Office Hours:
The Skin-stress Connection

Welcome to Office Hours, a new feature where we go one-on-one with our founder, Antony Nakhla, D.O, F.A.A.D., F.A.O.C.D., one of the country’s leading experts in skin cancer treatment, Mohs micrographic surgery, facial reconstruction and wound healing. Today we’re talking to Dr. Nakhla about the connection between stress and our skin.

During this unprecedented past year, one thing we may have all shared in common is grappling with an unusual amount of stress. It is well documented that stress has a negative impact on both our physical and emotional health. Stress is depleting. It affects our focus and can impair sleep, a critical time when the body rests and repairs. It challenges our immune system and taxes our entire system. Stress manifests on our skin in ways both visible and invisible, and has repercussions that are short-term as well as long-lasting.

Admittedly, though, even during the best of times, most of us would be hard-pressed to find a way to remove stress entirely from our lives. So, what can we do when we feel ourselves starting to spiral, to mitigate stress and its harmful effects to both body and soul? Below, the doctor is in.

Q: How does it all begin: What is a stress cascade?

Dr. Nakhla:

When stress occurs, the body goes into fight-or-flight mode. Epinephrine (also known as adrenaline) and cortisol surge. Your heart races, blood vessels tighten, eyes dilate, and muscles tense—even facial muscles. Blood sugar spikes; sweat and oil production increase. Your body is getting ready to run, or to fight.

Over time, prolonged bouts of stress are very taxing to your organs and entire system. These are primal hormones and molecules that should be released when you are about to run away from a cheetah, when you are gearing up for a fight. If your default mode is constant stress, you are not operating in an optimal state. You’re flooded with stress hormones that overtax your body, and you will see it in your skin.

Q: How do prolonged periods of stress affect the body, and ultimately, our skin?

Dr. Nakhla:

The secretion of the stress hormone cortisol triggers excess oil production by the sebaceous glands, which can lead to clogged pores and acne. This characteristic type of acne, called hormonal or “stress” acne, occurs as painful, deep-seated cysts around the neck and jawline.

—Chronic Condition Flare-ups
Persistent stress can weaken the immune system. Where the skin is concerned, this can trigger flare-ups on chronic conditions like rosacea, psoriasis, or eczema.

When your body is revved up and working overtime, you are consuming more of the valuable nutrients your system needs. You’re in a catabolic state: You are metabolizing everything and depleting your electrolytes, your water. You can easily become dehydrated.

Stress has also been found to impair skin barrier function—the skin’s first line of defense and its ability to protect itself. This leaves skin vulnerable and open to environmental aggressors like bacteria, viruses, fungi, and free radicals, as well as dehydrated, since a weakened barrier does not properly retain moisture.

—Impaired Sleep
Sleep can be one of the first things that suffers during periods of elevated stress. This can affect not only how you look—puffy eyes, dull, dehydrated skin—but how your body is operating.

The parasympathetic response includes all of the activities that happen during rest: recovery, repair, renewal. During periods of stress, the body shuts down certain organs and turns on the ones it needs to be immediately available. For example, blood that is supposed to flow to your GI system, kidneys, and liver is diverted to your heart and lungs. When these organs, responsible for detoxification and the elimination of wastes, are switched off,  those parasympathetic activities are not occurring, or are occurring in the wrong setting. Your body suffers from an accumulation of toxic, nitrogen by-products as a result. This mean the body is basically just not as productive as usual, not in tip-top shape, more vulnerable than usual, and (worst-case scenario) this can be a potential pathway to health issues of real concern like cancer, diabetes, high blood pressure, and cardiovascular events. In a very real sense, stress kills.

—Accelerated skin aging
Sustained, high levels of cortisol can lead to the breakdown of collagen and elastin. The persistent tightening of facial muscles, from furrowed brows to grimacing, can eventually etch lines into your face. Even your melanocytes will not be producing balanced levels of pigment in a stressed environment, so blotchiness and discoloration can occur.

Q: What role does diet play?

Dr. Nakhla:

Stress hormones are known appetite inducers: They make you crave oily, high-fat foods and sugar. Your body is gearing up for major work, so it wants to consume fat, sugar, and carbs. We know these foods are pro-inflammatory and literally age your entire body, including your skin.

Stress eating is a well-known phenomenon based on high cortisol levels of people who exist in a predominantly stressed state. There is a negative feedback loop that doesn’t kick in—normally, you’d eat and be sated, but when you are in a stressed state, your body continues to crave more because it is in fight-or-flight mode. The cascade is the same: It starts in your brain and ends in hormone release. This is why practicing mindful eating can be so helpful.

Q: Are there simple body hacks we can employ to quickly shut down the stress cascade and its accompanying negative feedback loop?

Dr. Nakhla:

The first thing to do is relax, take a breath. Your breath is the one thing you can control. When you breathe deeply and slowly, your heart rate has no choice but to slow down. This interrupts the stress cascade and helps reset things. When your heart rate slows, your blood vessels dilate and relax, and other neuromessengers start to relax. It’s one big feedback loop.

It’s important to recognize what is and is not within your control. The initial feeling is human, but the decision to persist in a stressed state is a decision. The things we cannot control we have to identify and accept, and we have to tap into those things that we can control, like our breath. When you feel that you are spiraling, stop, breathe deeply, close your eyes, put away distractions. It’s important to set aside time for self-care and mental health care. Whether it is meditation, soothing music, a bath, or simply doing something you enjoy, identify activities that can get your mind off what is stressing you.

Q. Does getting more sunshine help reduce stress?

Dr. Nakhla:

This is a common misconception and can lead to a host of health problems. The reverse is true actually. During periods of stress, the skin is even more vulnerable and must be protected from the additional stress of UV light, a known carcinogen and immune system inhibitor. The decrease in the skin’s T-cell function from UV light leads to an inability to fend of free radicals and prevent skin infections. For example, sunlight can activate insipient viruses like cold sores and shingles, known to recur during periods of physical and emotional stress.

While it is true that sunlight has benefits, including promoting Vitamin D in the skin and resetting the circadian rhythms through the ocular absorption of certain wavelengths of UV light, the risks begin to outweigh the benefits after about 10-15 minutes of direct, unprotected sun exposure. If a little is good, a lot is not especially in the case of direct sunlight, which should be limited to the arms, legs, and trunk. And of course, never the face.

I’m not saying hide indoors. Definitely get outside, but try to limit direct UV exposure to 15 or so minutes and of course to protect the skin from UV damage with proper sun care. Spending some time outside has  benefits—calming, distracting, meditative, pursuing sports and leisure activities. We also know that Vit D helps regulate a host of immune functions. However, make sure to wear SPF, cover your face with a hat and consider clothing made from UPF material, so you can enjoy the outdoors safely and not add insulte to injury by getting burned. Vit D supplements are an excellent way to boost your vitamin D levels without risking sun damage. You may also choose vit D-rich foods, like salmon, eggs, milk, etc. based on your diet. It is important to discuss with your physician before making any changes to your diet or taking any supplements.

Q: Finally, what can we do to replenish what has been depleted during a period of stress?

Dr. Nakhla:

Hydration is key, from taking in fluids to topical skin care. Replenish your skin with free radical scavengers that reduce the inflammatory process kick-started by stress. Peptide-, amino acid-, and antioxidant-rich products, like our Regenerating Serum, are smart things to incorporate into a daily regimen. The blend I specially formulated for our serum also contains savage root ginger extract, knot grass flavonoids, and vitamins A and C.

Also make sure to replenish your body with the right supplements. I recommend vitamin D, Co-Q 10, turmeric, a multivitamin, zinc, and magnesium: these are the things that get depleted during stress. Melatonin, which helps synchronize the body’s natural clock, also known as circadian rhythms, is a natural supplement that can help promote a better night’s sleep, as well as reset the hypothalamus-pituitary axis (the region of the brain where the stress cascade originates). Of course, speak with your doctor before making any changes to your diet or taking any supplements.

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