Psychodermatology is a field of study that examines the impact of emotions and stress on skin conditions. Many dermatological conditions have been directly attributed to nervous conditions including nail biting, skin picking, and hair pulling (trichotillomania). These are all common forms of obsessive-compulsive behaviour associated with exaggerated grooming.
Many nerve endings are connected to the skin. Tactile corpuscles in the dermis (for the reception of light touch) share a dermal layer with oil glands, sweat glands and hair follicles. Scratching, skin picking, nail biting, and hair pulling all provide some temporary positive sensory feedback that perpetuates the behaviour.
Additionally, many hormones and neurotransmitters have a big impact on the function of the skin and how it responds to environmental and psychological changes. For example, excess release of the stress hormone ‘cortisol’ increases the skin’s oil production potentially making acne symptoms worse.
The psychological aspect of itching was observed in a study whereby people shown images of fleas, mites, scratch marks and hives started to scratch. Scratching provides temporary relief but it can also cause skin damage and mast cell infiltration, in turn causing more intense itching.
Certain neurotransmitters (histamine, serotonin) and inflammatory mediators (prostaglandins, cytokines) are involved in the itch response. They bind to the nerve endings of itch receptors and induce axonal firing. Additionally, external stressors can activate the stress response system in the brain (hypothalamic-pituitary-adrenal axis; HPA axis), and the hormones of this HPA axis in turn activate mast cells in the skin.
Psoriasis, eczema, pruritis and acne are considered psychodermatological conditions because stress can trigger or exacerbate skin lesions. Additionally, skin disease in itself is a source of stress that can perpetuate the problem. Effective treatment involves not just treating the skin, but the nervous system and mental health too.
The Stress Response
Cortisol is produced and released by the adrenal glands to help support the body to deal with stress. It is a hormone that triggers a flood of glucose to the muscles to provide the energy for the fight or flight response. It also blocks insulin so that the glucose won’t be stored but will be available for immediate use.
Adrenaline and epinephrine are other hormones involved in the stress response as they increase your heart rate so you can flee from danger. This hearkens back to a time when we had the very real threat of being chased by wild animals or fellow humans yielding weapons. These days this response might be triggered by someone sneezing at the supermarket!
These hormones typically return to normal levels when the threat or stressor has passed. However sustained stress or an impaired stress response can cause the inappropriate release of stress hormones throughout the day. Living with a stressful situation or just the demands of modern life coupled with nutrient deficiencies can impair the stress response.
Inappropriately elevated stress hormones cause a cascade effect. The immune system and digestive system are suppressed as your body diverts blood and nutrients to the muscles and heart for escape. Blood sugar levels remain high and insulin levels drop meaning your cells don’t have access to the glucose they need to perform optimally. You may start to crave sugar and other carbohydrates for the energy your cells need.
Foods and Substances to Avoid
When people get tired and stressed they often reach for caffeine, alcohol, sugar and other comfort foods. Food affects your biology which is why healthy food can be used therapeutically and unhealthy food can cause or exacerbate certain health conditions.
Caffeine is found in coffee, tea, chocolate, colas and energy drinks. It has a stimulating effect that is short-lived, but has a rebound effect causing greater fatigue. Caffeine also weakens an impaired immune system, puts undue strain on the adrenal glands and causes depletion of many essential nutrients needed for nervous system function (such as B vitamins).
Alcohol is linked to chronic skin conditions because of its toxicity, immune suppression activity and its negative impact on mood, sleep and hormone balance. Like caffeine it depletes the body of vital nutrients in an effort to achieve homeostasis. Alcohol is commonly abused by people with depression and anxiety, creating further mood disturbance in most cases.
Sugar is an addictive substance that causes temporary feelings of wellbeing and energy, followed by rebound fatigue. It plays havoc with blood glucose levels and insulin production. Sugar is found in lollies, soft drinks, energy drinks, baked goods and most processed foods. Sugar is strongly linked to diabetes, obesity, heart disease and low immunity. The mineral chromium can help balance blood sugar levels and curb cravings.
Artificial Sweeteners can be even more harmful than sugar. They are found in many processed foods including diet soft drinks, chewing gum, sugar-free/low-sugar alternatives, shakes and even some supplements. Aspartame has been well-researched and is strongly linked to neurological abnormalities because of its methanol content.
Histaminic Foods are foods that either contain high levels of histamine or liberate histamine in the body. Histamine is a neurotransmitter that contributes to itching in psoriasis, pruritis and dermatitis and can also cause inflammation in acne and rosacea. High histamine foods are those that are pickled (sauerkraut), aged (cheeses), smoked or canned (fish, chicken), preserved or processed meats (ham, salami, bacon). Histamine liberators are citrus fruit, berries, tomatoes, cocoa, beans and pulses, nuts, yeast and food additives like glutamate (MSG), sulphites, nitrates, and colourings.
Natural Support
For patients taking anti-depressant or anti-anxiety medications we are careful not to co-administer any natural products that may interact with their medication. We will look at nutrients that may support the efficacy of existing treatments or replace any nutrients that may be depleted by the use of some medications.
As naturopaths we don’t prescribe synthetic hormones or increase the uptake of existing (deficient) hormones. Herbal medicine and nutritional supplements are utilised to nurture the endocrine glands back to health. This way the body can eventually restore balance through optimal hormone and neurotransmitter synthesis. This is done in conjunction with healthy dietary and lifestyle habits.
Exercise and recreation are crucially important for mental health. Exercise promotes hormonal balance and a healthy body. Social activity and time out from work and household chores improves your mood and rejuvenates the soul. Counselling may also be required to address any trauma or compulsive behaviours that are impacting on your recovery.
The natural approach to treating stress and anxiety is typically slower than conventional methods. If you suspect that you suffer from moderate to severe depression or are having any suicidal thoughts it is very important to be assessed by your doctor.
