Since the onset of the pandemic, more and more patients have been consulting dermatologists on their shingles and psoriasis, those red, scaly, worrisome patches.

Psychodermatologist Antonio C. Sison offers an explanation, pointing to a link between stress and the skin. “The pandemic has created an unprecedented global disruption and, with that, all sorts of stress triggers. To start with, there’s the fear of contracting a potentially fatal infection. Then there’s the mandatory use of face masks and face shields, physical distancing protocols, the shift from office dynamics to working at home, the shutdown of businesses, unemployment and just the overall uncertainty of when all this will end.”

He said stress can go two ways. It’s called “eustress” when the situation makes a person more positive and productive. “Distress” is what happens when the person is overwhelmed and feels defeated.

Signs of distress cover a wide range, from memory loss to poor concentration, anxiety and moodiness, to irregular bowel movement and changes in eating and sleeping habits, random aches and pains, and higher consumptions of alcohol and nicotine.

Risk factors

“It’s the brain’s main stress response system, the hypopituitary axis, which stimulates production of the stress hormone cortisol, that is affected. Higher cortisol levels mean increased oily secretions from the sebaceous glands, which bacteria feed on, resulting in acne lesions. Psoriasis may be triggered in genetically predisposed individuals. [Inversely], psoriasis lesions may stress out a patient due to the stigma attached to the condition,” Sison said.The disruption of regular exercise routine and eating habits may result in weight gain, which may contribute to the flare of psoriasis, he added.

Herpes zoster, scientific name for shingles, is caused by varicella zoster, the same virus that causes chicken pox. “A person who has had chicken pox may still have some of that virus lying dormant in the nerve tissue near the spinal cord or the brain,” Sison said. This causes the attendant pain or tingling sensation.

Stress and a weakened immune system are among the risk factors for the onset of herpes zoster, he added. Advancing age, poor diet and mood conditions may contribute to the deterioration of the immune system.

“Several publications have reported that patients who tested positive for the coronavirus were initially diagnosed with herpes zoster.”

Moisturize

There’s been a resurgence of a few other skin conditions lately, he added, among them acne resulting from prolonged use of face masks. “The main cause is bacteria that thrive in the humid environment created by the mask.” He doesn’t think that frequently changing masks will help alleviate the problem.

Interestingly, he said “excessive personal hygiene” also poses some problems. “Frequent hand sanitizing with disinfecting soaps and rubbing alcohol weakens the skin’s protective barrier. This could lead to dryness. Dry skin increases the risk of itchiness, and scratching results in skin abrasions and more irritation.” His simple advice: “Moisturize.”

Dermatologists refer some patients to Sison when the patients become depressed.

A psychodermatologist evaluates the patient for psychiatric disorders and then determines medication and therapy. Sison routinely performs Eye Movement Desensitization and Reprocessing (EMDR), where he guides the patient’s eye movements while recalling a trauma.

He said that patients with psoriasis chose a painful memory that occurred before the onset of their skin lesions. “The psychological changes after EMDR may vary. They are less bothered by the psoriasis,” he said.

From his current work on these cases, Sison has been led to conclude, “Traumatic experiences, or even just negative thinking, impact both mind and body.”

To relieve the source of stress or anxiety that surfaces, Sison’s first recourse is to recommend breathing techniques and exercises on relaxation and/or mind-body apps. He also suggests mindfulness which means to be aware of what, how and why we think and feel the way we do. Coupled with self-reflection, we can see how thoughts and memories can affect our health. —CONTRIBUTED INQ

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