When I was a kid, I had a persistent case of eczema on both of my hands.  Eczema is a common inflammatory skin condition that causes itchiness, a variable rash, and sometimes blistering. I remember slathering hydrocortisone cream on and wrapping both my hands in plastic wrap every night before bed, on the doctor’s recommendation.  The eczema eventually cleared up, but returned with a vengeance decades later when I was at naturopathic college. At that time, I tried natural creams, dietary changes, herbal remedies, and acupuncture with significant but not total success. Eventually my naturopath asked about stress. I remember saying, “i don’t feel stressed”.  Then I looked down at my hands.  “But maybe …”

We all know that stress can have a negative impact on our health. It’s widely believed that 75-90% of doctor’s visits are for stress-related illness. But what does that really mean?  How can stress in my brain cause eczema on my hands?  This post is a deeper dive into just what’s happening in our bodies when we are “stressed out”.

Stress Overload

When we hear the word “stress” we often think of psychosocial stress:  that overwhelmed feeling of trying to juggle too many things at once.  Or stressful events like moving, ending a relationship, or a death in the family. 

There are many other things that contribute to our stress load: from exercise and temperature changes to chemical toxicity, nutrient imbalance and infection.  These stresses can pile up and overload the system. In these situations, the response itself will cause illness. Virtually every symptom, every acute illness, and every chronic illness, is a manifestation of a stress response that went on too long.

So what was my stress load in naturopathic college?  Hard to remember. I was attending (most of my) classes, studying for exams, and working part-time when I could, and biking to and from school for about 2 hours a day. The cycling likely upped my exposure to smoggy Toronto air too. I was a mature student so I remember some can-I-do-this-at-my-age angst.  And there was definitely a blanket of financial worry. So yes, I think it’s likely that my stress load rose during those years. But how could it show up on my skin?

Let’s figure this out. There are three main mechanisms of the stress load appear in the literature: inflammation, insulin resistance and increased cortisol.  

1. Inflammation

Under stress, the body will increase the production of inflammatory mediators ike TNF-alpha, and c-reactive protein (CRP). Inflammation is a complex immune response causing a cascade of symptoms like pain and swelling. Over time, chronic inflammation can lead to an increase in musculoskeletal pain, digestive problems, fatigue, skin problems (think eczema!), allergies, increased risk of heart disease and cancer.

An exercise class is a good example of a short-term stressor that triggers inflammation as a stress response.  Several studies show that after exercise, there is an acute rise in inflammatory markers.  But if you allow adequate time to rest between sessions, the inflammation should take care of itself. In fact, there are many studies that show having a regular exercise program will reduce inflammatory markers like CRP. So in the short-term, there is a rise in inflammation, but the net result of regular exercise is usually a reduction in inflammation.  That’s good right? The problem arises when you exercise TOO much. Overexercise without allowing adequate rest time can lead to an increase in chronic inflammation – muscle tears and joint damage.

2. Elevated Cortisol

The adrenal hormone cortisol is important for the body’s primary stress response when you encounter a perceived threat. The rise of cortisol primes your body to fight an enemy or run from a predator.  Thankfully, those type of threats are less common nowadays. But cortisol still rises from modern-day stresses like work deadlines and keeping up with American politics.

Elevated cortisol suppresses body functions like digestion and immunity, that are non-essential in a fight-or-flight situation.  As with inflammation, this mechanism is useful in the short term, but if the perceived threat goes on too long, elevated cortisol can be damaging.  High blood pressure, suppressed immune function, bone loss, reduced libido, increased weight gain, fatigue and insomnia are all common manifestations of chronically elevated cortisol.

3. Insulin Resistance

In a fight-or-flight situation, our endocrine system triggers the release of more glucose into our bloodstream. This makes sense because we use glucose for fuel. If you need to escape quickly, that extra fuel could help you outrun that predator.  

But once again, the adaptation to acute stress doesn’t work in a chronic situation. If the stress load goes on too long, more and more glucose is released.  Excess glucose means the pancreas releases more insulin and, over time, this can lead to insulin resistance.  

Research studies are bearing this out.  And insulin resistance can eventually lead to diabetes, obesity, dementia, alzheimer’s disease, and increases your risk for heart disease.

Back To Me

So now we can apply what we’ve learned to illuminate my case of college-induced eczema.  We know that eczema is an inflammatory disease and is associated with many of the classic signs of inflammation:  redness, swelling, heat and elevated inflammatory markers. We also know that elevated cortisol suppresses the immune system which can lead to further inflammation.  Thirdly, a quick pubmed search reveals research linking a diminished tolerance for sugar (insulin resistance) to a propensity to develop eczema.  

Interesting!  All three main stress load mechanisms, combined with a physiological predisposition, and voila … my hands were red and itchy for a couple of years.  

After school was over, I worked on my work-life balance. I started meditating more, got some extra sleep, did some gardening, and had a more robust social life.  Every once in a while I feel an itch on one of my hands and it acts as a warning sign that my balance is in jeopardy — a loud and clear reminder to slow things down.