When you feel good, you look good, but when you're under stress, your skin is usually the first place to show it.
The interplay between stress and multiple biologic systems in our bodies can trigger the onset of psoriasis and other inflammatory skin diseases, including acne, atopic dermatitis, psoriasis, seborrheic eczema, chronic urticaria, alopecia areata, and pruritus (skin itching). Researchers use the term, "psychodermatologic disorder" to refer to skin conditions such as psoriasis that can be triggered or exacerbated by emotional stress. Scientists are seeking to learn more about the "brain–skin connection" in psoriasis and other inflammatory skin diseases. They have discovered that stress management can benefit individuals with psoriasis. Patients who listened to a meditation tape while undergoing phototherapy (light therapy) for psoriasis improved four times faster than those who received phototherapy only, as judged by two independent dermatologists. Psychotherapy has been shown to be an important treatment adjunct for individuals with persistent unresolved psychosocial stress-related psoriasis.
Perioral dermatitis results in bumps around the skin of the mouth, and a rash may appear around the eyes, nose, and forehead. The condition usually is characterized by an uncomfortable burning sensation around the mouth. Subjective symptoms of perioral dermatitis (POD) consist of a sensation of burning and tension. Itching is rare. Often, an uncritical use of topical steroids for minor or even undiagnosed skin alterations precedes the development of perioral dermatitis. Perioral dermatitis tends to be chronic. Patients may have marked lifestyle restrictions due to the disfiguring facial lesions
A doctor is likely to diagnose perioral dermatitis based on the skin's appearance. No tests are usually done. In some cases, a culture for bacteria may be needed to eliminate the possibility of infection.
Clinical criteria, prick tests, and specific IgE testing against a mixture of aeroallergens has been used to test for skin barrier dysfunction. In a German study, Perioral Dermatitis patients experienced significantly increased trans-epidermal water loss compared with rosacea patients and a control group, which indicated a skin barrier function disorder. This type of testing is not routinely used.
Treatment should be adapted to the severity and extension of the disease.
To treat perioral dermatitis, discontinue the use of all topical steroid medications and facial creams. In every case, an initial worsening of the symptoms may occur with treatment, especially if topical steroids are withdrawn. The patient should be made aware of this complication. In cases of preceding long-term use of topical steroids, steroid weaning with low-dose 0.1-0.5% hydrocortisone cream can be tried initially.
Zero-therapy is based on the idea that by ceasing use of all topical medications and cosmetics, the underlying causative factor for perioral dermatitis is eliminated. This form of therapy is appropriate in very compliant patients. It may be effective predominantly in cases associated with steroid abuse or when intolerance to cosmetics is suspected.
