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Is Your Skin Showing Stress?

A new emphasis on Zoom culture (coupled with ‘maskne,’ hand eczema and hair loss) have put local dermatologists on the front lines when it comes to healing our bodies.

Taylor Swope
Hair loss, face acne and hand eczema are three ways COVID-19 is affecting people's skin.

In the nine months since COVID-19 rocked our world, every errand and task outside of our homes has been divided between non-essential and essential. In many cases, that means routine doctor appointments have been canceled or delayed.

It has been a stressful year, to put it mildly. And, our bodies, including our skin, are feeling the effects. That’s why we asked several Central Ohio dermatologists to provide some tips on skincare as we weather what we hope will be the final stretch of the COVID-19 storm.

Dr. Angela Casey of the Center for Surgical Dermatology says some patients are still dealing with delayed skin cancer diagnoses as a result of offices being closed for two months and visits being delayed.

“We weren’t seeing patients in the office unless it was an obvious skin cancer that could be diagnosed via telehealth,” says Casey. There was also a delay in referrals because primary care offices were also closed early in the pandemic. By late summer, Casey, whose specialty is skin cancer surgery, had one of the longest surgical backlogs in her 12-year tenure.

Dr. Shari Hicks-Graham of Downtown Dermatology says that people staying at home more can account for more time focusing on themselves and their families. Everyone is also more aware of skin flaws due to the Zoom culture that has developed with people of all ages spending more time on video calls.

“All of these screens cause us to look at ourselves and each other all day long,” says Hicks-Graham. “We are more conscious of how others see us as well.”

Hicks-Graham is not only treating pandemic-related skincare concerns, but she is also seeing an increase in patients who want cosmetic treatments. Because the pace of life has slowed, people are noticing wrinkles and other facial flaws now more than ever before.

For those considering cosmetic procedures, having them done during the upcoming cold weather season may make sense. “Winter is a great time to do cosmetic procedures because we don’t see as many people, especially with the pandemic, so [visible] side effects won’t be noticed as much,” says Hicks-Graham. At-home, flexible work schedules are also producing an environment conducive for being treated with Botox and other fillers, or for CoolSculpting procedures that reduce fat.

Skin Stressors

Dr. Matthew Zirwas of Dermatologists of Central States says acne, psoriasis and eczema are three pre-existing conditions that have been exacerbated by the stress of the past 10 months. He explains that body chemistry changes under stress, causing higher cortisol levels.

Cortisol increases can be beneficial in the short-term for an energy boost and fueling the “fight or flight” response in a dangerous situation. However, long-term high levels of cortisol are unhealthy and can affect the skin’s outermost layer. Chronic, long-term stress (such as the pandemic or a divorce) or sub-acute stress (such as final exams) weaken the protective layer of skin over time resulting in more flare-ups.

Hair Loss

Zirwas says the hair loss condition known as telogen effluvium is a direct result of higher stress levels, and he has seen an increase during the last several months.

“Let’s say you have 10,000 hairs on your head,” says Zirwas. “On any given day, 9,000 are actively growing and 1,000 are in rest mode, which means they have stopped growing and will eventually fall out.” Typically, a hair will grow for three years, and then enter a rest period for three months. When it falls out, it will be replaced by new hair growth.

During stressful times, growing hairs enter the resting phase sooner than they should, so the natural cycle is interrupted. When this happens, people may start to notice their own hair loss after about 10 percent has fallen out. Some people may not even notice until they’ve lost 30 percent of their hair.

Zirwas says it is important to understand you will not go bald from this condition. There is an oral medication (which shares the same active ingredient as Rogaine) that has proven successful over time.

Additionally, Hicks-Graham says lab work can rule out anemia or thyroid issues that can cause hair loss. “Some underlying conditions can be exacerbated by stress, so it is important to know if anything else is going on,” she says.

Mask-Induced Acne

Dr. Susan Massick, a dermatologist affiliated with OSU’s Wexner Medical Center, says there are currently more acne breakouts due to wearing masks. “We want people to wear masks, and there are ways to address this issue,” she says.

When you wear a covering over your mouth and nose, the warm air creates more moisture and humidity, which increases oil production. There is always dirt buildup during a typical day and it is getting trapped in pores easier behind masks.

Massick has several recommendations to alleviate this “maskne.” First, always wear a clean mask. The mask’s material should be protective enough to prevent an exchange of fluids and particles. More abrasive fabric can be harder on skin.

Cloth masks should be washed in warm water with sensitive, fragrance-free detergents that are hypo-allergenic and noncomedogenic, meaning it doesn’t clog pores. Massick also advises not to use fabric softener when washing masks. “Any additional ingredient will cause irritation if you have something against your skin for a [long] period of time,” she says.

It is also important to remember which side of your mask was worn against your face. Reversing the mask and wearing the outer side on your face can add additional dirt since it has likely been contaminated. Doctors recommend washing your hands or using an alcohol-based sanitizer before removing your mask or putting on a mask to prevent germs transferring from your hands to your face.

Massick also adds that an easy intervention for acne is to avoid wearing makeup if you know you will be wearing a mask for an extended period of time. Not only does makeup stain the mask, it clogs pores faster. However, it is still recommended to use SPF 30 (or higher) sunscreen daily, even when wearing a mask.

Implement Routine

Casey says it is important to implement a regular skincare routine, if you don’t already have one. She recommends speaking to a skincare expert, whether that is a dermatologist, an esthetician, a physician’s assistant or a nurse practitioner who specialize in dermatology.

“Product selection is very individual,” she says. “There is not a blanket product recommendation for people with dry or oily skin.” If you have oily skin but do not add moisturizer, your skin will produce more oil to overcompensate for the lack of moisture. You can also strip too much of the skin’s natural oil by using astringents and toners but not moisturizing.

“There are a number of oils that help our skin barrier stay strong and help seal water in the skin, which is meant to be hydrated,” says Casey. “When we start removing or not supporting natural oils, this can lead to worsening skin conditions.”

An important message: Doctors do not recommend product selection based off a social media influencer’s experience because skincare should be tailored to each person’s needs.

Local medical experts recommend washing your face with a gentle cleanser that is hypo-allergenic and noncomedogenic at least twice a day. If you deal with acne or another skin condition, you can use medicated formulas that include salicylic acid or benzoyl peroxide. Micellar water is a good option, too.

Your skincare routine does not have to be complicated, local dermatologists explain. It can be tempting to spend a lot of money on multi-step routines but that is often not necessary. A good skincare regime can be as simple as cleansing and moisturizing.

For people with eczema or rosacea, this period of time may increase symptoms due to wearing a mask, as well as the stress involved. “This is a new experience in the world of dermatology in terms of seeing more directly the role that stress plays in skin diseases and how that manifests clinically,” says Casey.

For those with eczema, it is important to use a gentle cleanser and a moisturizer because hydrated skin is much less prone to irritation and inflammation. Casey recommends looking for products that include ceramide as an active ingredient. Hydrocortisone cream may be helpful with more stubborn spots.

Treating rosacea is similar to treating acne. Over-the-counter treatments such as adapalene gel or retinoid cream are recommended. Discuss any chronic skincare concerns with your dermatologist, especially in cases when a prescription treatment might be needed.

Hand Care

Zirwas said by early October, he was treating a third of his patients for dryness, redness and inflammation of their hands. That’s because everyone has been washing their hands and using alcohol-based sanitizers much more than during prepandemic times.

He recommends using a mild soap in cold water for hand washing to help prevent eczema from developing and worsening. Zirwas explains that the natural oil in our skin has the same consistency as butter. If you wash butter from a plate with cold water, it will only smear it around versus melting it with hot water. You want to keep as much natural oil on your hands as possible.

Hicks-Graham adds that the U.S. Centers for Disease Control does not necessarily recommend anti-bacterial soap for daily handwashing. In fact, you can even use a gentle facial cleanser on your hands as long as you wash for at least 20 seconds. She also recommends adding moisture back onto the hands while they are still damp. La Roche-Posay Baume is a good option, she says. And, it is helpful to add moisturizer at night before going to bed.

Zirwas says it is safe to use an alcohol-based sanitizer instead of washing hands with soap all the time. (Use alcohol products only if hands are not dry and red, or else this will be painful). Alcohol does not remove naturally protective oils from the skin, as soap and water do. He recommends Cavalon Durable Barrier Cream for moisturizing after handwashing or sanitizing because it creates a barrier that protects skin from soap and water for the next three washes.

Hicks-Graham says hand eczema can become severe and possibly even infected. So if you have symptoms of red and cracked skin, do not wait to see a doctor.

Meanwhile, local dermatologists encourage everyone to manage stress as effectively as possible. They agree that practicing meditation and yoga, or even undergoing therapy, may also help with skin afflictions during these extraordinary times.

“Normal treatments for these conditions work, but sometimes it just takes more aggressive treatment for things to improve under stress,” says Zirwas.