Adrenal Function and Skin

Chronic stress is physiologically dangerous but particularly damaging to the skin. The skin is the body's largest organ, protecting us from and interacting with our environment. It doesn't just shield; it also interacts. The skin is a component of the peripheral HPA axis that communicates with the HPA axis and a neuroendocrine system that responds to environmental stressors and maintains homeostasis.Keratinocytes, the outermost layer of cells in the skin, synthesize hormones and produce neurotransmitters and neuropeptides, which are the signaling agents of the HPA axis and the central nervous system. The skin regulates the HPA axis response to temperature and injury and responds to psychological stress. As a barrier organ, it evolved to block pathogens from entering the body and regulate an immune response. The adrenal hormone cortisol is synthesized in the skin and functions as the central regulator in the peripheral HPA axis response to the outside. Any stress or trauma activates a bidirectional feedback loop between cytokines and cortisol. Cortisol stimulates the release of inflammatory cytokines. It also suspends the release of inflammatory cytokines. Too much or too little will cause damage.

Cortisol mounts the inflammatory cytokine defense of redness, heat, itching, sensitivity, and swelling when skin is lacerated, cut, infected, or burned. White blood cells engulf pathogens. The healing cascade, which includes inflammation, blood clotting, cellular proliferation, and remodeling, is initiated by cortisol. Inflammation sets the stage for wound healing. Scratches, the occasional cut, sunburns, and bruises are a part of life, and so is stress. Chronic stress becomes a problem because it can lead to autoimmune skin issues, a blunted cortisol response to stress, hypersensitivity, and delayed healing. Stress triggers the inflammatory skin conditions eczema, psoriasis, and acne rosacea. All become autoimmune-driven because increased inflammation increases interferon and interleukin cytokines that are part of the autoimmune process.

For example, studies reveal higher rates of other autoimmune conditions, such as celiac, multiple sclerosis, and rheumatoid arthritis, in women who suffer from acne rosacea. Many men with acne rosacea have rheumatoid arthritis. If injured, keratinocytes produce adrenalin to stimulate mast cells to release histamine, which is part of the inflammatory process and one of the steps in wound healing. In a balanced HPA axis, cortisol is secreted to limit histamine release. The red nose I get when I used to drink certain wines is a histamine response to tannic acid, which, in my case, is a stressor. If this response is chronic, this redness can turn into acne rosacea, the extreme of which can become Rhinophyma, which Jimmy Durante and my grandfather had. Jimmy Durante was supposedly a heavy drinker, but my grandfather was a teetotaler, so his stressor wasn't alcohol. It could have been coffee or tea or some other stressor in his life I never knew about. He spent the last ten years of his life in the hospital ward of an elderly care home with Alzheimer's. If the HPA axis has blunted cortisol release attempts to prevent the destruction caused by too much cortisol, histamines will continue to flood the skin. Unlimited histamine triggers vasodilation, increases vascular permeability, and eventually causes the bulbous nose seen in Rhinophyma.

Too much cortisol doesn't have to be caused by Cushing's disease. Cushing's disease is rare, and you can have hypersecretion of cortisol without having Cushing's disease. Hypersecretion of cortisol can create stretch marks where the skin regularly stretches but doesn't heal. It can be on the abdomen, buttocks, thighs, and calves in women and buttocks, knees, and lower back in men. With high cortisol, the skin doesn't turn over, reducing collagen production. It can also cause easy bruising, delayed wound healing, and thin skin. Not only will a person be hypersensitive emotionally, but they will also have thin skin, literally. The red cheeks and flushing you get with stress are called facial plethora, caused by increased blood flow to the skin. Insulin resistance in a high cortisol state will cause the inability to make muscle tissue and edema. The most common clinical sign of edema is the swelling at the back of the neck, also called the buffalo hump. Think of these symptoms as extremes. Stress can cause cheeks to flush. It can cause you to sweat. The HPA axis will work very hard to blunt these responses if they go on too long, which will eventually cause you to produce less cortisol in response to stress.

Eczema, psoriasis, and hives are all considered autoimmune skin conditions, and stress triggers them. Stress activates the immune system, and chronic stress sends it into overdrive. Endocrinology continuously claims adrenal fatigue doesn't exist, but research papers discuss how chronic stress causes HPA axis fatigue. The adrenals aren't tired, but the HPA axis is. People who suffer from these skin conditions have lower cortisol levels. They also have more depression, anxiety, and low DHEA sulfate because the adrenals secrete DHEA sulfate to lower cortisol. Doctors prescribe antidepressants and immunosuppressants to treat these skin conditions. When people with psoriasis are stressed, they secrete less cortisol but more adrenalin as part of the inflammatory response. Psychological stress can provoke keratinocytes to release cytokines and histamine. Eventually, there will be no cortisol to stop this release. Stress leads to erratic skin turnover, increased keratinocyte proliferation, and the epidermal hyperplasia common in these conditions.

Lipogenesis in the skin, crucial for healthy skin, is also reduced.

The first step in addressing skin issues is to remove substances that trigger a stress response. Dietary change is so powerful in these instances. We can't remove all stress from our lives, but we can change how we eat, what we put on our skin, and the clothes we wear.