Stress & Eczema: A Vicious Cycle with Gowri Kabbur, MD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host.

It's often said that people wear stress across their faces. But in truth, signs of stress can appear anywhere on your body as eczema. Dry, red and itchy skin is often a byproduct of stressful times, and once eczema flares up, well, that irritation can lead to even more stress and anxiety. It's truly a vicious cycle. Today, we're going to look at why this happens and, better yet, how you can stop it. Joining us is dermatologist Gowri Kabbur, one of the many experts at Cleveland Clinic who pop into our weekly podcast to help you live a little healthier. Now, let's see what we can do to scratch eczema off of your worry list.

Dr. Kabbur, welcome back to the podcast. It's always great to have you on.

Dr. Gowri Kabbur:

Thank you, John. I'm glad to be back.

John Horton:

So when it comes to things that cause skin issues, stress would not have been anywhere near the top of my list if somebody asked what I thought was causing it. Are people surprised when you suggest stress as a reason behind an eczema flare-up?

Dr. Gowri Kabbur:

You know, surprisingly, no, John. I think a lot of my patients tend to associate that with their eczema flares. They already, themselves, notice that when they are more stressed it tends to get worse. But definitely, I do mention that as a trigger and we see it really often.

John Horton:

Let's get into why it happens. I mean, why does stress trigger eczema in some people? What's going on in our bodies to create this sort of skin outbreak?

Dr. Gowri Kabbur:

Well, as you know, the skin is the largest organ in our body and it's really closely connected to our immune system, our nervous system and our endocrine system. So when there's increased stress — whether that's physical stress, mental, emotional stress — it can trigger an increase in a hormone called cortisol, and that in itself can trigger a cascade of reactions that can filter down to our skin. So when we're stressed internally, it can manifest on our skin externally. And we see it actually in a lot of different body systems. People can have reactions to stress in pretty much every organ system in their body, but the skin is just one that's more visible.

John Horton:

Wow. It's so hard to believe that just you get this stress that builds up and it hits everything,

Dr. Gowri Kabbur:

It really can.

John Horton:

So is this sort of response from your skin more common if you're prone to eczema outbreaks, or can it just happen to anyone if you're all of a sudden in a really stressful situation?

Dr. Gowri Kabbur:

That's a great question. I think it's a bit of both actually. I do think that it can happen to anyone because of that really complex interplay between those three systems I talked about and our skin. If there's a big stressor, it can actually trigger a response, really, in anybody. But I think if you add on top of that that you have eczema — so you already have a problem with your skin barrier, a problem with the bacterial microbiome on your skin — it can make you more prone to getting these flares of eczema when you get stressed.

John Horton:

Just how linked is eczema with someone's emotional health?

Dr. Gowri Kabbur:

We actually have a fair amount of data linking eczema exacerbations to emotional and mental health. Patients who have untreated or uncontrolled atopic dermatitis can have a much higher rate of anxiety, depression, decrease in social interactions than the average person. If you think about it, you're dealing with a chronic skin condition that can be very visible, it can be very itchy, and that can affect so many parts of your life. It may affect your sleep, which is so important. It can affect your mood. It also may lead people to avoid social events and different things that they would have to interact with other people, whether that's out of embarrassment or out of discomfort. And there's actually been a lot of studies linking eczema in kids with truancy or missing school because of how bad the skin symptoms can be. So there definitely is a strong link.

John Horton:

Wow. It sounds like it just cascades a little bit. I mean, you get this buildup, you have stress, the eczema starts and then, it almost compounds and it gets worse and worse. I mean, will the eczema just spread and continue to just make life more miserable?

Dr. Gowri Kabbur:

Yeah, it can be a vicious cycle. So I think that it's really important to try to break that cycle, and there's different places that we can try to do that.

John Horton:

Well, and that's where we're going next. I guess, if someone does suspect that stress is leading to their eczema, what can they do?

Dr. Gowri Kabbur:

So there are a number of things that can be done to help control stress in one's life. I think that sleep is really important, and definitely patients who have eczema have poorer sleep in general because they're so itchy at night. But working on trying to get enough sleep — at least eight hours a night if you can manage it — can really make a big difference in how you're feeling and also just how your body resets. Exercise can also be helpful because it releases endorphins and it helps you feel better physically, and that in itself can help reduce stress levels and cortisol levels.

John Horton:

Now what about sweating when you exercise? Because you always think of that as, like, a skin irritant. If you have a flare-up, will that worsen the problem?

Dr. Gowri Kabbur:

Sometimes, it can, it just depends on how sensitive the patient's skin is. I definitely would recommend rinsing off after a workout, just to get rid of the sweat, and moisturize afterwards, if you are one of those people prone to irritation with sweating. But I think the benefits of exercise really outweigh that risk.

John Horton:

All right, so we've covered sleep and exercising more. What other things can you do to maybe keep that stress and eczema away?

Dr. Gowri Kabbur:

Well, I think diet can play a role. There are certain types of foods that are pro-inflammatory, such as foods that are really high in carbohydrates and fat. That in itself creates an inflammatory state in your body, which then can trigger more eczema. So I would say trying to cut back on simple carbs like sugars and really high-fat foods and leaning towards more nutritious, nutrient-rich foods like vegetables, like healthy grains with fiber, that can make a big difference and mitigating stress.

John Horton:

From doing this podcast, I'm beginning to believe that vegetables, fruit, and whole grains can solve every problem.

Dr. Gowri Kabbur:

They can make a big difference, yes.

John Horton:

What about just using simple relaxation techniques? I know we've talked about that a lot on the podcast. Just things you can do to bring stress down. Can that actually help your eczema go away?

Dr. Gowri Kabbur:

I think that it can help, especially in just managing internal stress, whether that's mental stress from work or emotional stress. Yoga, meditation that really focuses on breathing techniques, those are all great options to help kind of center and clear your mind and it can provide some inner peace for patients, and I think that in itself can reduce stress levels. So I think those are great avenues to explore if you do feel very stressed and you're looking for a way to kind of control that at home.

John Horton:

What about taking then that next step, if you are feeling the stress and anxiety and looking to seek out therapy? When should you do that?

Dr. Gowri Kabbur:

So that's a great question. I think that it's really person-dependent. Everyone's comfort level on taking that extra step varies. I personally think that it would be very beneficial because it can really provide an objective view to some of the things that are causing stress in your life, and therapy in itself can provide the tools that you can use to help control those different factors that could be contributing to stress. But of course, I think patients should be ready and open to it and not forced into it. So it definitely should be something that's your own choice. But professional help can make a big difference in controlling stress and also providing you the tools to manage it.

John Horton:

Is there a way to kind of determine whether or not you feel like your eczema is stress-induced versus caused by something else?

Dr. Gowri Kabbur:

That's a great question. I think that's really hard. There's no blood test to actually diagnose eczema. I wish there were, but there isn't. So I think a lot of it is dependent on what the patient is experiencing. Sometimes, if patients are unsure, I recommend that they keep an event diary. So when they get an episode of eczema, to sit down and jot down what's kind of going on at that time that could have been a factor. And sometimes, people find, "Oh, yeah. When I do this one activity, I always get a flare of my eczema." Or it sometimes can be, "Oh, whenever I'm thinking about my job deadlines, I always get a flare of my eczema." And it just kind of helps with a personal self-reflection to see if there is some type of recurrent trigger.

John Horton:

Yeah, to see if there's a pattern that kind of develops. And sometimes, we don't even realize that in our lives … just so caught up in everything that's going on.

Dr. Gowri Kabbur:

Yes, you're completely right. It can be really hard to initiate self-reflection, but sometimes, with the help of a professional or a healthcare provider, they can kind of help guide you along your way.

John Horton:

Well, this has been so helpful, Dr. Kabbur. But before we say our goodbyes, do you have anything else to add regarding stress and eczema?

Dr. Gowri Kabbur:

You know, I think stress can play a big role in health in general. So it definitely is worthwhile to take that extra step and to invest in methods to control stress, just for your overall well-being. And eczema is complex, but there are a lot of tools available to control your symptoms so that you're not stuck in this vicious cycle of stress and skin flares. So if you are concerned about what's going on with your skin or if you have questions, you can always make an appointment with a board-certified dermatologist or dermatology provider to talk further.

John Horton:

Well, it sounds like a way to get rid of your eczema and your stress. So, thank you so much for coming in today and sharing your wisdom.

Dr. Gowri Kabbur:

Yes, thank you, John. I'm always happy to come on here and share my thoughts.

John Horton:

Stress can leave its mark on your body in numerous ways, including eczema breakouts on your skin. If you're feeling overwhelmed and experiencing skin rashes, take steps to de-stress and address your emotional needs. With any luck, your skin issues will melt away along with that stress.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.