Psychodermatology is a relatively new field that involves looking at the connection between the mind (‘psych’) and the skin (‘dermatology’). Unlike other organs, the skin seems to show an immediate reaction to mental stress, which has piqued the interest of researchers in the past 20-30 years. As such, there is now ample studies clearly showing that many skin conditions are affected by stress and psychological events.

In eczema, stress is well-known to trigger flare-ups[1]. A study found that 70% of eczema patients experience stressful life events before the onset of their flare-up[2].

THE SCIENCE

Studies into the molecular and cellular interactions between mind and skin have aimed to define the mind-skin connection. One of the main theories is the neuro-immuno-cutaneous-endocrine model[3], which is based on the fact that the brain, nerves and skin are all derived from the same tissue in the embryo, called the ectoderm. As such, these tissues share many inflammatory molecules, and stress to one system can cause similar stress in the other.

The central nervous system responds to stress via the hypothalamic-pituitary-adrenal axis (HPA), causing increased release of stress hormones, and thus inflammatory molecules. The skin contains an axis similar to the HPA axis, which reacts similarly by releasing more inflammatory molecules. These inflammatory molecules then recruit the immune system. Overall, this causes damage to the skin, impairing the barrier function and leading to the well-known symptoms of eczema[4].

ITCH

One of the most characteristic and bothersome symptoms in eczema is the itchiness of the condition. The itch-scratch cycle is the vicious cycle where scratching an itch causes more damage, which in turn causes more itchiness. The inflammatory molecules mentioned above exacerbate the sensation of itch[5], thus directly contributing to the itch-scratch cycle.

KNOWN TREATMENTS

Due to the significance of stress in eczema, many non-pharmacological treatments aimed at reducing stress have a positive impact on the condition[6].

• Biofeedback is a behavioural conditioning technique where the patient is connected to some monitors (muscle tension, temperature etc) and taught relaxation techniques. The patient is asked to use these techniques, and then the effects are directly observed using the monitors.
• Cognitive behavioural therapy (CBT) works with dysfunctional thought patterns (‘cognitive’) or actions (‘behavioural’) that cause negative emotions in a patient. Since many people with eczema have so many negative thoughts and emotions regarding their condition, CBT can be very helpful in tackling them at their core.
• Hypnosis causes the patient to go into a trance-like state, where a relaxation response seems to cause positive changes in people with eczema. It also seems able to help with harmful habits such as scratching.

We can safely conclude that reducing stress levels has a positive impact on eczema – the method does not appear to matter as much, so long as you are feeling calmer and less stressed after employing it. Whether it’s meditation, mindfulness, aromatherapy, CBT, hypnosis, biofeedback or anything else you find helpful, less stress causes less activation of stress pathways in the body, causing less inflammation and thus less damage to the skin.