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Understanding PTSD
Post-traumatic stress disorder (PTSD) is a mental health condition that often develops after experiencing or witnessing a traumatic event. These usually include a situation where someone’s life has been threatened or severe injury has occurred, such as war, natural disaster, plane or car crashes, sexual assault, or abuse. The amygdala, a brain region responsible for controlling fear and triggering the fight-or-flight response, plays a significant role in PTSD. For people with PTSD and excessive stress, the amygdala can become hyperactive, causing an exaggerated response to perceived threats. Leading people with PTSD produce high levels of fight-or-flight hormones even when no real danger is present (Gupta et al., 2017). This excessive stress activates the hypothalamic-pituitary-adrenal axis (HPA axis), the primary physiological system mediating the body’s stress response. The HPA axis regulates the release of endocrine hormones, including cortisol, a major stress hormone. When activated it drives cortisol levels and pro-inflammatory effects, which impact the skin barrier, the immune system, and the fundamental functions of the skin (Gupta et al., 2017).
How PTSD Affects the Skin
This increase in cortisol is evident on the skin and can be compounded by the short term effects of PTSD, such as intense sweating or heightened alertness. Over time, the body adapts to this persistent level of stress, causing the skin’s distressed state to become its normalized appearance. The skin is densely packed with sensory nerves that transmit sensations such as touch, pain, temperature, itch, and other physical stimuli to the central nervous system. During sympathetic arousal in PTSD, these nerves become highly reactive, causing the skin to respond intensely and resulting in periods of excessive daytime sweating and night sweats. This heightened nervous system activity creates an exaggerated skin response, as the body attempts to cope with the physical symptoms of stress (Gupta et al., 2017). Over time, PTSD can cause the skin cells to widen, allowing essential moisture to escape and making the skin more vulnerable to harmful substances. This can result in dryness and excessive oil production. PTSD may also trigger the body’s inflammatory pathways, potentially leading to chronic inflammation in the skin. Those who experience prolonged psychological stress often report elevated levels of inflammation and impaired skin function. Dry skin, in particular, can occur as the body redirects water away from the skin’s outer layers, using this as a survival mechanism to maintain hydration in response to stress (Gupta et al., 2017).
Specific Skin Conditions Linked to PTSD
Chronic Idiopathic Urticaria (CIU) is a skin condition that causes itchy, red welts or spots called hives to appear on the skin for upwards of six weeks. There have been case reports indicating that CIU can appear as a core symptom of PTSD, sometimes emerging years after the initial trauma experience. In such instances, patients may not associate their recurrent CIU with PTSD, and the trauma triggers that lead to PTSD may be highly individual and not qualify as a stressor by a standard criteria (PTSD UK, n.d.).
Similarly, Rosacea is a common skin condition characterized by flushing or persistent redness, often affecting the face, with emotional stress frequently cited as one of its primary triggers. Acne, along with other stress-related skin conditions, can also be exacerbated by PTSD. The increased levels of stress hormones and inflammatory responses associated with PTSD can worsen existing acne or lead to new acne lesions (Zemler, 2023).
The Bidirectional Relationship Between Skin and PTSD
Alexithymia is a personality trait characterized by difficulty in expressing, describing, or understanding one’s emotions. This condition has been linked to various physical health issues, such as lower back pain, asthma, allergies, irritable bowel syndrome, and fibromyalgia. Recent research now suggests that alexithymia may contribute to skin conditions as well, including acne. Those with alexithymia struggle to communicate and process their emotions effectively, which has been seen to exacerbate the development of stress-related skin conditions (Gupta et al., 2017).
Psychological symptoms associated with PTSD often correlate with the physiological manifestations. Stress can overly activate nerves, particularly those involved in voluntary movement, which can result in a faster heartbeat but reduced blood flow to tissues, leading to lower oxygen levels throughout the body. Consequently, the skin becomes more sensitive and responsive to stress. When the brain perceives stress, it releases corticotropin, a hormone that stimulates the adrenal glands to produce stress hormones. This hormonal release triggers the release of histamine from skin cells, causing redness, itching, and the formation of bumps, similar to the reaction of a splinter or infection. This all due to the heightened sensitivity within the nervous system (Gupta et al., 2017).
Psycho-Dermatology
Psycho-dermatology is a specialized field that addresses skin conditions by integrating both psychiatric and physiological perspectives. This approach not only examines the physical aspects of skin issues, but also considers the emotional and mental health factors that may contribute to these conditions. Psycho-dermatologists go beyond prescribing medications and topical treatments by incorporating therapeutic interventions, such as cognitive-behavioral therapy (CBT) and psychoanalytic therapy. Given the comorbidity of PTSD with other mental health conditions, such as anxiety, depression, and substance abuse, this comprehensive approach is crucial for effective treatment (Gupta et al., 2017).
Lifestyle Changes
Research indicates that incorporating probiotic-rich foods into one’s diet can help reduce anxiety, depression, and acne. This natural therapy offers a dual benefit by addressing both skin conditions and PTSD symptoms. Additionally, seeking early intervention is crucial, as timely treatment can significantly improve the speed and effectiveness of symptom management. By combining medication, therapy, and lifestyle changes, individuals can achieve a more holistic and effective approach to managing PTSD-related skin conditions (Zemler, 2023).
References
Gupta, M. A., Jarosz, P., & Gupta, A. K. (2017). Posttraumatic stress disorder (PTSD) and the dermatology patient. Clinics in Dermatology, 35(3), 260–266. https://doi.org/10.1016/j.clindermatol.2017.01.005
PTSD UK. (n.d.). Skin conditions. PTSD UK. https://www.ptsduk.org/skin-conditions.
Zemler, J. (2023, June 27). The Surprising Connection between PTSD and Acne. Stylist. https://www.stylist.co.uk/beauty/skincare/acne-ptsd-skin-stress-anxiety-psychodermatology/636399.
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