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Eczéma et stress.

Are stress and eczema connected?

Eczema, or dermatitis, is a skin inflammation that has both physical and psychological consequences for those who suffer from it. Several factors can exacerbate this condition, among which stress. Learn more.

Eczema, Internal and External Causes.

Theeczema is a benign and non-contagious skin disorder, but it can drastically affect the quality of life of those who suffer from it. It notably leads to the formation of lesions and itchy red patches on the skin's surface. This dermatosis generally develops in early childhood and persists into adulthood in 10 to 15% of cases. There are several types of eczema, including atopic eczema.

Atopic eczema occurs in individuals with a specific genetic predisposition that favors allergies. In fact, they have a dysfunction of their skin barrier, due to a lack of sebum, lipids, and other molecules necessary for the integrity of the horny layer. This results in disproportionate allergic reactions to normal environmental elements. Eczema flare-ups can also be due to a reaction with a particular allergen, in which case it is referred to as contact eczema. This time, it is an acquired inflammatory disease, which disappears when the offending products have been removed.

Several external factors can also exacerbate eczema flare-ups, such as certain skin infections (notably staphylococcal), seasonal changes, or stress.

Stress-related eczema flare-ups.

The role of stress in eczema remains to this day somewhat poorly understood and, while several studies have confirmed the link between stress and eczema, work on this subject could benefit from further refinement. Additionally, it's important to note that several forms of dermatitis coexist, and it's possible that stress plays a more significant role in some of them. Today, stress is not labeled as an "eczema trigger," but rather as an "aggravating factor".

A study was conducted following an earthquake in Hanshin, Japan. This disaster helped to highlight the role of stress in the progression of eczema in a population. 1,457 patients with atopic dermatitis were included. Three areas were defined: severe destruction (zone A), moderate destruction (zone B), and no destruction (zone C).

One month after the trauma, individuals were required to answer a series of questions and were examined by physicians. A flare-up of atopic dermatitis was noted in 38% of patients in zone A, 34% of patients in zone B, and 7% of patients in zone C. Multiple logistic regression analysis showed that subjective distress was the most significant factor responsible for the intensification of skin symptoms, more so than exposure to a dusty environment.

How does stress trigger eczema flare-ups?

When we examine the biological mechanisms at play, we find that stress increases skin inflammation by triggering the degranulation of mast cells, immune cells involved in allergic reactions. This is mediated by neuropeptides released by cutaneous nerve fibers: CRH (Corticotropin Releasing Hormone), neurotensin, substance P, and other tachykinins. The release of these hormones triggers a cascade of reactions leading to the release of mediators responsible for the itchiness of eczema and the dilation of blood vessels.

Furthermore, cortisol, the stress hormone, affects the skin barrier by weakening it. It first reduces the synthesis of lipids, molecules that make up the stratum corneum and help maintain skin hydration. A reduction in the production of these lipids can lead to dry and easily irritable skin. Cortisol also increases the skin inflammation by stimulating the synthesis of pro-inflammatory cytokines, molecules involved in several inflammatory phenomena and implicated in eczema.

Managing stress to better live with eczema.

Stress is a common and multifactorial element in our lives: professional interviews, medical visits, bereavement... Unfortunately, it is not possible to alter any potential genetic susceptibility to stress or to change one's life when suffering from eczema. However, several methods can help to better respond to stress.

Ahealthy lifestyle notably allows for a better response to stress: regular practice of a sport, pleasant surroundings, avoidance of addictive products, regular sleep... Although there are few studies due to significant methodological difficulties and the unique nature of each patient, psychotherapies seem to have a role in the treatment of inflammatory skin diseases.

Furthermore, in general, psychosocial interventions have demonstrated effects on immunity. To better manage stress, cognitive-behavioral therapies such as relaxation or Schultz's autogenic training can be beneficial. Yoga and meditation can also help, as can techniques for self-assertion, cognitive restructuring, or non-violent conflict resolution. The goal is to develop a better ability to cope with stressful situations. However, it should be noted that the benefit of all these techniques for atopic dermatitis itself has not been proven.

Finally, while stress can trigger eczema flare-ups, it is likely that this disease itself is a cause of stress, creating a vicious cycle. By focusing on alleviating the symptoms of dermatitis, we likely also reduce stress, thereby improving the prognosis of the disease. This theory remains to be proven, but it seems worthwhile to keep it in mind.

Sources

  • ROGUEDAS A. M. et MISERY L. Atopie et stress. Annales de Dermatologie et de Vénéréologie (2004).

  • GOLDENBERG G. & al. Eczema. The Mount Sinai Journal of Medicine (2011).

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