Yoga and Dermatology
Yoga and Mindfulness in Eczema
The potential correlation between yoga and chronic skin conditions are of a growing topic and attention in the media as well as the doctors’ offices today. With the rising trend of yoga, which encompasses physical postures, breathing, and meditation or mindfulness, it is no question that people will ask their doctor about this topic. In this chapter, eczema and its potential benefits from yoga will be discussed.
Eczema, also known as Atopic Dermatitis, is a common itchy rash characterized by scaly patches of dry and irritated skin. It is recognized as a multifactorial skin condition caused by genetics and can be worsened by environmental factors.1 The occurrence of eczema is rising and reported to affect approximately 15–20% of children and 1–3% of adults.3,4 Many studies have reported the role of stress in causing and worsening chronic skin rashes.1 There is an abundance of evidence to support that eczema is worsened by stress.5-8 In fact, it has been described that even stress in the prenatal environment can influence fetal skin barrier development and function.9 More recently, it has been shown that even minor everyday stressors can affect and predict symptom severity.10 Stress and eczema are thought to be related in a bidirectional fashion, perpetuating an itch-scratch-stress cycle.
Without a doubt, yoga has become a popular way for the mind and body to reach well-being with roughly 30 million people practicing worldwide.11 Yoga encompasses the combination of physical postures, controlled breathing and meditation or mindfulness. With approximately 14 million Americans reporting that a physician or therapist has recommended it to them, it has certainly gained popularity as a therapeutic practice.12,13 In fact, it has been suggested that people who practice yoga, even for a brief time, may benefit from decreased anxiety, stress, and discomfort resulting in a better quality of life.14,15
Studies have shown that different yoga styles do not differ in their ability to reach positive benefits.16 The choice of an individual yoga style can be based on personal preferences and availability. However, it is worth mentioning whether “hot yoga” has been reported to benefit or exacerbate eczema. Heat and mechanical stimulation on the skin surface can influence itch-intensity.17,18 On the contrary, sweat contains components that act as natural moisture-retaining factors as well as antibacterial factors to protect against infection. The increase in moisture and possibility of decreased infection may help eczema. However, the opposing view highlights that various salts, glucose, and other minerals contained in sweat may leak into the damaged skin barrier resulting in irritation and increased itching.19,20 In all, because there are several factors involved and practice is very individualized, one should use comfort level and experience to determine if a practice is improving or worsening their skin conditions.
Skin Conditions and Stress
It is well known that there is an interaction between the mind, skin, and body. Specifically, it has been described that the connection between our mood, immune system, and the way our skin handles stress can manifest as skin conditions.21-24 Aside from stress being a well-known trigger of many skin conditions, eczema may also lead to abnormal skin-barrier function, such as wound healing or our skin’s ability to fight off bacteria.25,26 Although stress is not thought to directly cause eczema, it does precipitate flares and worsen it for those that have eczema.27 Likewise, eczema is frequently accompanied with several psychiatric disorders, such as depression and anxiety, with estimates at 30% to 60% afflicted.28 Therefore, it is important to consider a multifaceted approach when faced with chronic skin conditions.
How Yoga Can Help
Various studies suggest that people who participate in more mindful and relaxed yoga programs may see improvements in anxiety, somatic stress, and uneasiness consequently affecting health-related quality of life. Not only has yoga been shown to help certain skin conditions, but a recent study reported that 90-minute sessions of mindfulness meditation and gentle Hatha yoga over a 2-month period led to recognizable benefits on a cellular level in cancer survivors.29
Specifically, psychosocial interventions providing stress reduction and emotional support resulted in telomerase maintenance in distressed breast cancer survivors compared to emotional expression guidance and group support. This effect demonstrates potential biomarkers of psychosocial stress. Given the increasing literature on the association between telomerase and cancer initiation, survival, and death, this finding may support the potential for stress-reducing interventions impacting diseases.30 Other chronic conditions have also been described to benefit from yoga as a supplement to current medical treatments.31,32 A large analysis presented a review of several trials on yoga.31 While there were 26 medical conditions described in the review; breast cancer, asthma, and depression were the most studied conditions. Although many reports have described the positive effects of yoga, research in this area remains limited for most conditions, especially skin-related.
It is important to mention that people with certain dermatologic conditions are also at risk for other medical problems; for example, psoriasis, another chronic skin disease is associated with metabolic diseases such as obesity, diabetes, and liver disease. This highlights the importance in considering different approaches for a healthy mind and body as a supplement to medical care.
Interestingly, many studies have assessed positive effects of meditation on sleep. This association could potentially be an area of interest for those with eczema suffering from decreased sleep due to itching and stress.33
In summary, many skin problems, especially eczema, can cause stress and vice versa, creating a challenging cycle to overcome. Therefore, using additional tools like yoga may be beneficial. With accurate diagnosis by a dermatologist and appropriate medical treatments, yoga can help improve dermatologic problems and quality of life.
- Leibovici V, Canetti L, Yahalomi S, Cooper-Kazaz R, Bonne O, Ingber A, Bachar E.Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study. J Eur Acad Dermatol Venereol. 2010 Aug;24(8):897-903.
- Larsen FS, Hanifin JM. Epidemiology of atopic dermatitis. Immunol Allergy Clin North Am 2002; 22: 1–24.
- Schmitt J, Bauer A, Meurer M. Atopic eczema in adulthood. Hautarzt 2008; 59: 841–850.
- Brown DG. Stress as a precipitant factor of eczema. J Psychosom Res. 1972; 16: 321–327.
- Lammintausta K, Kalimo K, Raitala R et al. Prognosis of atopic dermatitis. A prospective study in early adulthood. Int J Dermatol 1991; 30: 563–568.
- Gil KM, Keef FJ, Sampson HA, et al. The relation of stress and family environment to atopic dermatitis symptoms in children. J Psychosom Res 1987;31: 673 – 84.
- Linnet J, Jemec GBE. Anxiety, aggression, and body ideal in adult atopic dermatitis patients. Dermatology Psychosomatics 2001;2:124 – 9.
- Ginsburg IH, Prystowsky JH, Kornfeld DS, et al. The role of emotional factors in adults with atopic der- matitis. Int J Dermatol 1993;32:656 – 60.
- Vaughn AR, Tannhauser P, Sivamani RK, Shi VY.Mother Nature in Eczema: Maternal Factors Influencing Atopic Dermatitis. Pediatr Dermatol. 2017 May;34(3):240-246
- King RM, Wilson GV. Use of a diary technique to investigate psychosomatic relations in atopic dermatitis. J Psychosom Res 1991; 35: 697–706.
- Yoga wars. BBC News Magazine Web site. http://news.bbc.co.uk/1/hi/7844691.stm. Accessed 10 Aug 2017.
- “Yoga in America” Market Study. Yoga Journal Web site. https://www.yogajournal.com/page/yogainamericastudy. Accessed 10 Aug 2017.
- De Michaelis E. A History of Modern Yoga: Patanjali and Western Esotericism. London, UK: Continuum International Publishing Group; 2005.
- Telles S, Singh N, Yadav A, Balkrishna A. Effect of yoga on different aspects of mental health. Indian J Physiol Pharmacol. 2012;56(3):245-254.
- Rodriguez-Vallecillo E, Woodbury-Fariña MA. Dermatological manifestations of stress in normal and psychiatric populations. Psychiatr Clin North Am. 2014;37(4):625-651.
- Murota H, Katayama I. Evolving understanding on the aetiology of thermally provoked itch. Eur J Pain 2016;20:47e50.
- Wahlgren CF. Itch and atopic dermatitis: clinical and experimental studies. Acta Derm Venereol Suppl (Stockh) 1991;165:1e53.
- Murota H, Yamaga K, Ono E, Murayama N, Yokozeki H, Katayama I. Why does sweat lead to the development of itch in atopic dermatitis?. Exp Dermatol. 2019;28(12):1416-1421. doi:10.1111/exd.13981
- Murota H, Yamaga K, Ono E, Katayama I. Sweat in the pathogenesis of atopic dermatitis. Allergol Int. 2018;67(4):455-459. doi:10.1016/j.alit.2018.06.003
- Stander S, Raap U, Weisshaar E et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges. 2011;9:456–463.
- Arck PC, Slominski A, Theoharides TC, Peters EM, Paus R. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697-704.
- Recognizing the mind-skin connection. Harvard Health Publications Web site. http://www.health.harvard.edu/newsletter_article/Recognizing_the_mind-skin_connection. Accessed 10 Aug 2017.
- Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008; 21:22–31.
- Garg A, Chren MM, Sands LP, Matsui MS, Marenus KD, Feingold KR, Elias PM. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders. Arch Dermatol. 2001;137:53–59.
- Elias PM, Sun R, Eder AR, Wakefield JS, Man M-Q. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27–36.
- Picardi A, Abeni D. Stressful life events and skin diseases: disentangling evidence from myth. Psychother Psychosom. 2001 May-Jun; 70(3):118-36.
- Korabel H, Dudek D, Jaworek A, Wojas-Pelc A Psychodermatology: psychological and psychiatrical aspects of dermatology. Przegl Lek. 2008; 65(5):244-8.
- Carlson LE, Beattie TL, Giese-Davis J, et al. Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. 2015;121:476-484.
- Willeit P, Willeit J, Mayr A, et al. Telomere length and risk of incident cancer and cancer mortality. JAMA. 2010;304:69-75.
- Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328.
- Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med. 1998;60:625-632.
- Evid Based Complement Alternat Med. 2015;2015:902708. doi: 10.1155/2015/902708. Epub 2015 Jun 16. The Effects of Mind-Body Interventions on Sleep Quality: A Systematic Review. Neuendorf R1, Wahbeh H2, Chamine I3, Yu J3, Hutchison K3, Oken BS3.