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The mind–skin connection

Stress can aggravate any skin condition and eczema is no exception. ‘Generally, the mind and skin are very closely linked,’ explains Dr Anthony Bewley, a consultant dermatologist who specialises in psychodermatology. ‘If you get stressed, it can lead to skin problems, and skin problems, in turn, lead to stress. This is often part of the process with atopic eczema.’

What’s the link?

The brain connects to the skin through nerves called cutaneous nerves. When you’re under stress, these nerve endings promote inflammation in the skin through your blood vessels and immune system. ‘Stress makes the whole immune system more triggered and active, and it also links in with the hormonal system,’ says Anthony. When your brain recognises stress, it stimulates the release of hormones including cortisol and adrenaline through the hormonal system. Over time, if you consistently have too much cortisol in your body, it can dampen the immune system, resulting in blunting of the inflammatory response in the skin.

The roots of stress

We all have deadlines, get stuck in traffic jams and miss trains. But that sort of short-term stress isn’t the issue. With skin conditions, it’s long-term stress that causes problems, such as being in an unhappy relationship or having financial difficulties. Unfortunately – and unfairly – for many people with eczema, the condition itself is also a major factor in keeping stress levels high. ‘Eczema can be very obvious, particularly if it’s on the face or hands, and people can feel very self-conscious,’ says Anthony. ‘Children who grow up with eczema may get teased by other kids. The effect on body image shouldn’t be underestimated because it impacts on so many other factors, such as playing sports and having relationships.’

Dermatology nurse adviser, Helen Dennis, says that she’s had patients who haven’t left the house for weeks because they’re so self-conscious about their appearance. ‘Staying indoors alone is no good for your mental health so it can make everything worse,’ she says. It’s not just body image concerns that cause stress. ‘The itch is a huge issue too,’ says Anthony. ‘During the day, itching is partly driven by stressful events. Then you scratch and the itching gets worse. It can give people a sense of being out of control. Lack of sleep due to itching is another big factor. It has a major impact on emotional stability and on daily functioning. If children are waking up through the night, it impacts on parents too, so the whole family becomes stressed and dysfunctional.’

Take control – of your skin and your mind

‘I find people with eczema are often very driven,’ says Anthony. ‘It can become tempting to look for a magic key – for example, the one food you need to cut out. But it’s not about that. What really helps is to find various ways to manage both your eczema and what’s going on in your brain.’

As well as using emollients and topical steroids as prescribed, Anthony suggests the following:

Practise mindfulness. This can help ‘declutter’ the anxious thinking that goes with atopic eczema. It means focusing on whatever you’re doing in the moment and paying attention to your breathing. Practices such as meditation and yoga can help you be more mindful.

Get into a good sleep routine. It’s important to establish good sleeping patterns as much as possible. Make sure you take time to wind down before going to bed, whether that’s listening to music or having a bath.

Have a balanced diet with plenty of fruit and vegetables. Don’t drink too much alcohol or smoke, and avoid refined sugar, which is proinflammatory. Make sure you drink plenty of water to keep your skin hydrated.

Try to be as active as possible – exercise helps reduce levels of stress hormones, so find something you enjoy and can manage on a regular basis, whether that’s walking or dancing.

Don’t isolate yourself. Spending time with friends is important for managing stress, so try to see other people, even if you’re feeling self-conscious about your skin.