Role of stress in skin disease examined

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Richard D. Granstein, MD: “Has the time come for stress management techniques to be part of the armamentarium for treating skin disorders? If so, which ones?”

Can stress cause or intensify the onset of skin disease? That’s the question Richard D. Granstein, MD, focused on during the August 20 session “Is Stress Causing My Skin Disease?” (B008). Dr. Granstein is the chairman of the Department of Dermatology at the Weill Medical College of Cornell University and dermatologist-in-chief at the New York Weill Cornell Medical Center of New York-Presbyterian Hospital.

He began the session by asking audience members to raise their hands if they thought stress was a contributing factor to the development or exacerbation of skin disorders. More than two-thirds raised their hands. But why is stress so influential?

“People talk about stress all the time,” Dr. Granstein said. “There are two types of stressors: processive stressors (which are elements in the environment perceived as potential dangers that do not directly cause damage) and systemic stressors (which cause a disturbance in the organism’s homeostasis). Both of these stressors often occur simultaneously, and are usually accompanied by pain and/or intensive emotions.”

Most patients and dermatologists believe that stress may worsen numerous skin conditions, including hives, psoriasis, acne, and rosacea, and also is one of the most common causes of eczema, he said. Unexplained itching also is believed by some to be caused by stress.

In particular, Dr. Granstein discussed the clinical evidence behind stress, how it may cause or exacerbate certain inflammatory skin diseases, and the psychological and neurological influences it has on skin physiology and pathophysiology. He also focused on the evidence that stress and the nervous system both impact the immune system, in addition to promoting inflammation of the skin.

Dr. Granstein cited a published case where surgery was required to remove a torn meniscus from the right knee. Until the surgery, both of the patient’s knees had been covered symmetrically with typical psoriasis plaques. The crucial point, he said, was that there was a relationship between the sensory nerve supply and the remission of the skin disorder.

The publication (Arch Dermatol 104:220-221, 1971) stated that, “The left knee was subjected to surgical preparation and dressings corresponding to those used on the right, and nothing happened. Lesions on the left knee persisted unchanged. It would appear that loss of nerve supply resulted in a dramatically prompt reversal of whatever those nerves were contributing to plaque formation … The remission and relapse relate directly to the cutting of the nerve and its regeneration, and are not likely to have been accidental coincidences.”

In the latter half of the session — one of several new “meeting briefs” launched at Summer Academy Meeting — Dr. Granstein focused on the measures that could be taken to alleviate stress in regards to a therapeutic modality. Dr. Granstein said, “Has the time come for stress management techniques to be part of the armamentarium for treating skin disorders? If so, which ones?”

He also listed some potential techniques for alleviating stress, such as meditation, progressive muscle relaxation, visualization, and self-hypnosis. “In selected patients, it is reasonable to consider stress-alleviation strategies, including counseling, support groups and psychotherapy,” Dr. Granstein said.

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