Are stress and eczema linked?

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 would benefit from being refined. Furthermore, let's remember 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 labelled 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 doctors. 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 in the intensification of skin symptoms, more so than exposure to a dusty environment.

When we delve into 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 fibres: 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, impacts the skin barrier by weakening it. It initially reduces the synthesis of lipids, molecules that constitute the stratum corneum and help maintain skin hydration. A decrease 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 various inflammatory phenomena and implicated in eczema.

Stress is a common and multifactorial element of our lives: professional interviews, medical appointments, 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 substances, regular sleep... Although there are few studies due to significant methodological difficulties and the unique nature of each patient, psychotherapies appear to have a role in the treatment of inflammatory skin conditions.

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

Finally, while stress can promote the onset of 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 probably 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.