HEALTH Dermatologists explain how stress and lifestyle take a toll on our skin
Dinesh, a healthy middle-aged man with a headful of hair, experienced an unexpected downfall in business. The creditors were closing in and he had no way out. One morning, he found himself nearly bald. He had lost almost all his hair overnight. “As strange as it sounds, it is possible to suddenly turn bald due to any type of stress,” says senior consultant dermatologist V.R. Janaki.
Reshma was in a bad marriage and worried sick about her young son's future. After a while, she noticed a rash of angry red spots all over her face — acne. It took many courses of medicine, therapy and yoga to keep the acne at bay.
There's a very close link between stress and some skin conditions. Likewise, some skin conditions can also cause stress, say dermatologists.
“The skin's biggest advantage is visibility and its ability to reflect your state of mind. Anger, sorrow, happiness — everything shows on your face. So does stress. It precipitates/aggravates existing conditions,” says Dr. Janaki.
Stress increases because of fear and stigma. For instance, in the case of people with vitiligo (loss of pigmentation in the skin), the stress levels are high, says C.R. Srinivas, Head, Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore. “The patient's initial reaction is intense, even violent. But, once we explain the condition, the fear decreases. With the fear gone, the stress reduces. The mind learns to combat the condition,” he says.
Stress-related conditions include Lichen planus (itchy, dark blue papules on the skin, mouth, etc.), acne, hair loss, itching, dandruff, psoriasis and hives. It is to combat stress, says Dr. Janaki, that many a time, dermatologists prescribe mild tranquillisers along with anti-histamines to calm the patient.
Dr. Srinivas speaks about the stress-induced Lichen simplex chronicus, characterised by chronic itching and scratching, Trichotillomania (pulling hair) and nail biting. “It's a vicious cycle,” he says. The conditions are caused by stress, and they in turn, lead to more stress and problems.
Since the psychological angle cannot be ignored while treating the symptoms, dermatologists either refer patients to psychiatrists or turn counsellors themselves. “This is why it is very important to spend time with every patient,” says Tanuja Reddy, consultant dermatologist, Vijaya Health Centre, Chennai. “Most of the time, I just talk to them. It helps get to the root of the problem. You pick up cues — there could be relationship issues at home, a fight with the in-laws, etc. They just need to talk,” she says. Dr. Tanuja recalls seeing a patient who complained of severe itching. “He carried a huge file. When we got talking, I learnt his wife had a kidney problem. He could not deal with it. That caused the itching.”
Says Dr. Janaki: “You can make a diagnosis in two minutes and write a prescription in another two. But what the patient needs from you is a patient hearing, a holistic cure.”
Dr. Srinivas says patients must realise dermatologists can only control certain conditions, not offer total cure. “Psoriasis can never be cured. But, people get taken in by tall claims. Counselling requires a lot of effort. Sometimes, it works better when you take a psychiatrist into confidence to help a patient feel better.”
Dr. Janaki has been practising since the 1970s. She says there is a three-fold to four-fold increase in stress-related dermatological conditions since then. However, don't blame stress for everything, she cautions. Lifestyle is a trigger too, says Dr. Tanuja. “What your father earned when he was 35, you earn at 20. You don't realise you're earning stress too,” she says. Dr. Srinivas agrees about the increase in the number of cases but wonders if that is because we tend to get stressed out easily about many issues.
(The names of the patients have been changed.)
SUBHA J RAO