There’s something magical about a wedding. Vowing to love and cherish your partner for the rest of your life is in itself both solemn and joyous, and the heartfelt happiness of family and friends only magnifies the beauty of the moment.
Even the most laidback wedding can be stressful to plan, though. If you have eczema, you know that it loves to crop up during stressful periods. A simple Google search on “eczema wedding day” will yield a hefty crop of blog posts from people whose eczema decided to flare on their big day.
How does stress (or even just anticipation) trigger eczema? Can you prevent wedding-day eczema? What should you do if your eczema flares before your wedding (or worse, on your wedding day itself)?
Stress and eczema–a common pair
As our body’s largest organ, the skin is both our first alert system in times of danger and the immune system’s first defense against pathogens. It is not so surprising that it would be affected deleteriously by stress. About 73% of adults diagnosed with eczema report that stress triggers flares or exacerbates existing flares. Research has confirmed that there is a link between stress and atopic dermatitis flares.
The Chemistry of Stress
Deep within your brain, a small structure called the hypothalamus is working around the clock to ensure that your body adapts optimally to your changing surroundings. When we are stressed, it begins secreting higher concentrations of a hormone called corticotropin-releasing hormone (CRH).
CRH acts upon the pituitary gland, which in turn acts upon the adrenal glands to increase their production of some hormones you’re probably somewhat familiar with–cortisol and epinephrine (adrenaline).
Cortisol, the so-called stress hormone, is tasked with making the body’s energy stores more available. Epinephrine increases heart rate and respiration rate. Its precursor, norepinephrine, causes vasoconstriction, or narrowing of the blood vessels, so that blood pressure rises. These changes developed to help us spring into action when we are threatened.
Under normal conditions, these changes help us evade danger or beat it back–then, when the threat is over, cortisol binds with special receptors that tell the hypothalamus to stop producing CRH. The heart slows down. The blood vessels return to normal and blood pressure goes down. We return to baseline.
Under conditions of constant stress, though, the hypothalamus never gets a message to fall back. It continues to produce CRH, and the system remains flooded with cortisol. Cortisol stimulates mast cells in the skin, leading to inflammation.
Stress and your skin
Your skin responds to signals from neurotransmitters and sends signals of its own all the time. Specialized cells in the skin produce their own neurotransmitters and neuropeptides, among them serotonin and prolactin (both of which are related to mood), as well as corticotropin-releasing hormone and a peptide called substance P.
Substance P is the most abundant peptide in the nervous system. It enhances nociception, or the perception of pain, during stressful events; it also enhances the perception of itch.
Some researchers postulate that when we are stressed, higher levels of Substance P kick off an itch-scratch cycle in people who are prone to eczema. The increased sensitivity to itch leads to scratching. Scratching damages the inflamed skin, which in turn leads to more itching. This in itself is stressful, so the reaction is viciously reinforced. This could be part of the reason that stress worsens preexisting eczema flares.
Stress and immune system dysregulation
Those who are stressed often have higher blood levels of immunoglobulin e (IgE), an antibody responsible for defending the body against pathogens and irritants, and special disease-fighting white blood cells called eosinophils. Both IgE and eosinophils are associated with overactive innate immune system responses, and they are both involved in the development of atopic dermatitis.
It’s easy to see how wedding day stress can trigger eczema. What can you do about it, though?
Can you prevent wedding-day eczema flares?
Eczema is a complicated disorder, and there’s no fool-proof formula for preventing it. There are ways to lessen the probability of a flare. Avoiding or minimizing exposure to triggers–including stress–is the first and most important step you can take to dodge a flare.
Triggers to watch for
Discuss the issue with your wedding party, as well; consider asking close family, bridesmaids, and groomsmen to forego their pet fragrances at wedding-related functions.
If the thought of artificial flowers makes you wilt, take heart. Not all flowers are equally allergenic. A good florist will be knowledgeable about common flower allergies and can probably accommodate your needs. This is one part of your wedding planning that needs to be addressed as early as possible. Flowers grow according to season–and the best ones for you may not be readily available on short notice.
Some of the least allergenic flowers:
Some of the most allergenic flowers:
Be aware that your mileage may vary. Some of the least allergenic flowers may still aggravate your eczema! Early in your planning stage, ask your florist for some samples of the flowers you would like to use. Test your exposure, one specimen at a time.
Nail dryers for gel nails are another (often surprising) source of UV radiation. If you like the look of gel nails, speak to your manicurist about alternatives that do not require the UV-light dryers.
Give your skin lots of TLC
Most of us don’t get time off from work or family obligations to accommodate wedding planning. Some parts of our daily routine will inevitably be sacrificed in favor of accomplishing the new tasks required of us.
Sacrificing skincare exposes you to greater risk of a flare. Having eczema means that your skin barrier is already fragile; stress and exhaustion make it even more vulnerable. Give it a little extra attention, even if it means you have to let another task slide (the evening dishes or folding the laundry, for example).
Ways you can help your skin barrier ahead of your wedding day:
Use a dermatologist-approved moisturizer such as CeraVeⓇ, CetaphilⓇ, or HarlanMD’s Perfect Repair™ moisturizing cream. At the first sign of itch, add an ointment such as petroleum jelly (VaselineⓇ) or AquaphorⓇ Healing Ointment.
A hygrometer is an inexpensive tool that measures humidity. Check levels regularly. Use a dehumidifier if the humidity rises above 60. Use a humidifier if it dips below 50. Both dehumidifiers and humidifiers should be cleaned regularly according to manufacturer's instructions to avoid mold growth.
Ask your dermatologist about using a product like SmartLotionⓇ to control breakthrough symptoms and help with tapering off of steroids when it is time. Developed by a board-certified dermatologist with years of treating inflammatory skin disorders, SmartLotionⓇ uses a combination of 0.75% hydrocortisone and prebiotic sulfur to control inflammation without the risk of TSW or skin atrophy. Under a doctor’s guidance, most patients can safely use it alongside most prescription medications.
A qualified makeup artist can be an asset to brides (and grooms!) with eczema. Find one that is experienced with skin disorders and discuss your options early on.
Say “I Do” to love–not to stress
Bridal reality shows make it easy to believe that stress is just baked into the wedding-planning experience. We watch as planners, dress purveyors, and florists bustle frantically to provide brides the wedding they’ve always dreamed of–at the expense of everyone’s equanimity.
When all is said and done, though, you will be just as married whether you take on the stress or not. Perhaps there’s no way to completely remove stress from your planning process–but there are ways to alleviate it and minimize its effects.
Five tips for managing pre-wedding stress:
Some might regret giving up on their dream destination. Others might regret giving up the traditional family wedding. The correct choice is the one that you and your spouse can live with.
When you are getting overwhelmed, take a moment to slow your breathing. Pay attention to what you are feeling, acknowledging your emotions and the sensations of your body. Do not judge those feelings or try to change them. Turn your attention to the outside world. Make note of the things you hear, see, smell, and feel.
It’s important to acknowledge when you're disappointed and overwhelmed. It’s equally important to bring yourself to a place of acceptance and calm.
Some people do this by finding humor in the situation. Others find that taking a moment to acknowledge all the things that have gone right. Still others give themselves a quiet moment to deal with their frustration.
If Eczema Makes an Appearance
There’s no guarantee against eczema flares. If eczema decides to gate-crash your wedding, take a deep breath and remind yourself that imperfection is part of life. Remember that your partner is marrying you, not your skin. Embrace the joy of the occasion and make the best of it.
Before your wedding day, put together an eczema survival kit. This way you’ll be prepared to address any eruptions with grace and elan.
Your Wedding Day Eczema Survival Kit:
The best makeup for eczema flares is no makeup. If you choose to wear makeup, though, there are some guidelines to take heed of.
- Prep, prep, prep! Before you begin, lay cool compresses over the skin for several minutes. Cleanse as usual, then apply a serum containing humectants (such as hyaluronic acid); wait about two minutes and then apply moisturizer. Consider using a barrier cream such as petroleum jelly or AquaphorⓇ spray ointment over your usual moisturizer. Allow skin to fully absorb moisturizer before applying makeup.
- Use a primer. Primers give makeup staying power, and many of them are formulated to reduce uneven tone and improve radiance. Some primers act as serums, as well, giving your skin an added boost of moisture.
- Use a color-corrector. For most skin tones, green-tinted correctors tend to work best at reducing redness. If lesions have darker bluish or purple discoloration, peach, orange, and red correctors work better. Yellow combats the dullness of dry skin. Discuss this with a makeup artist ahead of time to find which tones work best for your skintone.
- Use creamy makeup. Powders draw attention to uneven texture and dryness. If you do use a powder, use a very fine, light product.
- Avoid matte foundations Matte makeup can reduce skin’s brightness. A dewy look draws attention away from dry, flaky skin.
- Use soft, clean sponges and fingertips to apply and blend your makeup. Avoid tugging and harshly rubbing skin, as this increases inflammation
- Remove makeup ASAP. Remove your makeup as soon as you can–but be gentle. Before cleansing, use a product meant to remove makeup. Use a soft cloth and light, circular motions to remove makeup. Follow this by cleansing. Apply hydrating serum, moisturizer, and an eczema cream such as SmartLotionⓇ. You may want to lay a cool, damp compress over your skin for a minute or two after using the eczema cream. Once the eczema cream has had time to be absorbed, apply a healing ointment.
Look Beyond Your Wedding Day
On the day of your wedding, you stand on the cusp of two different eras. Your days as a single person are drawing to a close; your days as half of a partnership are just about to begin. This is a moment ripe with love, optimism, and possibility.
Let your joy shine through, regardless of whether your eczema flares or not. If you do, that’s what you and your partner will remember ten years down the line–not your eczema.