What your stressed skin could be trying to tell you
When Sarah Kugelman was in her early 30s, she was severely stressed. Her high-powered job in the beauty industry in Ohio, US, meant she was working long hours, travelling regularly - and neglecting her health.
She went on to suffer from various infections and illnesses, but not before she noticed an effect on her looks. "Everything was playing out on my skin," she explains, now some 20 years later. "I had no glow - it was really dull. I was only 31 and had accelerated signs of ageing with wrinkles.
"I also had cystic acne, not just occasional small breakouts. The spots were itchy and red, too, almost like an allergic reaction.
"I moved back home to my parents in New York. The family doctor said if you don't slow down, you won't live to 40. That was a huge warning for me." When stressed, the adrenal glands produce cortisol, a hormone that can have an immunosuppressive effect, meaning bacteria that would normally be fought off can grow on the skin and lead to acne.
Stress can also cause DNA damage, leaving cells less able to repair themselves, leading to signs of accelerated ageing. As happened with Kugelman, stress can also lead to skin irritation as the body creates more histamines.
Dr Claudia Louch, a London-based dermatologist internationally famed for her natural approach, says she has noticed a dramatic increase in middle-aged women experiencing acne for the first time since their teenage years. Typically, they have perioral acne, which appears around the mouth and chin.
"I see it more because as women we face much more challenging roles than ever before," she explains. "We're expected to be mothers, have a career, a family. Jobs are demanding and there is stress about how we look. Women hammer away in the gym on top of it and that's another physical stress."
She believes that while stress can have a negative impact on the skin, it is often also linked to underlying causes - be they hormonal imbalances, yeast infections or poor nutrition. Her clinic tackles skin problems by investigating what is going on inside the body, via a full hormonal check, blood screen and hi-tech equipment looking at the skin. Clients are then often prescribed supplements, given full dietary plans and advised to use certain natural products to restore hydration to the skin.
This two-pronged approach to battle-stressed skin is something Kugelman also recognised when she was dealing with her own issues. "It's a balance of dealing with what's going on inside as well as outside," she explains. "It's about seven to eight hours' sleep at night, drinking four cups of water a day, doing some kind of fitness regularly, doing some kind of meditation and learning when you're stressed.
"But dealing with what's going on outside is important, too. If you look into the mirror and your skin looks terrible, you won't feel good about yourself. Treat it from both ends."
Though she returned to her job in the beauty industry after battling with stress in her 30s, she was later inspired to set up her own skincare brand, Skyn, which treats stress skin "using pure and potent ingredients", such as gooseberry extract. People suffering with sudden acne linked to stress are also advised to try and reduce their stress levels by improving their diet and exercise.
Yet Dr Louch warns that often, without correct guidance and information, this can have an adverse effect - particularly with the rise of "clean eating" as people forego important nutrients in favour of a high-sugar diet, often believing that because they have cut out refined sugar, it "doesn't count".
"A lot of people think they're eating healthily, but they're not," she says. "A lot of diets are high in fat and sugar, [and include] things like nuts and seeds. People substitute dairy with nut milk, which is just sugar. And 10 nuts have the same calories as a chocolate bar. They eat more avocados and salmon, which is better than saturated fat, but fat is fat."
She also warns that too much exercise can lead to an increase in stressed skin, as the body becomes physically exhausted: "A lot of people overdo it, whether overweight or underweight. It's a stress to your body because it has to repair injuries and balance things out. I always say your body needs a break, so do it on alternate days. You should be moving but not overdoing it."
The path to treating stress skin is not as simple as popping a pill. But by improving health and nutrition, as well as treating the skin with the products it needs, it can eventually clear. For Kugelman, stress skin is firmly in the past. "People always tell me I have beautiful skin now," she laughs. "I'm 53 but people think I'm in my 30s. It shows it is possible."
STRESSED SKIN: HOW TO BEAT IT
* Examine your diet: "If you're eating a lot of white foods with flour, yeast and also lots of sugar, try and cut down," says Sarah Kugelman. "It's best to have a diet high in antioxidants, with foods like sweet potatoes and avocados."
* Keep to a fitness regimen, but build in rest: "Exercise helps sweat out impurities from lymph nodes and sends oxygen to all organs and the skin. It can help to clear and detoxify your skin."
* Take it easy on yourself: "Yoga, acupuncture and meditation are all known to help with stress."
* Make sure you have enough sleep: "If your body has at least eight hours' rest a night, it can renew itself and rejuvenate, which will make a huge difference to your skin."
* If your skin still doesn't respond, consult an expert: "You may have hormonal problems or an underlying infection. So get it checked."
7 OTHER THINGS YOUR SKIN COULD BE TELLING YOU
* Oily skin? Reduce dairy As soya and almond milk converts will tell you, dairy is not always your skin's friend. According to dermatologists, cow's milk - which is often thick with progesterone from the expectant cow - can knock your ordinary hormone levels off-kilter, resulting in bumpy, oily skin. Patients with inflammatory conditions such as acne, psoriasis and eczema are routinely put on low-dairy diets to help clear their skin complaints.
* Acne breakouts? Take a break: Cortisol, the hormone released during periods of high physiological stress, is a key player when it comes to adult acne. As well as triggering the release of oil, high levels of cortisol have an immunosuppressive effect, enabling bacteria to thrive on the skin, leading to breakouts.
* Sandpaper skin? Could be an underactive thyroid? Raw and itchy skin is not uncommon in those in a state of hormonal flux - for instance, menstruating women. Other telltale signs of thyroid disease are muscle cramps and weight gain.
* Dark circles? Cleanse your kidneys: When no amount of cold tea bags or cucumber slices can shift the excess baggage around your eyes, it usually means time for an early night (dark circles will appear as your epidermis struggles to make up for lost regeneration time). However, when the eye bags are also puffy - and especially if accompanied by swelling of the hands and feet - it could indicate kidney deficiency or bowel congestion. Try flushing the kidneys with cranberry tablets, which help clear excess calcium oxalate, one of the main contributors to kidney stones.
* Mismatched skin? Eat the rainbow: Unevenly coloured patches of skin are your body's way of telling you to broaden your culinary horizon. For those on restricted diets - from vegetarians and vegans to so-called "clean" eaters - nutrient deficiency can manifest itself on your body's surface, or as cracked lips.
* Bumpy eyelids? Curb your cholesterol: Cheese-guzzlers and those fond of a thick steak may be familiar with xanthelasma, a lumpy eyelid condition that's the result of a high-cholesterol diet. Opting for fibrous foods will quickly quash the yellowish lipids deposits, but it could be time for a cholesterol test to find out whether your levels are healthy.
* White patches? Double-check for diabetes: When your blood-sugar levels max out, your body creates a series of surface-level warning signs. With vitiligo, smooth white patches appear on the skin because the cells that make pigment are destroyed - and could prefigure a diabetes diagnosis.
- The Telegraph, London