Itchy skin can be psychologically stressful

NEW YORK (Reuters Health) – Chronically itchy skin can take not only a physical toll but a psychological one as well, a new study suggests.

Research has linked various skin conditions, such as severe acne, psoriasis and eczema, to higher risks of depression, anxiety and stress in some individuals. But it has not been clear whether chronic itchiness -- a common symptom of skin disorders -- can cause its own distress.

The new study, of more than 2,200 Japanese adults age 18 and up, found that 3 percent complained of chronically itchy skin, also known as pruritus. And the more severe the problem, the more likely they were to score high on a measure of psychological stress.

The findings suggest that the symptom itself, and not just the disorders it marks, can take an emotional toll, according to the researchers, led by Dr. Yosuke Yamamoto of Kyoto University in Japan.

They report the results in the latest issue of Archives of Dermatology.

The study included 2,224 Japanese adults who kept health diaries over one month and completed a standard questionnaire called the Perceived Stress Scale -- which measures, for instance, how often a person has felt "nervous" or "stressed" in the past month.

Participants used the diaries to record the presence and severity of various symptoms, including itchiness.

Overall, Yamamoto's team found, participants with itchy skin had a higher average score on the stress scale than other participants did. And the more frequent the symptom, the higher the scores.

The link between itchiness and stress was also seen among participants who had more than two health complaints. This, according to the researchers, suggests that itchiness itself has psychological effects independent of other health problems.

A number of skin conditions -- including eczema, recurrent hives and psoriasis -- are marked by sometimes intensely itchy skin. The current findings suggest that if the symptom is not well-controlled, it can be a source of psychological, as well as physical, hardship, according to the researchers.

They point out that the questionnaire they used in the study cannot diagnose clinical depression or other mental health disorders. But people's scores do serve as an indicator of general psychological distress.

In turn, the researchers note, chronic stress may affect the immune, hormonal and cardiovascular systems, potentially affecting long-term physical health.


SOURCE: Archives of Dermatology, December 2009.

Molecules in Skin Link Eczema and Asthma

In a study appearing in the May 19 in the journal PLoS Biology, research as shown below indicates that skin conditions such as acne, eczema, dermatitis and rosacea are in fact triggered as a result of an immune system response. A substance secreted by eczema-damaged skin might trigger asthma in children, U.S. researchers suggest. The theory comes from a study of mice with an eczema-like condition, which suggested that early treatment of eczema and inhibition of the trigger substance might help prevent asthma.

An estimated 50 percent to 70 percent of children with severe eczema (known as atopic dermatitis) develop asthma, compared with about 9 percent of children in the general population. In the United States, about 17 percent of children have eczema, although not all cases are severe.

The progression from eczema to asthma is called the atopic march. "Over the years, the clinical community has struggled to explain atopic march," Raphael Kopan, a professor of developmental biology and dermatology at Washington University School of Medicine in St. Louis and an author of the study, said in a news release from the school.

"So, when we found that the skin of mice with an eczema-like condition produced a substance previously implicated in asthma, we decided to investigate further," Kopan said. "We found that the mice also suffered from asthma-like responses to inhaled allergens, implicating the substance, called TSLP, as the link between eczema and asthma."

The researchers found that TSLP (thylmic stromal lymphopoietin) is secreted by damaged skin to alert the body that the skin's protective barrier has failed. TSLP activates an immune response that fights invaders. "We are excited, because we've narrowed down the problem of atopic march to one molecule," Kopan said. "We've shown that skin can act as a signaling organ and drive allergic inflammation in the lung by releasing TSLP. Now, it will be important to address how to prevent defective skin from producing TSLP. If that can be done," she said, "the link between eczema and asthma could be broken."

Over the counter acne treatments are often too strong and strip the skin of its protective barrier layer causing the skin to produce more oil as to repair and replenish the protective barrier destroyed by contact with harsh chemicals often found in acne treatments.

The skin is a protective barrier between our body organs and outside bacteria, pollution and disease. In fact it is a complex system of action and reaction. When TSLP (thylmic stromal lymphopoietin) is secreted by damaged skin to alert the body that the skin's protective barrier has failed, the TSLP activates an immune response that fights invaders. Skin conditions such as rosacea, acne, and eczema partially result from an overly acidic body and skin.