In the United States alone, one in eight individuals say they frequently or sometimes experience stress in their daily lives.¹ Aestheticians can be extremely beneficial in helping reduce the psychological and physiological detriments of stress in the spa setting by creating a fast, efficient way to address both skin care and stress concerns. This article will examine the physiological effects of stress on the body and the skin and highlight ways to help counteract these effects on the surface of the skin.

SO, WHAT IS STRESS?
Stress is defined as a physical, chemical, or emotional factor that causes bodily or mental tension. Stress can be caused by psychological, environmental, and social factors that trigger a cascade of responses within the body. According to Ying Chen and John Lyga, “Psychological stress arises when people are under mental, physical, or emotional pressure. It arises when the individual perceives that the pressure exceeds his adaptive power. It is perceived by the brain and stress hormones. This triggers a wide range of physiological and behavioral changes and responses that try to adapt the body to the stress. However, if the stress responses are inadequate or excess, they may trigger adverse physiological events.”² Stress has been implicated as the trigger or aggravator of many serious physiological conditions such as heart disease, migraines, multiple sclerosis, and neurological deterioration.

According to the Mayo Clinic, when an individual encounters a perceived threat, the hypothalamus, a region at the base of the brain, sets off an alarm system in the body.³ Through a combination of nerve and hormonal signals, this system prompts the adrenal glands to release hormones, including adrenaline and cortisol. Adrenaline increases heart rate, elevates blood pressure, and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances the brain’s use of glucose, and increases the availability of substances that repair tissues. Also, to the body’s (and skin’s) detriment, cortisol curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system, and growth processes.

Skin has many important functions, including acting as a protective barrier and supporting and upholding immune functions. As part of the respiratory system, the skin absorbs and releases important compounds. It also maintains balance between the external environment and the internal organs, as well as registers external stimuli such as pain, heat, cold, and pressure.

The skin registers external stress and is targeted by internal and external stress responses. Stress can initiate the fight-or-flight response, a complex reaction of neurologic and endocrinologic systems. This, in turn, can exacerbate existing skin conditions or instigate them. These include a wide array of symptoms, from excess oiliness to extreme dryness, and can lead to many skin concerns.

SKIN UNDER STRESS
Here is a look at some major skin concerns associated with stress and their causes.

Acne
Studies have found that increased acne severity was significantly associated with increased stress levels.⁴ Stress triggers cortisol, which, in turn, can stimulate oil production, trigger inflammatory acne, and worsen the condition of existing acne. Why? Stimulated nerves can promote proliferation and differentiation of sebaceous glands.⁵ It also stimulates inflammatory responses in the skin.

Increased Dryness and Reduced Healing Ability
A recent study found that high levels of stress effects the skin’s natural moisture barrier.⁶ This study found that there was a relationship between psychological stress and the epidermal permeability barrier function. The study measured the transepidermal water loss in the skin and found that the epidermal permeability barrier function level showed significant deterioration during higher stress periods.

This same study indicated that increases in transepidermal water loss, which led to compromised barrier function, also led to decrease in wound healing. It also implied a relationship between psychological stress and the exacerbation or protracted healing of skin disease, which could deplete the skin’s natural moisture reserves.

Psoriasis
This is a chronic skin inflammatory disease affecting about 2% of populations worldwide. It is characterized by over-proliferation of keratinocytes and inflammation. Plaques are most seen over the elbows, knees, and scalp. Research suggests that daily stressors affect cortisol levels at moments of high stress and influence disease outcome in clients with psoriasis.⁷

Eczema and Atopic Dermatitis
Eczema is a form of atopic dermatitis often accompanied with various other skin conditions such as dry skin. It is characterized by itchy, inflamed skin that typically affects the inside of elbows, backs of the knees, and the face – it may even cover the entire body. Atopic dermatitis tends to flare up when the person is exposed to trigger factors including irritants, allergens, low or high humidity, heat, sweating, and emotional stress. Exposure to a trigger factor produces skin inflammation which, in turn, can trigger itching and redness. As research notes, increased and sustained psychological stress is very common in patients with atopic dermatitis.⁸ Stress is a well-known trigger for atopic dermatitis and can contribute adversely to exacerbation, as well as decrease the important barrier function of the skin by increasing systemic levels of glucocorticoids, which inhibits the synthesis of ceramides, cholesterol, and free fatty acids.

Early Onset of the Appearance of Skin Aging
Another negative effect of the release of cortisol is the destruction of collagen – the breaking down of the connective tissue that keeps an individual’s complexion taut and firm.⁹

One of the most studied areas related to stress and aging is with telomeres, the repetitive nucleotide sequences located at the ends of chromosomes. Sometimes referred to as protective caps, telomeres are said to help delay the chromosome from shortening. This shortening naturally occurs as the body ages. Damage to the telomeres shortens the chromosomes, which, in turn, accelerates signs of aging. New studies have concluded that psychological stress – both perceived stress and chronicity of stress – is significantly associated with higher oxidative stress, lower telomerase activity, and shorter telomere length.”¹⁰

MANAGING SIGNS OF STRESS
Stress management strategies include eating a healthy diet, getting regular exercise and plenty of sleep, practicing relaxation techniques, such as yoga and meditation, taking time for hobbies, fostering relationships by volunteering in the community, and seeking professional help when needed.

In skin care, strategies include incorporating soothing and calming ingredients that contain natural fragrances into skin care products and incorporating ingredients that help to restore the essential protective lipid barrier of the skin. These are key in helping to reduce the appearance of stress on the skin’s surface. This is augmented by a protocol that helps create a relaxing environment in a professional skin care spa by incorporating massage into facial and body treatments.

Incorporating the following ingredients into skin care programs for stressed skin can help counteract the visible signs associated with stressed skin conditions.

Aloe Barbadensis Leaf Juice (Aloe Vera): This extract contains over 200 substances, including 20 minerals, 20 amino acids, 12 vitamins, and active enzymes.

Camellia Japonica: Camellia japonica, also known as rose of winter, is a flowering tree or shrub naturally occurring in China, Japan, and Korea. Extract of camellia japonica flowers contains antioxidant phenolic compounds such as quercetin.

Chamomilla Recutita (Matricaria) Flower Extract: This extract, made from the daisy-like white and yellow heads of the chamomile flowers, is known to be soothing and calming.

Hyaluronic Acid: This polysaccharide ingredient is prevalently found in the skin. For skin care, it can be derived from wheat, corn seed, and yeast. Hyaluronic acid is the key component of the extracellular matrix, which is the space filler or supporting scaffold of cells. It allows skin cells to retain moisture and provides volume. One gram of hyaluronic acid is able to retain 1,000 grams of water, so it is one of the most hydrophilic molecules found in the natural world.

Micro Silver: Micro silver is a revolutionary new ingredient made from pure, micronized silver. This releases pure, soluble silver ions at the surface, forming an invisible layer on the skin.

Mirabilis Jalapa: Also known as the Marvel of Peru, mirabilis jalapa is an extract useful to help lessen the appearance of dry skin.

Niacinamide (Vitamin B3): One of the most studied skin care ingredients is niacinamide or vitamin B3. As an essential component of living cells, vitamin B3 is essential for protein, carbohydrates, and fat metabolism. It is considered a precursor in the synthesis of coenzymes involved in cell metabolism and, as such, plays a key role in the production of energy.¹² When applied topically, it helps to reduce the appearance of fine lines and wrinkles, hyperpigmented spots, red blotchiness, and skin sallowness. In addition, elasticity can be improved, as well the skin’s barrier function.^13,14,15

Quercetin: This is a bioflavonoid found in apples, berries, parsley, onions, grapefruit, and wine.

Rutin: Rutin is a bioflavonoid found in high concentrations in citrus fruit, buckwheat, asparagus, and rhubarb.

Seaweed: Seaweed is the most beneficial ingredient for stressed and sensitized skin. Seaweed extract is chemically similar to seawater, which is biologically similar in chemical composition to an individual’s intercellular fluid. Laminaria digitata seaweed extract, for example, contains 12 vitamins, 42 minerals and trace elements, and 18 amino acids to help skin look hydrated, restored, renewed, and radiant. It is one of the richest sources of natural antioxidants, such as phlorotannins, sulfated polysaccharides, fucosterol, and fucoxanthins.¹¹ Seaweed also contains essential fatty acids that help maintain the skin’s barrier and polysaccharides, such as alginic acid, which help to lock moisture into the skin.

A CALMING COMBINATION
Incorporating a soothing facial massage into an express facial is another way to complement a skin protocol for stressed skin. This type of facial protocol can incorporate skin care ingredients that help visibly reduce the signs of stress, as well as massage techniques intended to help relax the client to reduce anxiety. Such a protocol can typically be performed in as little as 30 minutes in an express facial bar setting to further reduce anxiety and stress without taking too much time from the busy client’s day.

This protocol can help to reduce the appearance of redness. A soft, soothing sheet mask that combines seaweed extracts with hyaluronic acid can be used and incorporating a silver ball massager for sensitive skin is also an option to help provide gentle, consistent pressure throughout the treatment. With this type of treatment, skin often appears more hydrated and smoother-looking.

Be sure to always recommend positive lifestyle changes, as well as a cleanser, serum, sheet mask, day cream, and night cream for homecare to help reduce the appearance of signs of stressed skin between treatments.

References
1 Saad, Lydia. “Eight in 10 Americans Afflicted by Stress.” Gallup. Dec 2017. https://news.gallup.com/poll/224336/eight-americans-afflicted-stress.aspx.
2 Chen, Ying and John Lyga. “Brain-Skin Connection: Stress, Inflammation and Skin Aging.” Inflammation Allergy Drug Targets 13, no. 3 (2014): 177-190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082169.
3 “Chronic stress puts your health at risk.” Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037.
4 Chiu A, Y.S. Chon, and A.B. Kimball. “The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress.” Archives of Dermatology 139, no. 7 (2003): 897-900. https://www.ncbi.nlm.nih.gov/pubmed/12873885.
5 Oyetakin-White P, B. Koo, M. Matsui, D. Yarosh, C. Fthenakis, K. Cooper, and E. Baron. “Effects of Sleep Quality on Skin Aging and Function.” Journal of Investigative Dermatology (2013): S126–S126.
6 Fukuda, S., S. Baba, and T. Akasaka. “Psychological stress has the potential to cause a decline in the epidermal permeability barrier function of the horny layer.” International Journal of Cosmetic Science 37, no. 1 (2015): 63-9. https://www.ncbi.nlm.nih.gov/pubmed/25298045.
7 Evers, A.W., E.W. Verhoeven, F.W. Kraaimaat, E.M. de Jong, S.J. de Brouwer, J. Schalkwijk, F.C. Sweep, and P.C. van de Kerkhof. “How stress gets under the skin: cortisol and stress reactivity in psoriasis.” The British Journal of Dermatology 163, no. 5 (2010): 986-91 Https://www.ncbi.nlm.nih.gov/pubmed/20716227.
8 Levin, Jacquelyn, Sheila Fallon Friedlander, and James Q. Del Rosso. “Atopic Dermatitis and the Stratum Corneum: Part 2: Other Structural and Functional Characteristics of the Stratum Corneum Barrier in Atopic Skin.” Journal of Clinical and Aesthetic Dermatology 6, no. 11 (2013): 49-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848653.
9 Ibid, ref. 2.
10 Epel, Elissa S., Elizabeth H. Blackburn, Jue Lin, Firdaus S. Dhabhar, Nancy E. Adler, Jason D. Morrow, and Richard M. Cawthon. “Accelerated telomere shortening in response to life stress.” Proceedings of the National Academy of Sciences of the USA 101, no. 49 (2004): 17312-17315. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC534658.
11 Kim, Se-Kwan. “Marine Cosmeceuticals.” Journal of Cosmetic Dermatology 13, no. 1 (2014).
12 Levin, Jacquelyn and Saira B. Momin. “How Much DO We Really Know About Our Favorite Cosmeceutical Ingredients?” The Journal of Clinical and Aesthetic Dermatology 3, no. 2 (2010): 22-41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921764.
13 Bissett, D.L., K. Miyamoto, P. Sun, J. Li, and C.A. Berge. “Topical nicotinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin.” International Journal of Cosmetic Science 26, no. 5 (2004): 231-8.
https://www.ncbi.nlm.nih.gov/pubmed/18492135.
14 Bissett, D.L., J.E. Oblong, and C.A. Berge. “Niacinamide: a B vitamin that improves aging facial skin appearance.” Dermatologic Surgery 31, no. 7 pt. 2 (2005): 860-5. https://www.ncbi.nlm.nih.gov/pubmed/16029679.
15 Tanno O, Ota Y, Kitamura N, Katsube T, Inoue S. “Nicotinamide increases biosynthesis of ceramides as well as other stratum corneum lipids to improve the epidermal permeability barrier.” The British Journal of Dermatology 143, no. 3 (2000): 524–31. https://www.ncbi.nlm.nih.gov/pubmed/10971324.

Lydia Sarfati is a master aesthetician and the founder and CEO of Repêchage. Sarfati is an international industry leader and the developer of the world-renowned Repêchage Four-Layer Facial. Sarfati oversees a 50,000-square-foot, ISO 9001:2015-certified manufacturing, research, development, and training facility in Secaucus, New Jersey. She appears nationally and internationally at aesthetic tradeshows and attends and conducts overseas conferences in Asia, Europe, the Middle East, Central America, and South Africa. She has produced 17 step-by-step instructional videos and published “The Repêchage Book of Skincare Science & Protocols” and “Success at Your Fingertips: How to Succeed in the Skin Care Business.” For more information, go to repechage.com, pro.repechage.com, or learningwithlydia.com.