Tag Archive: stress

Is It Bad to Pick on Your Acne?

November 4, 2018

Anyone who has survived adolescence knows the feeling of seeing an ugly head of pus on the face and having the urge to press it out. Despite many commonly known warnings about the evils that befall those that pop pimples (the pimples will spread, grow infected and/or scar), few resist.

However, there are cases in which this behavior can become extreme. Such behavior becomes a condition called excoriation disorder (also known as dermatillomania, acne excoriée, neurotic excoriation, or psychogenic excoriation) when it is repetitive and intentionally self-harming.

Characteristics of excoriation disorder

Skin-picking is quite common and may occur at any age. It typically begins in adolescence as it coincides with the onset of puberty. Patients suffering from acne or eczema are more likely to pick their skin.

What distinguishes excoriation disorder from normal skin picking is that this behavior is self-injurious and involves repetitive scratching or picking at healthy skin, minor skin irregularities or general skin-picking automatically without realizing it. The behavior also results in tissue damage.

Sufferers of this disorder may skin-pick any area of the body and usually do so in multiple places. The most common areas are the face, followed by the hands, fingers, arms or legs. Acne, papules, scabs, scars, calluses and insect bites are also sometimes excoriation sites.

While potential skin-picking triggers may vary across individuals, common ones include emotions such as stress, anger, and anxiety. Skin-picking is often common during sedentary activities as well such as watching television and reading, boredom and feeling tired.

Excessive picking can result in tissue damage and lead to medical complications such as localized infections. Such behavior often begins with the onset of a dermatological condition like acne, and often worsens conditions by preventing wounds from healing properly.

Psychological aspect of the disorder

The behavior associated with skin picking shares similar symptoms with obsessive-compulsive disorder (OCD) and impulse control disorder. Features that resemble OCD include obsessions about an irregularity on the skin or preoccupation with having smooth skin and excoriating in response to the thoughts. Individuals who pick their skin may also experience mild to moderate levels of depression and/or anxiety.

Through the experience of picking, sufferers may feel tension prior to excoriating and relief or pleasure during or afterwards. However, any positive feelings are unfortunately transient and give way to the urge to pick again.

Treatment

Individuals who skin pick rarely seek dermatological or psychiatric treatment for their condition; they are either embarrassed or believe that the condition is untreatable.

Instead, some patients may avoid social activities as it may expose their scars or injuries. Others resort to cosmetics, clothing and/or bandages to camouflage their scars.

However, there are other ways out. For excoriation disorder, both pharmacological and nonpharmacological treatments can help.

Behavioural interventions

Cognitive-behavioral therapy and habit reversal therapy can be powerful interventions for excoriation disorder sufferers. Cognitive-behavioral therapy involves psychoeducation, cognitive restructuring and an emphasis on relapse prevention.

Habit reversal therapy involves self-monitoring and substituting skin-picking with an incompatible action. For examples, patients can be advised to clench their fists whenever they feel the urge to skin pick. Another example is to introduce a new behavioural sequence that ends with a harmless action: the hand approaches the face to pick the skin but then consciously deviates to a different location such as the ear.

Pharmacotherapy treatments

Research on the use of medications for excoriation disorder is currently limited. Individuals who suffer from skin picking should receive a thorough physical examination before going on any medication.

Having said that, many individuals can benefit from drug interventions. Pharmacological agents used to treat excoriation disorder include:

Selective serotonin reuptake inhibitors

It is widely believed that imbalanced or low serotonin levels contribute to depression, anxiety disorders and some personality disorders. Better regulating serotonin is believed to help improve the brain function and thereby reduce the urge to skin-pick. Common drugs that increase levels of serotonin to the brain include clomipramine, fluoxetine and sertraline.

Opioid antagonists

Like serotonin, people with low dopamine may exhibit more depression, anxiety, poor outlook, addiction and self-harming behavior. Opioid antagonists (naltrexone, nalmefene) increase the dopamine levels in our body and help diminish the urge to pick.

Glutamatergic agents

Examples include N-acetyl cysteine (NAC) and riluzole. Skin picking, along with other compulsive and habitual disorders, is said to arise from defective signalling of a substance called glutamate. With glutamatergic agents such as NAC, it helps to increase levels of glutamate in the brain, ensuring signalling functions normally again, reducing the urge to pick on skin.

When to visit a dermatologist

When picking on acne becomes serious, such as causing frequent infections or severe scarring, patients should seek help and visit a dermatologist. While skin picking is rather common, patients should take note if the intensity and frequency of such behaviour increases over time. Skin picking can inflict severe tissue damage, and may require a long period of time for scars to heal. A dermatologist will be able to provide professional treatment and advice before the condition worsens.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.
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Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.

 

 

Stressing Out Can Aggravate Your Acne – Here’s How

October 22, 2018

Any acne google search will reveal links between acne breakouts and a variety of factors including cosmetics, spicy food, sunlight, chocolate, and even sweat. However, one less tangible factor that is often included but rarely explained is stress.

Stress is truly a significant factor in acne. While it is unlikely to cause acne alone, it can trigger flares and aggravate the condition by causing excessive oil production and delaying the wound recovery time of acne.

Stress induces excessive oil production

During periods of high stress, the hypothalamic-pituitary-adrenal (HPA) axis is activated and produces hormones. The HPA axis is the interaction between our body’s central nervous system (brain) and the endocrine system (hormonal-related).

The HPA releases androgens and corticotropin-releasing hormones (CRHs) in response to stress. CRHs bind to the receptors on our oil glands and accelerate lipid synthesis. CRHs also activates the testosterone in our body, which further enhances lipid production.

When the body experiences stress, neuropeptides are also released. Neuropeptides are small proteins found in the brain that are engaged in the functions of signalling and communication. Neuropeptides can also influence hormones. In particular, a neuropeptide called Substance P can stimulate the growth in the number and size of oil glands, which contributes to acne.

Stress delays wound recovery

Individuals with high levels of perceived psychological stress have shown significantly delayed recovery rates of the skin barrier. In other words, stress slows down the body’s ability to heal wounds, which can be a factor in slowing the repair of acne injuries.

Stress also triggers the increased level of the hormones glucocorticoids and catecholamines, which can adversely influence the healing process.

Glucocorticoids reduce the number of cytokines at the site of injury. Cytokines are essential in the early stage of wound healing as they protect against infection and prepare the injured site for repair by sending signals for phagocytes. Phagocytes kill and digest unwanted microorganisms. The later stages of wound repair are thus delayed with lower level of cytokines, meaning more time is required for acne to heal.

Further, catecholamines regulate a range of immune functions such as cell proliferation, production of cytokines (essential in wound-healing process) and antibodies. Elevated catecholamine levels during times of stress can inhibit the production of cytokines or suppress the body’s natural immune response to attacks.

Stress promotes habits that aggravate acne

The stresses of daily life may encourage individuals to pick at or scratch their skin. Such habits cause further inflammation, scarring and hyperpigmentation.

Stressed individuals are also more likely to have unhealthy habits, such as poor sleep patterns, imbalanced nutrition, and excessive consumption of alcohol. Stressed-out individuals can, at times, overeat in the face of chronic stress or increase their intake of calorie-rich food to calm the nerves. Comfort foods such as ice cream or cake can help to tone down the body’s stress responses but trigger acne or inflammation.

Finally, stress can cause people to neglect good self-care, including maintaining a usual skincare routine.

How to lessen the impact stress has on your skin?

Physical exercise can alleviate stress and regulate the production of stress-related hormones. Patients suffering from acne may be tempted to steer from exercise due to the discomfort from sweat, but exercising can provide important benefits to your skin. Just shower immediately after exercising and use a gentle moisturizer to keep your skin hydrated.

Experiment with other stress-reduction techniques as well such as meditation, yoga or reading a good book. If a stressful event is around the corner, be sure to get sufficient sleep and consume proper meals to eliminate other potential triggers that can aggravate your acne.

In addition to managing your stress-levels, consider visiting a dermatologist. Acne is treatable with the help of an accredited dermatologist, so it is worthwhile to seek professional advice.

© 2018 TWL Specialist Skin and Laser Centre. All rights reserved.

—–
Meet with Dr. Teo Wan Lin, an accredited dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email appt@twlskin.com. Alternatively, you may fill up our contact form here.