Skin conditions, like many other illness, have a plethora of causes and contributing factors. We wish we could say there is one cause for it, and thus one treatment that will work for everyone. However, the truth is far more complicated than that. There are still many skin conditions where we do not fully understand the cause or how different factors affect them. For those where we have gleaned more information, this doesn’t always mean much in terms of a treatment – knowing something tends to run in families does not tell us how to fix it.
However, the more we know about a skin condition, the more we understand and the closer we get to the best way to manage and treat it. Covering a few examples of skin conditions, here is a non-exhaustive list of different factors that may have contributed to yours:
If something seems to run in a family, then there usually is a genetic factor at play. Most illnesses, including skin conditions, have some kind of genetic factor influencing them. Sometimes, this influence is more difficult to define such as in acne or alopecia areata. We know that if there is a familial tendency towards severe acne, then this tendency will also be present in the children. In alopecia, 10-25% of patients have a family history of either alopecia areata or other autoimmune conditions.
In other conditions such as eczema, the genetic factor is more defined. There is new evidence that shows eczema sufferers have inherited abnormalities in the skin barrier, which predisposes them to the characteristic barrier failure. The main abnormality we know about is in a protein called filaggrin. Filaggrin is a protein that binds keratin fibres in skin cells. Abnormal filaggrin is associated with earlier onset, severe and persistent eczema.
Within the immune system, there are many different types of white blood cells. T-cells are one such type, and are divided into Th-1 and Th-2, which are kept in balance. In eczema, there are more Th-2 cells, which cause more inflammation and contribute to the loss of the barrier function of the skin. This allows more irritants (soap, dirt, detergent) or allergens (pollen, dust mites, microbes) to pass through, to which the immune system reacts strongly, causing even further loss of the barrier function.
Alopecia and psoriasis are both auto-immune conditions, which means the body uses the immune system to attack itself, usually due to not recognising itself as non-harmful. In alopecia, T cells attack and destroy the hair follicles. In psoriasis, T cells attack the skin cells.
Contact urticaria is an allergic reaction that occurs within minutes to 1 hour of contact with the irritant. Reactions to latex, antibiotics, nickel and many others substances are all within this category.
As mentioned, certain irritants or allergens can exacerbate eczema. Certain face products can worsen acne. Smoking, excessive alcohol, diet can all have negative effects on some skin conditions.
Climate also plays a significant role since the skin is constantly exposed to it. Some say cold damp weather tends to make eczema worse, whereas some sun exposure (within limit!) seems to improve it. However, being hot tends to make skin redder and itchier. High humidity also worsens acne.
A higher level of male hormones is correlated with more severe acne. This is also why many people develop acne in their teens, after which it resolves – the hormonal changes cause symptoms during teenage years, after which they stabilise in adulthood. This hormonal change can occur due to a number of reasons, the most common of which are polycystic ovaries, psychological stress and depression.
Hormonal changes are also a trigger for alopecia, psoriasis and other skin conditions.
Stress and negative emotions all have a significant impact on almost all skin conditions. There are many studies showing that people who struggle with a skin condition are more likely to struggle with their mental health. Many studies also show that a reduction in stress levels leads to an improvement in symptoms. Read more about psychodermatology in acne and eczema in our articles [Insert: Understanding Psychodermatology] and [Insert: Psychodermatology and Acne.]