Until last year, Anna Robertson never had problems with her skin. But in October, with the strain of WFH culminating in the end of her marriage, the mother-of-three noticed patches of rough, scaly, itchy skin. "They started on my nose and spread to my eyelids," she says. "Managing the sale of our house, working and looking after the children, aged seven, 12 and 15, during the pandemic has been incredibly stressful. I saw a private dermatologist who diagnosed stress-related eczema."
In the year since the pandemic began, experts have reported a huge rise in skin complaints, from sudden outbreaks of eczema to acne to increased signs of ageing. Increased screen use and changes to our diet are all thought to raise the risk of breakouts and skin problems, though in many cases stress is thought to be the key driver – as it was for Anna, who had never had eczema before in her life.
Dr Alia Ahmed, consultant dermatologist at the UK’s Frimley Health Foundation Trust, says she has seen an uptick in patients presenting with stress-related skin problems, such as eczema, psoriasis, acne, alopecia (hair loss) and urticaria (hives). "I have also had to increase the potency of treatment for some patients to control their skin condition," says Dr Ahmed. "My patients – both men and women – are experiencing high levels of stress. The pandemic adds to existing problems like financial worries, poor sleep and diet and lack of motivation to exercise."
Dr Mayoni Gooneratne, founder of The Clinic private health and skincare clinics in London, adds: "I have seen more acute conditions like eczema and other types of dermatitis than before. Ageing has become accelerated, too."
Dermatologist Dr Hiba Injibar, founder of the Dermasurge Clinic on Harley Street, says that the number of people inquiring about adult acne at her practice has gone up by 30 per cent. She says that in spite of the fact that we’re coming into contact with fewer pollutants that can block pores, because we’re at home, more people have fallen victim to adult acne this year due to falling out of their skincare routines and because stress is a major cause of cystic acne. "There is also the added issue of ‘maskne’ [acne caused by mask-wearing] and acne on the brow caused by visors," she says.
It’s well known that stress has a major effect on skin, with ‘psychodermatology’ – where psychological techniques are used to treat skin complaints – increasingly popular. Studies have shown that emotional stress slows wound healing and can increase acne severity – and some research suggests antidepressants have the side-effect of improved skin.
The brain’s stress response causes the release of various chemicals and hormones, including the ‘stress hormone’ cortisol, that drive inflammation both in the body and the skin, Dr Ahmed explains. Our skin becomes less able to defend itself, delaying the healing process and driving allergic responses. Stress hormones can also alter the production and breakdown of collagen and elastin, causing premature ageing, lines, wrinkles, increased pigmentation and dull skin, and reduce production of hyaluronic acid, which results in dehydrated skin.
The longer the pandemic lasts, the more likely our skin will suffer, says Dr Ahmed. "Long-term or chronic stress results in the body entering a permanent ‘stress-response’ state, which can aggravate existing skin problems through a poor natural immune response, ongoing inflammation and loss of an effective skin barrier."
Stress can also encourage unhealthy lifestyle habits and poor sleep – one in four of us are struggling to sleep well during the pandemic, according to researchers at Southampton University.
It’s a vicious circle: stress hormones correlate with lack of sleep, and sleep deprivation activates their release. "This is one of the reasons why poor sleep is associated with signs of premature ageing, lack of hydration, larger pores, textural changes and changes in blood flow to the skin. In addition, lack of sleep can disrupt the process of skin repair overnight," says Dr Ahmed.
For 46-year-old Ruth Chappell, worry over Covid and her vulnerable parents caused a dramatic worsening of the psoriasis she has had since childhood. "I’ve found patches in places I’d never had it before," says Ruth. "Of course I was constantly handwashing and using sanitiser, so my hands were a mess. It was horrendous. I thought this was it for the rest of my life."
How can you tell if your skin is stressed? In terms of acne, a telltale sign that emotions are the cause is when it shows up around the lower face and jaw, says Dr Gooneratne. Dr Ahmed advises keeping a symptom diary to see if flare-ups have correlated with a stressful time in your life.
Treatment requires a holistic approach, she adds. "I treat the mind and skin together, as stress can trigger skin disorders, which in turn cause stress."
For eczema, Dr Ahmed recommends using gentle soap substitutes, emollients and treatment creams that may contain steroids. Acne treatment can include topical or oral antibiotics, topical retinoids or oral isotretinoin and rosacea treatment that can include topical antibiotics, antiparasitic medications or azelaic acid, oral antibiotics or low-dose oral isotretinoin.
"These chronic conditions benefit from treatment that manages the signs and symptoms, as well as addressing the psychological impact with interventions such as stress management techniques, relaxation therapies and mindfulness," she says.
For premature ageing, useful skincare ingredients include retinoids, vitamin C and hydroxy acids, says Dr Mayoni. "Plus, when clinics are open, an injectable skin-hydrating and plumping cosmetic treatment will help to give your skin a real zing."
Dr Ahmed says simple lifestyle changes can help, too – including drinking 2.5 litres of fluid a day, to keep skin hydrated and reduce anxiety – taking regular exercise and getting plenty of sleep.
"Try meditation or mindfulness to help combat stress," she adds. "I often recommend the Headspace app to my patients. Create positivity around you. Surround yourself with your favourite scents, music or colours at home to improve your mental health.
"Find an achievable act that makes you happy, incorporate it into your morning routine and another into the evening. This way, you start off the day with mood enhancement and you have the same to look forward to in the evening."
Desperate for a way to get her psoriasis under control, Ruth Chappell remembered that a course of medical light therapy had been beneficial in the past and bought a home UVB light device. "It’s not for everyone – you need to know how to use it safely and in tiny doses of just 20 seconds to start – but it helped clear up the worst of the patches." She says she also feels less stressed thanks to the arrival of vaccines.
Anna Robertson was prescribed a mild steroid cream, but says that things really improved when she completed her house sale. "I started doing yoga with an online teacher and used a meditation app, which have both helped me feel less anxious. My skin is much better," she says.