July 3, 2006
Stress and your skin
Not many people may know it, but stress can affect the skin’s health in more severe ways than the appearance of an occasional wrinkle or a pesky pimple.
Neurocutaneous dermatoses. These are skin disorders where the influence of psyche is manifested as skin lesions. The essential factors that bring about these skin disorders are stress, tension, and anxiety. The following are the more common types of cutaneous neuroses:
1. Emotional factors have long been believed to influence acne (pimple), and they continue to be regarded as a probable influence. The mechanism is presumed to be the increased production of adrenal androgens when the patient is under stress. This leads to increaseseborrhea.
This disease is characterized by inflammation around comedones, which are composed of sebum and keratin. In the larger lesions the sebaceous gland is partly or completely destroyed, sometimes with the formation of large cysts.
Depending upon the degree of involvement, treatment varies from topical application of mild lotions to systemic therapy with antibiotics or retinoids. Local surgical treatment is helpful in bringing about quick resolution of the comedones and pustules as well as the cysts. The edge of the follicle is nicked with a sharp pointed number 11 scalpel blade and the contents of the comedo are expressed with a comedo extractor.
2. Alopecia or hair loss, particularly alopecia areata is characterized by rapid and complete loss of hair in one, or more often several, round or oval patches, usually on the scalp, the bearded area, the eyebrows, the eyelashes, and rarely on other hairy areas of the body. Nearly always, the hair lossis patchy in distribution; however, cases may present in a diffuse pattern. At the periphery of the bald patch are loose hairs that may be broken off near the scalp, leaving short stumps.
Stress alopecia is oftentimes manifested as alopecia areata resulting from severe and acute emotional upset. The severe stress of war conditions or acute illness may induce complete hair loss in a matter of a few weeks.
It is not known why some patches will grow in a few weeks without any treatment and others will completely resist all forms of therapy. Spontaneous recovery is extremely common. That is presumably why all treatments, in uncontrolled trials, give high response rates. It is only when patients in a poor prognostic category, such as those with prepubertal onset, or cases of total or universal involvement, or concomitant atopic disease, are considered, that the real lack of efficacy surfaces.
3. Neurodermatitis is another common cutaneous neuroses. This circumscribed, lichenified, pruritic patch may develop on any part of the body. However, the disease has a predilection for the back and sides of the neck, and the extremities especially the wrists and ankles. An upper eyelid, the orifice of one or both ears, or a palm or sole may also be involved, and the ankle flexus is a favorite site as well.
It is not known by what mechanism the act tearing through the epidermis (upper layer of skin) with the fingernails, or burning the skin with painfully hot water, is made not merely painless but exquisitely and irresistibly pleasurable. But that is what happens, and virtually every patient with the disorder experiences this mysterious hallucination. Scratching of a localized area on a chronic basis is a response to unknown factors.
Essentially, the goal of treatment is cessation of pruritus or itchiness. Recurrences are frequent even after most thorough treatment. There are instances when the clearance of one lesion will see the onset of another elsewhere.
4. Trichotillomania is yet another hair problem resulting from neurosis. It is characterized by an abnormal urge to pull out hair. The site involved are generally the frontal region of the scalp, the eyebrows, and the beard. These are irregular areas of hair loss, which may be linear or bizarrely shaped. The disease is seven times more common in children than in adults, and girls were affected 2.5 times more often than boys.
The disease often develops in the setting of psychosocial stress in the family, which may revolve about school problems, sibling rivalry, moving to a new house, the hospitalization of a mother, or a disturbed mother-daughter relationship.
One should address the diagnosis openly, and referral to a child psychiatrist may be beneficial. In adults with the problem, psychiatric impairment may be severe.
DR. PERRY DE LA CRUZ obtained his medical degree from the University of Sto. Tomas. He is a diplomate of the Philippine Board of Cosmetic Surgey; a fellow of the Philippine Society for Cosmetic Surgery, and the American Academy of Cosmetic Surgery; and a member of the Asian Pacific Academy of Cosmetic Surgery. He pioneered research on "Serial Revision of Leg Scars" in 1988.
Clinic:
Asian Hospital and Medical Center
Unit 517 Medical Office Building
205 Civic Drive, Alabang Muntinlupa City
Telephone no. 771-9299
Visit his Web site at www.geocities.com/docperryster or e-mail him at docperryster@gmail.com.
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