Impact Of Stress And Anxiety On Fox-Fordyce Disease

Introduction

Fox-Fordyce disease is a skin disorder that causes itchy red bumps on the skin, particularly the neck, underarms and pubic area. People with Fox-Fordyce disease are at risk of flare-ups of the condition, through added stress and anxiety. However, through understanding how stress and anxiety can affect this disease, new methods can be created to manage the itchy symptoms of this disease. 

What is fox-fordyce disease?

Fox-fordyce disease, clinically known as apocrine miliaria, is a rare life-long condition, developing mostly in young women in their reproductive years. It occurs when the apocrine glands (a type of sweat gland) are blocked, causing a persistent itch (irritation) and little red bumps (inflammation) appearing on areas of the neck, underarms and pubic area. The specific cause of Fox-Fordyce disease is not known, however, this blockage of the sweat glands is likely due to the build of keratin in the follicle.¹

Understanding stress and anxiety

Stress, according to the World Health Organisation, is defined as “a state of worry or mental tension caused by a situation”; it is a natural human response and occurs in everyday life, with causes stemming from work, relationships, health concerns and so on. Stress is not a permanent emotion, meaning it disappears with time.² Anxiety is the persistence of fear or worry about life’s situations and can be a symptom of many anxiety-based disorders, like General Anxiety Disorder (GAD) and Post-Traumatic Stress Disorder (PTSD).³

Stress, anxiety and the body 

Stress and anxiety can manifest physical effects on the body, from tensing the muscles in the body (musculoskeletal system) into a contracted state to causing increased stress on the heart by increasing the heart rate of the body and activating a “fight or flight” response. This all occurs under a short window where stress is applied, an acute stress episode. Once this stress episode has passed, the body is able to return to its normal state. The endocrine system, the bodily system controlled by hormones, and the nervous system are also impacted by stress. High levels of cortisol, the stress hormone, over a long period of time can cause anxiety.⁴

However, the body being under long-term stress (chronic stress) can cause detrimental effects on the body, especially the skin. 

Stress, anxiety and the skin

The skin is the physical barrier of the body. It’s the body’s first line of defence to the external environment. However, the skin also reflects the workings of its internal environment and can reveal if something is not quite right within the body through being closely connected to the endocrine system and the nervous system. The release of neurohormones like cortisol, neuropeptides and neurotransmitters can directly impact the skin. The neurotransmitter, catecholamine, may directly impact glands, blood vessels and smooth muscles. Also, increased release of histamine and serotonin would increase inflammation and increase the sensitivity of the nerve cells under the skin, therefore decreasing the itch-sensitive threshold in the itch-specific receptors. For people with Fox-Fordyce disease, this inflammation would lead to a flare-up of the disease causing an overwhelming urge to itch their skin which can further irritate the skin and lead to more harm.⁵

Managing stress and fox-fordyce disease  

Managing Fox-Fordyce Disease: First line treatments and other management strategies 

Fox-Fordyce disease is a disease with no cure but can be usually managed with different first-line therapies, like topical and oral therapies. Topical therapies include applying a steroid cream, such as topical clindamycin, to improve the condition of the skin and relieve the itching. Oral treatment consists of swallowing medication like oral isotretinoin (a retinol), an oestrogen-based oral contraceptive or antihistamines to calm the irritation caused by the disease. There is no strict regimen of what medication should be used when, as the severity of the disease varies from person to person.⁵

Instead of opting for topical treatment which can cause skin thinning (steroids) if used for an extended period of time or causing drowsiness from antihistamines, surgical treatments may be opted for treating this condition. Surgery would relieve you of the symptoms by removing the affected area. This option might not be the most viable option for most people due to its success in case studies, due to the risk of scarring and the operation not being covered by the NHS, making it financially impossible for most people.⁵

Managing stress

Managing your stress levels can be a difficult task to do, especially when your stress is chronic and becomes anxiety. By managing this stress, we can lower our cortisol levels, therefore lowering the chances of a flare-up. There are many easy ways to decrease your stress levels from meditation to exercise, which can be done at home, at the gym, by yourself or even with friends. More structured stress management interventions like Mindfulness-Based Stress Reduction (MBSR) aim to provide users with the chance to learn a range of de-stressing techniques including breathing meditation and yoga-inspired exercises. These interventions are often adapted and tailored to suit the needs of patients being treated for chronic, debilitating diseases. Randomised trials have shown improvement in stress management and improved health outcomes within participants.⁶

For those with Fox-Fordyce disease, it is important to combine these approaches to tackle both sides of the condition: the physical itchy symptoms and the effects on the person’s mental well-being. 

Lastly, it is important to remember that this disease is not who you are nor does it define you. Please seek help if you are struggling with your mental health visit www.samaritans.org or call 116 123. 

Summary

• Fox-Fordyce disease is a condition that causes red itchy bumps to appear on the neck, underarms and pubic areas
• A build-up of stress and anxiety within people with this condition can cause painful flares-up 
• Despite having no cure, there are many methods of managing Fox-Fordyce ranging from topical creams to an operation
• Stress management practices, like Mindfulness-Based Stress Reduction, have been proven to reduce stress and improve health outcomes
• Combining these approaches will combat both sides of the condition
• Remember: this disease does not define you and if you are struggling, please talk to someone!