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How Significant Life Events Can Lead To Skin Disorders

In this article we discuss how our perception of stress can really depend on our childhoods; how stressful events can lead to skin problems and mental health issues; why stress can cause skin disease; and whether autoimmune diseases are linked to stress. How childhood development and experiences can shape our perception of stress: A child’s environment shapes their internal world, their beliefs about the world surrounding them and about themselves. Such thought processes can evolve into fixed beliefs or limiting self-beliefs transcending into adulthood. Within their environment includes people that surround them. Early relationships that we form can shape our response to stress and our emotions. How a child develops beliefs and thought patterns depends on how well they are nurtured. If a child is not nurtured well eg. in the case of neglect and experiences any form of distress in their environment, this can lead to negative thoughts and emotions which then have a significant impact on the individual’s belief systems (such as not feeling worthy of love, feeling guilt etc) and behaviours, all of which can then affect their self esteem and confidence. This can lead to disorders and behavioural problems in adulthood. They can develop a negative self‐image, mood disorders, problems with temper/anger, and neuroticism. Such problems have often been found in people with conditions that have a heightened genetic allergic immune response, known as atopy, such as atopic dermatitis. Senra and Wollenburg (2014) found that some mothers of children with early onset skin disorders have been found to suffer more from depression and can feel more stress having to look after a child with skin problems. In the case of children with atopic dermatitis, caring for them can cause disruptions in the family dynamic and effect relationships between different family members. Such dynamics can cause stress in the child (1). Repeated/continual stressors in life can challenge what an individual thinks and believes about themselves and the world around them. This can impact on social interactions, ability to form relationships, and can even impact on how far the individual progresses in life. When the individual goes on to experience further events in life that trigger the same stressful response, this can further cement their negative beliefs about themselves in their mind whilst they continue to suffer from a skin condition that in itself can also be a trigger for stress and negative emotions. The significance of traumatic events in development of skin disease: Traumatic events cause an increase in psychological stress and hence such events have been linked to the development of a wide range of psychological problems which manifest in the skin. People with post traumatic stress disorder (PTSD) often suffer from nightmares and flashbacks but can also describe intrusive thoughts felt as sensations such as pain, numbness, tingling, and crawling in their skin. The stress can trigger an inflammatory response in the body leading to inflammatory skin conditions. Sometimes early onset trauma leading to PTSD can lead to people having difficulty describing and identifying their feelings. This can lead to dissociative states whereby a person becomes disconnected from their thoughts, feelings, memories or sense of identity. This can manifest as a sensation of numbness or perhaps the development of skin problems eg. marks on the skin, where there is no medical explanation that can be found for why they have appeared ie. they most likely have been self-inflicted unknowingly by the individual (1). A 2017 study published in the Journal of Clinical Dermatology revealed other symptoms of skin disorders that can also be associated with post traumatic stress disorder (PTSD). PTSD can activate the sympathetic nervous system leading to night sweats and itching. Emotional and physical neglect, and all types of abuse can sometimes manifest as infantile eczema, self-injury to the skin, and repetitive behaviours such as pulling one’s own hair out and skin-picking disorders. Sometimes traumatic events can lead to eating disorders which can have a knock on effect on the skin (2). How does stress actually cause skin disease/conditions to develop? When we experience stress, this stimulates regions in the brain to trigger the hypothalamic–pituitary-adrenal (HPA) axis in the body to produce stress hormones in response. This can lead to a range of bodily effects including regulating blood pressure but it also stimulates the immune system causing inflammation in the body. If experienced acutely ie. as an initial response it promotes healing in the body. However continued stress such as that endured by past traumatic experiences triggered by reoccurring stressful stimuli can stimulate the HPA axis in such a way whereby stress hormones are produced which impair the immune system and cause chronic inflammation. This can lead to conditions such as psoriasis, chronic urticaria (hives and itching), and atopic dermatitis. Stress can therefore make skin conditions worse. The inflammation can affect the lipid biolayer of the epidermis (the surface layers of the skin) breaking down the barrier. If itching ensues, then scratching can further break down the epidermis letting bacteria in which can worsen inflammation as well as leading to skin infections. This inflammation has been shown in blood levels of patients with chronic skin conditions revealing raised inflammatory markers. Some people with PTSD have a heightened immune response worsening their skin condition. The study by Gupta, Jarosz & Gupta (2017) recommended that we should consider PTSD to be an underlying factor in long term/recurrent/treatment-resistant skin conditions whose flare-ups are triggered by stress (2). We now have more of an understanding of the brain–skin connection and how the communications between our neurological system, endocrine system and immune system can underly any inflammatory skin disease. It is these very communications that cause us to adapt our fight or flight responses triggering anxiety. What affects our physiological stress response is how our brains/minds interpret stress. Is there a link between stress and autoimmune conditions? Many retrospective studies have found that up to 80% of patients reported uncommon emotional stress before they developed an autoimmune disease. But because there are so many different causes and types of stress, it can be very challenging to prove that stress directly causes autoimmune disease. Autoimmune diseases develop from a combination of genetic, environmental, hormonal, and immunological factors. However, we cannot find a known trigger in 50% of autoimmune cases. This is why physical and psychological stress are thought to play a factor, especially as there have been many animal and human studies, and recent reviews which show how stress can raise stress hormones and impair the immune system by affecting the production of inflammatory cytokines. So not only is stress linked to skin diseases and autoimmune conditions, but such diseases can cause significant stress further worsening the condition and lives of many patients (3). A Swedish retrospective study in 2018 involving 106,464 patients demonstrated that stress-related disorders have a significant association with an increased risk of autoimmune disease. The study was not without it’s limitations being a retrospective study and cannot confirm that stress directly causes autoimmune diseases but it establishes that there is an increased risk nonetheless (4). (1) Senra, M. and Wollenberg, A. (2014), Psychodermatological aspects of atopic dermatitis. Br J Dermatol, 170: 38-43. (2) Gupta MA, Jarosz P, Gupta AK. Posttraumatic stress disorder (PTSD) and the dermatology patient. Clin Dermatol. 2017 May-Jun;35(3):260-266. doi: 10.1016/j.clindermatol.2017.01.005. Epub 2017 Jan 22. PMID: 28511822. (3) Stojanovich L, Marisavljevich D. Stress as a trigger of autoimmune disease. Autoimmun Rev. 2008 Jan;7(3):209-13. doi: 10.1016/j.autrev.2007.11.007. Epub 2007 Nov 29. PMID: 18190880. (4) Song H, Fang F, Tomasson G, et al. Association of Stress-Related Disorders With Subsequent Autoimmune Disease. JAMA. 2018;319(23):2388–2400. doi:10.1001/jama.2018.7028

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