Modern life and stress appear to be intrinsically bound - balancing family, friends, work and general life means stress is present in all of our lives almost all of the time. 

Though we mainly experience stress as a psychological process it plays a significant role in our physical health. The relationship between AD and stress is complex as the condition can be triggered by stress but is also a cause of stress.

Though we don’t possess any secrets to rid your life of stress, we hope that by explaining how stress impacts your skin you may feel motivated to take steps to manage your stress better. We also take a look at the evidence behind stress management techniques and their impact on your skin. 

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AD and the neuroimmune network

The relationship between AD and stress can begin before birth. It has been shown babies that have been exposed to stress in the womb have an exaggerated stress response in early childhood.

In this early period of hyperactivity, stress causes an imbalanced suppression of immune cells leading to a skewed presence of T-helper type 2 cells which are responsible for allergic inflammation in atopic dermatitis. 

Over time this persistently elevated stress state leads to reduced responsiveness of the normal hormonal pathways. In this later period, cortisol production is reduced due to chronic overactivity and subsequent desensitisation of the pathways. Cortisol is a naturally occurring steroid hormone released by the hypothalamic-pituitary axis. Cortisol has multiple actions on the body including increasing the availability of glucose and suppressing inflammation (cortisol is the basis of steroid medications). In individuals with chronic stress, the release of cortisol decreases leading to reduced inflammation suppression. 

Furthermore, studies and experiments have shown that stress leads to increased water loss from the skin, increased risk of infections and weakening of the skin barrier function through altering the integrity and cohesion of cells in the skin. 

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What can you do

Psychotherapy and relaxation techniques can be used to reduce external stress (AD triggering) and stress from the condition. Techniques can also be used to combat negative behaviours that exacerbate the condition (itching). Multiple different strategies have been employed and studied with results showing improved patient anxiety, itch-scratch patterns and reduced steroid usage. 

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CBT can be used to help restructure patterns of both thought and behaviour. 

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Positive self-talk

The idea is that your internal dialogue impacts your subconscious brain therefore negative self-talk about your skin leads to more negative thoughts and worsening anxiety/stress, while positive self-talk can do the opposite.

Behaviour change

By forcefully substituting a harmful activity like scratching with something less damaging to the skin and repeating this over time the new activity will eventually become the conditioned response and scratching will stop. 

Relaxation therapy

CBT, autogenic therapy, massage and hypnosis have all been used as tools to reduce stress and anxiety. The idea is to alter autonomic responses and switch off ‘fight or flight’ stress responses through learnt techniques. 

Autogenic therapy

Autogenic training (AT) is a relaxation technique that uses the mental repetition of six exercises: heaviness, warmth, calm and regular heart function, self-regulation of respiration, warmth in the upper abdomen area, and agreeable cooling of the forehead. These work by decreasing sympathetic tone (the fight and flight response) and allow people to disconnect from their bodies. Repeated practice of the exercises increases the person’s capacity to induce ever-deeper relaxation and fosters the accumulation of therapeutic benefits.

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