your family’s health. If you or your family members have any atopic conditions, that’s an important clue.

The doctor will want to rule out other conditions that can cause skin inflammation. The doctor might recommend that you see a dermatologist or an allergist.

How Is Eczema Treated?

If you’re diagnosed with eczema, your doctor might:

  • prescribe medicines to put on the skin that soothe the redness and irritation, such as creams or ointments that contain corticosteroids (not the same as steroids used by some athletes)
  • recommend other medicines to take by mouth if the eczema is really bad or you get it a lot

If someone has severe eczema, ultraviolet light therapy can help clear up the condition. Newer medicines that change the way the skin’s immune system reacts also may help.

How Can I Deal With Eczema?

There’s no cure for eczema. But you can help prevent a flare-up:

  • Moisturize! A scent-free moisturizer will prevent your skin from becoming irritated and cracked. Moisturize every day, ideally twice or three times a day. The best time to apply moisturizer is after the skin has been soaked in a bath or shower, then patted dry gently. Ointments (such as petroleum jelly) and creams are best because they contain a lot of oil. Lotions have too much water to be helpful.
  • Stay away from things that can irritate your skin. Besides your known triggers, some things you may want to avoid include household cleaners, drying soaps, detergents, and scented lotions. For facial eczema, wash gently with a nondrying facial cleanser or soap substitute, and use facial moisturizers, makeup, and sunscreens that say “non-comedogenic/oil-free” on the product label.
  • Use warm water. Too much exposure to hot water can dry out your skin, so take short warm — not hot — showers and baths and wear gloves if your hands will be in water for long periods of time. Gently and thoroughly pat your skin dry, using a soft towel.
  • Say yes to cotton. Clothes made of scratchy fabric like wool can irritate your skin. Soft cotton clothes are a better bet.
  • Don’t scratch. It’s hard to resist, but scratching can make eczema worse and make it harder for skin to heal. You might break the skin and let bacteria in, causing an infection.
  • Stay cool. Sudden changes in temperature, sweating, and becoming overheated may cause your eczema to kick in.
  • Take your meds. Follow your doctor’s directions for all medicines.
  • Unwind. Stress can aggravate eczema, so try to relax.

What Else Should I Know?

If you live with eczema, tune in to what triggers it and how to manage it. For example, if you find that some types of makeup irritate your skin, ask a dermatologist to recommend brands that are less likely to do so.

Your self-esteem doesn’t have to suffer because you have eczema, and neither does your social life! Getting involved in your school and extracurricular activities can be a great way to get your mind off the itch.

Don’t forget to exercise. It’s a great way to blow off stress — try walking, bike riding, swimming, or another sport that keeps your skin cool and dry while you work out.

Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: September 2019

Eczema (Atopic Dermatitis)

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Eczema is a condition where the skin gets irritated, red, dry, bumpy, and itchy. There are several types of eczema, but the most common is atopic dermatitis. To many people, “eczema” and “atopic dermatitis” mean the same thing.

The signs of eczema (EK-zeh-ma):

  • are mainly dry, itchy skin. Because it is so itchy, it is often called “the itch that rashes.”
  • include redness, scales, and bumps that can leak fluid and then crust over
  • tend to come and go. When they get worse, it is called a flare-up.
  • may be more noticeable at night

Symptoms can vary:

  • Infants younger than 1 year old usually have the eczema rash on their cheeks, forehead, or scalp. It may spread to the knees, elbows, and trunk (but not usually the diaper area).

  • Older kids and teens usually get the rash in the bends of the elbows, behind the knees, on the neck, or on the inner wrists and ankles. Their skin is often scalier and drier than when the eczema first began. It also can be thicker, darker, or scarred from all the scratching (called lichenification).

Doctors don’t know exactly what causes eczema. It might be that there’s a difference in the way a person’s immune system reacts to things. Skin allergies may be involved in some forms of eczema.

Many kids and teens with eczema have family members who have it. Experts think it passes from parents to kids through genes. Eczema is fairly common.

People with eczema also may have asthma and some types of allergies, such as hay fever. Eczema, asthma, and hay fever are known as “atopic” conditions. These affect people who are overly sensitive to allergens in the environment. For some, food allergies may bring these on or make them worse. For others, allergies to animal dander, dust, pollen or other things might be the triggers.

Eczema is not contagious.

There is no specific test used to diagnose eczema. The doctor will look at the rash and ask about symptoms, the child’s past health, and the family’s health. If family members have any atopic conditions, that’s an important clue.

The doctor will rule out other conditions that can cause skin inflammation, and might recommend that your child see a dermatologist or an allergist.

The doctor may ask you to ban some foods (such as eggs, milk, soy, or nuts) from your child’s diet, switch detergents or soaps, or make other changes for a time to see if your child is reacting to something.

There is no cure for eczema. But treatments can help with symptoms. The doctor will recommend different treatments based on how severe the symptoms are, the child’s age, and where the rash is. Some are “topical” and applied to the skin. Others are taken by mouth.

Topical moisturizers. Skin should be moisturized often (ideally, two or three times a day). The best time to apply moisturizer is after a bath or shower, with the skin patted dry gently. Ointments (such as petroleum jelly) and creams are best because they contain a lot of oil. Lotions have too much water to be helpful.

Topical corticosteroids, also called cortisone or steroid creams or ointments. These ease skin inflammation. (These aren’t the same as steroids used by some athletes.) It’s important not to use a topical steroid prescribed for someone else. These creams and ointments vary in strength, and using the wrong strength in sensitive areas can damage the skin, especially in infants.

Other topical anti-inflammatory medicines. These include medicines that change the way the skin’s immune system reacts.

Medicine taken by mouth. These can include antihistamines (anti-allergy medicine) to help itchy kids sleep better at night, antibiotics if a rash gets infected by bacteria, and corticosteroid pills or other medicines that suppress the immune system.

Other types of treatment can include:

  • phototherapy: treatment with ultraviolet light
  • wet wraps: damp cloths placed on irritated areas of skin
  • bleach baths: bathing in very diluted bleach solution

How Can Parents Help?

Help prevent or treat eczema by keeping your child’s skin from getting dry or itchy and avoiding triggers that cause flare-ups. Try these suggestions:

  • Kids should take short baths or showers in warm (not hot) water. Use mild unscented soaps or non-soap cleansers and pat the skin dry before putting on cream or ointment. Teens should use unscented makeup and oil-free facial moisturizers.
  • Ask your doctor if it’s OK to use oatmeal soaking products in the bath to help control itching.
  • Kids should wear soft clothes that “breathe,” such as those made from cotton. Wool or polyester may be too harsh or irritating.
  • Keep your child’s fingernails short to prevent skin damage from scratching. Try having your child wear comfortable, light gloves to bed if scratching at night is a problem.
  • Kids should avoid becoming overheated, which can lead to flare-ups.
  • Kids should drink plenty of water, which adds moisture to the skin.
  • Get rid of known allergens in your household and help your child avoid others, like pollen, mold, and tobacco smoke.
  • Stress can make eczema worse. Help your child find ways to deal with stress (like exercise, deep breathing, or talking to a counselor).

When Should I Call the Doctor?

Children and teens with eczema are prone to skin infections. Call your doctor right away if you notice any early signs of skin infection, such as

  • fever
  • redness and warmth on or around affected areas
  • pus-filled bumps on or around affected areas
  • areas on the skin that look like cold sores or fever blisters

Also call your doctor if you notice a sudden change or worsening of the eczema, or if it isn’t responding to the doctor’s recommendations.

For many kids, eczema begins to improve by the age of 5 or 6. Sometimes it goes away. In other kids, it may start again as they enter puberty. Some people still have eczema as adults, with areas of itching that look dry and scaly.

Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: September 2019

Winter can be grim: coughs, cold, flu and the general sense of malaise brought on by dark nights, too much food and not enough exercise. And to add to the misery, as the temperature plunges and the heating goes on, normally reliable and trouble-free skin can start to itch, flake and drive a person to distraction. Welcome to the onset of winter eczema. About 1.6 million adults in the UK live with eczema, many since childhood. It can be a year-round torment or flare up in the cold months. A recent Allergy UK survey of adults with eczema found that 88% say it has an impact on their daily lives, 58% say it affects personal relationships and 73% claim that their social life suffers. But despite the scale of the problem, adult eczema remains an underfunded, under-recognised and undertreated condition that can cause profound distress.

Why is it worse in winter?

“A combination of cold weather, warm indoor environments, hot baths and woolly clothes can all aggravate eczema. Heat is a common trigger, stimulating the itch/scratch cycle,” says Holly Shaw, nurse adviser at Allergy UK. She adds that sources such as central heating and fan heaters can be a problem and suggests turning car heating vents away from your face and keeping central heating in the home at a steady, comfortable ambient temperature. Wearing cotton clothes helps to keep a layer of moist air next to the skin, which stops it drying out and helps to break the cycle of itch and scratching, says dermatologist Dr Howard Stevens. Eczema is a complex condition, though; an inherited tendency, mild dysfunction of the skin barrier and immune system and exposure to environmental factors such as pets, house dust mites and pollen may all play a role.

What is the difference between eczema and dermatitis?

None – eczema and dermatitis are two names for the same thing. Eczema comes from the Greek word “to boil”, which seems appropriate for the red, dry and itchy skin it describes. Repeated scratching can make the skin thick and infection can cause weeping and blistering. The two main causes of eczema are an overactive immune system (atopy) that also causes hay-fever, allergies and asthma, or contact with chemicals.

The id reaction could mean eczema can appear anywhere on the body. Photograph: Getty Images/iStockphoto

Why are my hands red raw since I started my new job in a hospital?

It could be the hand sanitiser. Contact dermatitis causes red, cracked, itchy and sore skin in places where irritant chemicals, or ones you are allergic to, touch the skin. A patch of eczema round the belly button, earlobes or round a new piercing is often due to an allergy to nickel, which is found in buttons, jean studs and cheap jewellery. Hand sanitisers, excessive hand washing and chemicals used by hairdressers, painters and gardeners can all be irritants and cause eczema, primarily on the backs of hands. Stevens says “applying moisturisers immediately after washing hands replaces the natural oils in the outer layer of the skin that are removed by soaps and detergents”.Allergic reactions tend to affect the back of the hands where the skin is thinner and more sensitive and irritant eczema affects the spaces between fingers and under rings. Hand eczema often affects the nails too which look rough, ragged and cracked. People who develop contact eczema at work may find it so hard to avoid the chemicals responsible that they eventually have to give up their jobs.

The eczema started on my hands but has spread over my body. What’s going on?

It could be your id. Although contact eczema is limited to the area that touches the chemical, a strange phenomenon called the id reaction or utoeczematisation means that the immune response to the affected area leads to widespread eczema anywhere on the body.

Can I be referred for allergy testing?

Good luck; the waiting lists are horrific in many areas; it’s just not a high priority, although Allergy UK argues it should be. Patch testing can be used to identify which chemicals are responsible, but it helps to give some thought to likely suspects because there is a limit to how many chemicals can be tested for. “Luckily, a relatively small number of chemicals cause most of the problems, so the commonly used standard battery of patch test allergens identifies 70% of the chemicals that commonly cause eczema,” says Stevens.

What can I do in the meantime?

The solution lies in identifying and avoiding the cause, heaps of emollient (moisturiser) and a possibly short course of a potent steroid ointment from your GP – wrapping the hands in clingfilm overnight helps the steroid to penetrate the skin better and stops it rubbing off on the bedclothes, which could be a real fire hazard in the case of paraffin-based emollients. In very severe cases, short courses of oral steroids are prescribed or longer-term courses of immunosuppressants that damp down the whole immune system. Antibiotics are only useful if there are signs of infection-like pus or weeping blisters.

Do most kids grow out of it?

Many kids do, but not all, and some people develop it for the first time as adults. In kids, atopic eczema typically affects the backs of knees and elbow creases. Adults often find hands, eyelids and skin creases affected. Anyone with atopic eczema is also more prone to contact eczema. And as well as being more prone to other allergic conditions such as asthma, hay-fever and food allergies, there are also links with insomnia, depression and attention deficit hyperactivity disorder (ADHD). Some adults with eczema are well aware that they get a flare up when exposed to a particular trigger such as stress but, often, the eczema waxes and wanes for no apparent reason.

I’m sick of it. What can I do?

You are probably all too aware of the options: try to identify and avoid triggers; wear loose, cool layers to avoid getting too hot; use emollients, steroid ointments or creams, or antihistamines to stop itching; tacrolimus or pimecrolimus ointments, which are non-steroid options; and drugs that suppress the immune system (such as oral steroids) if all else fails. Talking therapy can be useful to deal with the stress that can be both a trigger and consequence of eczema and dealing with the impact it has on life.

Any hope on the horizon?

Yes. There are two hopeful products in the pipeline; crisaborole (Eucrisa), a non-steroidal ointment for mild or moderate eczema, and an injectable, biologic drug called dupilumab for more severe cases.

If you find that your eczema flares up right before a big presentation or in the middle of tax season, it’s no coincidence. Experts have known for years that stress can make the skin condition worse.

When you’re tense, your body tries to protect your skin by boosting inflammation there. If you already have it because of eczema, that boost will make your symptoms worse.

The key is to try to manage your stress. It might be one of the best ways to help keep your disease in check. Here are seven tips to get the tension in your life under control.

1. Get enough sleep.

A good night’s rest can lower your stress. But it’s not always easy to sleep when your skin is itchy. If eczema is keeping you up at night, talk with your doctor about how to get a better handle on your symptoms. You can try taking an antihistamine before bed. This type of medicine can ease itching, and it can make you sleepy.

2. Find support.

Your skin condition can add to your daily stress. You might feel like you just can’t get comfortable. It helps to talk with other people who have the same problem and know what you’re going through. They might even have advice on new things you can try to feel better. Look for support groups for eczema online or find one that meets in your community.

3. Learn to relax.

From deep breathing to yoga and guided imagery, there are many ways to wind down. What works for you may be different than what helps other people relax. So explore your options. You can try progressive relaxation or listening to a relaxation CD. Or take a few minutes each day to write about what you’re feeling. You can rip up the paper or delete the file when you’re done.

4. Get some exercise.

It’s one of the best stress-busters around. Whether you like walking, swimming, or playing tennis, exercise can make you feel better overall. But if sweat is a trigger for your eczema, take a cool or lukewarm shower soon after your workout to wash it off.

How Is Stress Linked to Atopic Dermatitis?

Atopic dermatitis (AD) is caused by a combination of factors, including genetic predisposition, environmental factors, and dysfunctions in the skin barrier and the immune system. One of the environmental factors that plays a role in the development of AD is emotional stress. Stress affects the immune system and the neuroendocrine system, which is responsible for releasing hormones that act as chemical messengers to regulate various systems like digestion, respiration, blood pressure, and heart rate.1

In addition to the development of AD, stress can also trigger a relapse. Several research studies have demonstrated an association between stressors and worsening AD or onset of flares. In addition, living with a chronic skin condition like AD can increase stress and negatively impact an individual’s quality of life.1

How stress affects atopic dermatitis

One of the key characteristics of AD is a dysfunction in the immune system, which leads to chronic inflammation in the skin. Stress seems to worsen this dysfunction of the immune response, creating more of the inflammatory reaction. People with AD have an increased response to stress, including a higher amount of cortisol released in the body. Cortisol is known as the “stress hormone” and is best known for its involvement in the “fight-or-flight” response of the body. Early exposure to stress in children can lead to a persistent sensitization, which increases a vulnerability to stress later in life.

Stress negatively affects the skin barrier function, which can lead to more moisture loss and an increased susceptibility to infection. People with AD already have a compromised skin barrier due to the reduced amount of the protein filaggrin, which plays an important role in the structure and formation of the skin layers. Stress in people with AD can further reduce the skin’s ability to keep germs out and keep water in.1

Treating atopic dermatitis with psychological approaches

Because of the impact of stress on AD, interventions that lower stress or increase relaxation have been used as adjuncts to standard topical treatments. In addition to teaching relaxation techniques and improving stress management, several strategies aim to reduce the distress around the itch of AD, which is persistent and distressing.

The itch with AD can cause people to scratch their skin until they bleed, which increases the chance of infection. In addition, the scratching maintains the skin lesions and can lead to lichenification, or a thickening of the skin that is always itchy. Therapies that help people prevent scratching and increase their ability to handle the distress that is associated with itchiness can help treat AD.2

Psychological approaches that have been studied in people with AD include:

  • Relaxation techniques
  • Psychotherapy (also known as “talk therapy”)
  • Stress management
  • Habit reversal training (aimed at reducing the frequency of scratching)
  • Relaxation with imagery2

Some research studies have shown that people with AD who receive psychological therapy along with standard medical care have significantly larger improvements in their skin condition than those who just received standard medical care or skin care education. The addition of psychological treatment also reduces the amount of topical steroids needed.1,2

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