THE CORRELATION BETWEEN

STRESS AND DERMATITIS

By:
NOER KAMILA
030.08.182

FACULTY OF MEDICINE
TRISAKTI UNIVERSITY
JAKARTA

i.

PREFACE
1

This paper titled the correlation between Stress and Dermatitis was created for
the purpose of completing the assignment for the Medical English III in Trisakti University,
Faculty of Medicine. The reason why this particular tittle was chosen is the issue about
psychosomatic problem especially which become popular nowadays. By reading the content
of this paper, the reader will know how stress can induce dermatitis.
Many thanks and appreciation to those who have helped in the process of making this
paper especially Prof. Dr. dr. H.A.Prayitno,Sp.KJ (K) who have agreed upon this title which
makes this paper can be done. Furthermore, my apologies for any errors contained in this
paper for it is created during a learning process.

Jakarta, 11 July 2011

Noer Kamila

ii.

TABLES OF CONTENTS

Preface

1
2

ii

Tables of Contents

Introduction

II

III

I.1

Background

I.2

Method of Writing

Stress

5
6

II.1

Definition

II.2

Symptoms

II.3

Mechanism

II.4

Causes

Dermatitis
III.1

Definition

11

III.2

Epidemiology

III.3

Sign and Symptoms

III.4

Classification

III.5

Diagnosis

13

III.6

Treatment

14

12

IV

Discussion

16

Conclusion

18

VI

Reference

19

I.

INTRODUCTION

I.1 Background
Dermatitis or Eczema is inflammation of the outer layer of the skin, characterized by
one or more of these symptoms : redness, skin edema, dryness, crusting, flaking, blistering,
cracking, oozing or bleeding. Some studies shows that stress, either physical and
psychological, is become one of the trigger. But, the most common that cause this condition
is psychological stress. The hypothalamus releases a compound called corticotrophin
releasing factor (CRF), then travels to the pituitary gland, where it triggers the release of a
hormone, adrenocorticotrophic hormone (ACTH). ACTH is released into the bloodstream and
causes the cortex of the adrenal gland to release the stress hormones, particularly cortisol. If
the stress hormones level elevated too long it will suppress the immune system. Decreased
immune system is coupled with stress from environmental factors can cause the patient
suffering from eczema. Environmental factors that can make the body suffer from eczema. In
patients who have a history of atopic have a great tendency toward stress-related eczema.

The lifetime clinician-recorded prevalence of eczema has been seen to peak in

infancy, with female predominance of eczema presentations occurring during the
reproductive period of 1549 years. Although little data on the trend of eczema prevalence
over time exists prior to the Second World War (19391945),the prevalence of eczema has
been found to have increased substantially in the latter half of the 20th Century, with eczema
in school-aged children being found to increase between the late 1940s and 2000. That means
that stress because of the second world war induced the high prevalence of eczema. A review
4

of epidemiological data in the UK has also found an inexorable rise in the prevalence of
eczema over time. Further recent increases in the incidence and lifetime prevalence of
eczema in England have also been reported, such that an estimated 5,773,700 or about one in
every nine people have been diagnosed with the disease by a clinician at some point in their
lives.
I.2 Method of Writing
The creation of this paper is made possible with the aid of various sources such as the
library, medical website, and medical journal.
I.3 Keywords
Dermatitis, Eczema, Stress.

II.

STRESS

II.1 Definition
Stress is a normal psychological and physical reaction to the ever increasing demands of life.
Surveys show that most Americans experience challenges with stress at some point during the
year. In looking at the causes of stress, remember that your brain comes hard-wired with an
alarm system for your protection. When your brain perceives a threat, it signals your body to
release a burst of hormones to fuel your capacity for a response. This has been labeled the
"fight-or-flight" response. Once the threat is gone, your body is meant to return to a normal
relaxed state. Unfortunately, the nonstop stress of modern life means that your alarm system
rarely shuts off. The stress response is the bodys way of protecting you. When working
properly, it helps you stay focused, energetic, and alert. In emergency situations, stress can
save your life giving you extra strength to defend yourself, for example, or spurring you to
slam on the brakes to avoid an accident.

II.2 Symptoms

Stress Warning Signs and Symptoms

Cognitive Symptoms
Memory problems

Emotional Symptoms
Moodiness

Inability to concentrate

Irritability or short temper

Poor judgment

Agitation, inability to relax

Seeing only the negative

Feeling overwhelmed

Anxious or racing thoughts

Sense of loneliness and isolation

6

Constant worrying

Physical Symptoms
Aches and pains

Depression or general unhappiness

Behavioral Symptoms
Eating more or less

Diarrhea or constipation

Sleeping too much or too little

Nausea, dizziness

Isolating yourself from others

Chest pain, rapid heartbeat

Procrastinating or neglecting

Loss of sex drive

Frequent colds

responsibilities

Using alcohol, cigarettes, or drugs

to relax

Nervous habits (e.g. nail biting,

pacing)

II.3 Mechanism

A diagram of the General Adaptation Syndrome model.

Physiologists define stress as how the body reacts to a stressor, real or imagined, a stimulus
that causes stress. Acute stressors affect an organism in the short term; chronic stressors over
the longer term.
Selye researched the effects of stress.
Alarm is the first stage. When the threat or stressor is identified or realized, the body's stress
response is a state of alarm. During this stage adrenaline will be produced in order to bring
about the fight-or-flight response. There is also some activation of the HPA axis, producing
cortisol.
Resistance is the second stage. If the stressor persists, it becomes necessary to attempt some
means of coping with the stress. Although the body begins to try to adapt to the strains or
demands of the environment, the body cannot keep this up indefinitely, so its resources are
gradually depleted.
Exhaustion is the third and final stage in the GAS model. At this point, all of the body's
resources are eventually depleted and the body is unable to maintain normal function. The
initial autonomic nervous system symptoms may reappear (sweating, raised heart rate etc.). If
stage three is extended, long term damage may result as the body, and the immune system is
exhausted and function is impaired resulting in decompensation.
The result can manifest itself in obvious illnesses such as ulcers, depression, diabetes, trouble
with the digestive system or even cardiovascular problems, along with other mental illnesses.

II.4 Cause of stress

The situations and pressures that cause stress are known as stressors. We usually think of
stressors as being negative, such as an exhausting work schedule or a rocky relationship.
However, anything that puts high demands on you or forces you to adjust can be stressful.
8

This includes positive events such as getting married, buying a house, going to college, or
receiving a promotion.
What causes stress depends, at least in part, on your perception of it. Something that's
stressful to you may not faze someone else; they may even enjoy it. For example, your
morning commute may make you anxious and tense because you worry that traffic will make
you late. Others, however, may find the trip relaxing because they allow more than enough
time and enjoy listening to music while they drive.

Common external causes of stress

Not all stress is caused by external factors. Stress can also be self-generated:

Major life changes

Financial problems

Work

Being too busy

Children and family

Relationship difficulties
Common internal causes of stress

Not all stress is caused by external factors. Stress can also be self-generated:

Inability to accept uncertainty

Unrealistic expectations

Pessimism

Perfectionism

Negative self-talk

Lack of assertiveness

III.

DERMATITIS

III.1 Definition
Dermatitis or Eczema is inflammation of the epidermis (the outer layer of the skin).
The term eczema is broadly applied to a range of persistent skin conditions. These include
dryness and recurring skin rashes that are characterized by one or more of these symptoms:
redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking,
oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes
due to healed injuries. Scratching open a healing lesion may result in scarring and may
enlarge the rash.
III.2 Epidemiology
10

The lifetime clinician-recorded prevalence of eczema has been seen to peak in

infancy, with female predominance of eczema presentations occurring during the
reproductive period of 1549 years. Although little data on the trend of eczema prevalence
over time exists prior to the Second World War (193945), the prevalence of eczema has been
found to have increased substantially in the latter half of the 20th Century, with eczema in
school-aged children being found to increase between the late 1940s and 2000.
A review of epidemiological data in the UK has also found an inexorable rise in the
prevalence of eczema over time. Further recent increases in the incidence and lifetime
prevalence of eczema in England have also been reported, such that an estimated 5,773,700
or about one in every nine people have been diagnosed with the disease by a clinician at some
point in their lives.

III.3

Sign and Symptoms

It can be difficult to avoid all the triggers, or irritants, that may cause or worsen

eczema flare-ups. In many people, the itchy patches of eczema usually appear where the
elbow bends; on the backs of the knees, ankles, and wrists; and on the face, neck, and upper
chest although any part of the body can be affected.
In an eczema flare-up, skin may feel hot and itchy at first. Then, if the person
scratches, the skin may become red, inflamed, or blistered. Some people who have eczema
scratch their skin so much it becomes almost leathery in texture. Others find that their skin
becomes extremely dry and scaly. Even though many people have eczema, the symptoms can
vary quite a bit from person to person.

III.4

Classification
11

The term eczema refers to a set of clinical characteristics. Classification of the

underlying diseases has been haphazard and unsystematic, with many synonyms used to
describe the same condition. A type of eczema may be described by location (e.g., hand
eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose
eczema). Further adding to the confusion, many sources use the term eczema for the most
common type of eczema (atopic dermatitis) interchangeably.
The European Academy of Allergology and Clinical Immunology (EAACI) published
a position paper in 2001 which simplifies the nomenclature of allergy-related diseases
including atopic and allergic contact eczemas. Non-allergic eczemas are not affected by this
proposal. The classification below is ordered by incidence frequency :
1.

Atopic eczema is an allergic disease believed to have a hereditary component and

often runs in families whose members also have asthma. Itchy rash is particularly noticeable
on head and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging
doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact
dermatitis. It is very common in developed countries, and rising.
2.

Contact dermatitis is of two types: allergic (resulting from a delayed reaction to

some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a
detergent, such as sodium lauryl sulfate, for example). Some substances act both as allergen
and irritant (wet cement, for example). Other substances cause a problem after sunlight
exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema
are of the irritant type, which is the most common occupational skin disease. Contact eczema
is curable, provided the offending substance can be avoided and its traces removed from
ones environment.
3.

Xerotic eczema is dry skin that becomes so serious it turns into eczema. It worsens in

dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin
12

resembles a dry, cracked, river bed. This disorder is very common among the older
population. Ichthyosis is a related disorder.
4.

Seborrhoeic dermatitis or Seborrheic dermatitis is a condition sometimes

classified as a form of eczema that is closely related to dandruff. It causes dry or greasy
peeling of the scalp, eyebrows, and face, and sometimes trunk. The condition is harmless
except in severe cases of cradle cap. In newborns it causes a thick, yellow crusty scalp rash
called cradle cap, which seems related to lack of biotin and is often curable.

III.4 Diagnosis
Diagnosing atopic eczema can be difficult because it may be confused with other skin
conditions. For example, eczema can easily be confused with a skin condition called contact
dermatitis, which happens when the skin comes in contact with an irritating substance like the
perfume in a certain detergent.
In addition to a physical examination, a doctor will take your medical history by
asking about any concerns and symptoms, past health, family's health, any medications, any
allergies and other issues. Things in your environment that may be contributing to your skin
irritation. For example, started using a new shower gel or body lotion before the symptoms
appeared. Emotional stress can also lead to eczema flare-ups. Also allergic testing by pricking
test could be done to eliminate the trigger which is cause eczema.

III.5 Treatment
Eczema can't be cured, but you can do plenty of things to prevent a flare-up. Avoid
substances that stress skin is the point. For facial eczema, wash gently with a nondrying facial
cleanser or soap substitute, use a facial moisturizer that says noncomedogenic/oil-free, and
apply only hypoallergenic makeup and sunscreens.
13

Try to avoid hot water. Too much exposure to hot water or overuse of soaps or
cleansers can dry out skin, so take short warm showers and baths and wear gloves if the
hands will be in water for long periods of time. Be sure to gently and thoroughly pat skin dry,
as rubbing with a coarse towel will irritate the eczema. Also, it isn't the water that causes your
skin to react; it's the water evaporating that's not captured in the skin.
Don't scratch that itch. Even though it's difficult to resist, scratching your itch can
worsen eczema and make it more difficult for the skin to heal because you can break the skin
and bacteria can get in, causing an infection. Keep your cool. Sudden changes in temperature,
sweating, and becoming overheated may cause your eczema to kick in. For some people with
severe eczema, ultraviolet light therapy can help clear up the condition. Newer medications
that change the way the skin's immune system reacts also may help.
Corticosteroids are highly effective in controlling or suppressing symptoms in most
cases. For mild-moderate eczema a weak steroid may be used (e.g. hydrocortisone), while in
more severe cases a higher-potency steroid (e.g. clobetasol propionate) may be used. In
severe cases, oral or injectable corticosteroids may be used. While these usually bring about
rapid improvements, they have greater side effects.
Topical immunomodulators like pimecrolimus (Elidel and Douglan) and tacrolimus
(Protopic) were developed after corticosteroid treatments, effectively suppressing the immune
system in the affected area, and appear to yield better results in some populations.
When eczema is severe and does not respond to other forms of treatment, immunosuppressant
drugs are sometimes prescribed. These dampen the immune system and can result in dramatic
improvements to the patient's eczema. The most commonly used immunosuppressants for
eczema are ciclosporin, azathioprine and methotrexate. These drugs were generally designed
for other medical conditions but have been found to be effective against eczema.

14

Anti-itch drugs, often antihistamine, may reduce the itch during a flare up of eczema,
and the reduced scratching in turn reduces damage and irritation to the skin. However, in
eczema, the itch relief is often due to the sedative side effects of these drugs, rather than their
specific antihistamine effect. Hence, sedating antihistamines such as promethazine
(Phenergan) or diphenhydramine (Benadryl) are more effective at relieving itch than the
newer, nonsedating antihistamines.

V.

DISCUSSION

Stress can contribute to eczema flare-ups, and conversely eczema flare-ups can result
in stress for both the patient and the caregiver. The severity and extent of the skin involved is
variable. Stress may trigger a flare up or may exacerbate existing eczema. Physical and
psychological stress can cause this disease. Stress can lead to the emergence of this disease
particularly in those who have a history of atopic. But the disease is not solely due to stress,
there are environmental factors in it.
This is the hypothesis, when the stress happen, the hypothalamus releases a compound
called corticotrophin releasing factor (CRF), then travels to the pituitary gland, where it
triggers the release of a hormone, adrenocorticotrophic hormone (ACTH). ACTH is released
15

into the bloodstream and causes the cortex of the adrenal gland to release the stress
hormones, particularly cortisol. If the stress hormones level elevated too long it will suppress
the immune system. Decreased immune system is coupled with stress from environmental
factors can cause the patient suffering from eczema. Environmental factors that can make the
body suffer from eczema. In patients who have a history of atopic have a great tendency
toward stress-related eczema
Increased IgE production and increased cytokine levels have been detected in patients with
eczematous skin lesions. Although some patients do not have elevated IgE levels,
approximately 80 percent with various types of atopic disease will show increased levels.6
Studies have observed that acute lesions (< 3 days) have increased levels of interleukin (IL) 4
and IL-13, while chronic lesions (> 2 weeks) are rich in IL-5, interferon (IFN) and IL-12.3
-Cytokines play a role in skin inflammation, erythema and edema, which are characteristic of
eczema. Helper T cells, which differentiate into type 1 (TH1) and type 2 (TH2), also play a
role in skin disorders and immunological responses. TH2 cells, which are stimulated by IL-4,
IL-5 and IL-13, are overexpressed in acute lesions. However, there is down regulation of the
TH1 cells. This overexpression of TH2 cells is thought to be linked to atopic conditions.

16

V.

CONCLUSION
Stress is a part of life that is unavoidable, no matter what age you are. There is good

stress, which motivates you while there is also bad stress that, well, stresses you out and can
give rise to a host of health problems. For those suffering with eczema, too much stress can
signal a flare-up or even many flare-ups in a row if the stress is long term. Eczema cant be
cured, but it can be managed, and you can learn to avoid the things that trigger it. Eczema is a
generic term applied to a variety of skin conditions that are characterized by an itchy rash.
The most common types of eczema are seborrheic dermatitis, atopic dermatitis, nummular
eczema, contact dermatitis and dyshidrotic eczema. In addition to the typical red, itchy rash,
some types of eczema will cause skin blisters that may weep.

17

Stress can induced the HPA axis system which is related to the eczema. ACTH is
released into the bloodstream and causes the cortex of the adrenal gland to release the stress
hormones, particularly cortisol. If the stress hormones level elevated too long it will suppress
the immune system. This is not merely stand alone that cause eczema, in the presence of
environmental factors can also cause this disease.
There are pharmacological such as, corticosteroids. And non-pharmacological
treatment for eczema such as, keeping the skin clean. But the very first thing it is important to
not scratch the itch and keep the skin moist so the eczema dont spread up everywhere.
Because the dry skin can exacerbate the eczema. And the most important thing of all is to
manage our stress itself. Stress is a friend of our life, try to deal with it everyday. If it is
difficult for us, at least try to reduce it and also we have to keep the hygiene of the skin so the
other external factor cant present as an other trigger for the stress.

VI.

REFERENCE

1.

Simpson CR, Newton J, Hippisley-Cox J, Sheikh A (March 2009). "Trends in the

epidemiology and prescribing of medication for eczema in England". Journal of the Royal
Society of Medicine 102 (3): 10817.
2.

Johannes Ring; Bernhard Przybilla; Thomas Ruzicka (2006). Handbook of atopic

eczema. Birkhuser. p. 4.
3.

Johansson SG, Hourihane JO, Bousquet J, et al. (September 2001). "A revised

nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task
force". Allergy 56 (9): 81324.

18

4.

Bufford, JD; Gern JE (May 2005). "The hygiene hypothesis revisited". Immunology

and Allergy Clinics of North America 25 (2): 247262.

5.

Carswell F, Thompson S (1986). "Does natural sensitisation in eczema occur through

the skin?". Lancet 2 (8497): 135.

6.

Henszel , Kuna-Grygiel W (2006). "[House dust mites in the etiology of allergic

diseases]" (in Polish). Annales Academiae Medicae Stetinensis 52 (2): 1237.

19