There are a lot of studies that show the close connection between the barrier function of the skin and stress. Barriers are quite sensitive to stress, and the skin is the largest barrier we have between our body and the environment. If you are stressed, it wants to help to defend you, however sometimes it overdoes the job.

Often people say that when you are stressed, the immune system doesn't work properly or is weak and this can cause skin diseases because it can’t defend itself against environmental challenges, against bacteria, viruses, fungi, toxins. The common belief is that all you need to do is strengthen your immune response, but the immune system is quite complex and usually doesn't have strength or weakness. It is built to adapt to a variety of challenges using tailored immune responses. 

My favourite example is to compare winter and summer: In summer we visit new places, play sports and this brings us into contact with new challenges to our skin's barrier and immune system: sunshine, new toxins, new germs, maybe a scratch here and there. We are good at defending against such new challenges when our immune system is in a state called activated innate immunity, the immune response you are basically born with. 

Innate immunity allows you to fend off a germ without knowing what it is, but it causes a lot of collateral damage around the agents and cells that are to be eliminated. Your immune system needs to be tuned to terminate this response after a while. 

In winter, you tend to stay home with the same people and the same germs so your immune system can take the time to mount the right specific response. You now need an immune system that is flexible and can switch to adaptive immunity. It is a bit like having constant low level stress, and the problem is you do not recover from it if it goes on continuously. 

In summary, you need a bit of acute stress here and there with pauses in between to defend your body and your skin optimally against new and old challenges. A little bit of acute stress here and there will help to keep your barrier up and running, a lot of chronic stress however will compromise it. 

Learning the difference between 'healthy stress' and 'unhealthy stress' can help you to cope with these situations, and help your skin better adapt to its environment. Healthy stress is a situation that stresses you acutely but then goes away again quickly. Unhealthy stress makes you feel chronically stressed and unable to switch between alertness and relaxation at will.

When we talk about skin, we use words such as, 'I feel the cold more intensely, I feel touch more intensely', 'I itch all the time', 'my rashes have become worse' and of course, exacerbations of skin diseases such as atopic dermatitis and psoriasis.

You need to learn the signs and symptoms that your body is telling you that you are in a severely stressed state, what kind of stress it is and if you can cope with it. Once you notice the stressors in your life and the connection to symptoms you have, you should look into the sources and if you can change them. 

If you learn to respond to the signs appropriately, you can develop a well-trained stress and immune response which is highly adaptive. If you don't learn to read your body's signs and you do not respond to them, if you tend to neglect the stress feelings, you will be more likely to experience chronic stress and its consequences. There are a lot of things you can do to change that.

First of all, prevention is important. If you can't sleep, you are nauseous, cold or sensitive to pain, then you need rest, good food and exercise. You need friends to talk to and help to solve any conflicts in and around you. It helps to adhere to the rules of a healthy lifestyle, but sometimes this is not enough. 

We tend to respond to stress by smoking, drinking more alcohol than is good for us, fighting with relatives and superiors, all things that increase stress. In this case you need to learn how to get out of this pathological cycle, how to resolve the sources of stress and how to help yourself to be mindful and conflict-solving. 

If you encounter any of these problems, it's important to ask yourself why, what can I do about it. In this situation it is good to seek professional help. Go to your doctor and tell them that you can't sleep or that your atopic dermatitis has gotten worse. Ask your doctor if there could be a connection with the stress and what can be done about it. 

From case to case, person to person, disease to disease, it's important to see if there is too much stress, if it is lifestyle behaviours such as smoking, overeating, or if it is something in your past or a conflict in the present that is affecting you. I am a dermatologist as well as a psychosomatic doctor and that allows me to understand the physical side as much as the mental side of disease and I am convinced that neither side stands alone. Somatic disease always affects mental health and mental distress always has physical effects. Most people are able to see the connection when helped along.

Let's look at an example: A patient with exacerbated psoriasis that began just a few weeks after his wife's cancer diagnosis. This man has worked his farm for 40 years and never learned to speak about his feelings, so of course you can't ask him, 'Do you think you are scared and that may be the reason you are now seeing an exacerbation of your psoriasis?' He will answer, 'No!'

By asking him about his skin problems as well as his life – when did his psoriasis start, when did his skin get worse over the years, when were difficult phases in his life – you may together conclude that there is a connection between his skin getting worse and the stressful phases in his life. 

'You got your psoriasis when you were 16 and your father died. It was quite bad for a couple of years until you were happy in your job, and then you married and your first child cost you all your sleep and you had your first exacerbation.' He will say, 'Yes, I realise that whenever there was something going on in my life, it got worse.' Then the door is open, the connection can be made, and slowly but surely you can talk about his wife's diagnosis and what it means to him. 

If you let the facts speak for themselves, that connection appears by itself. Usually the patient knows there is something wrong and why the body responds to it. It's a question of finding the right language and to allow it to be spoken out.