I had fun tonight. See you again Wednesday?

That sounds great.

I'll be there Wednesday, too. Who is that? Girl, I'm your plexoriasis.

No, I have a date.

You know what? By Wednesday, I'll be down there. Okay. I'm nervous enough already. I'm calling my doctor. Tired of plexoriasis third wheeling? Learn about treating beneath the skin with something different at beneaththeskin. Com. I don't think that there are many people in the world who can claim that life isn't at least a little stressful sometimes. And that stress manifestsates itself in unexpected ways, like on our skin. But when it comes to alleviating our struggles, the relief of feeling seen and acknowledged is immense.

He literally looks at me and goes, You're a poor, poor guy. He's like, I am so sorry that you have to go through this. And I literally almost cried. I mean, he just really felt and could see the pain pain and discomfort that I was going through.

Hi, guys, and welcome. I'm so glad you're here. I'm Nicole Berry, and this is Skinquarees, a show all about our skin and its health. As we grow in age, our skin is really a record of a life well-lived because there isn't one body part that I could think of that reflects our well-being as clearly as our skin. So let's go on this journey together. To really understand what's going on with our skin, let's unravel the mysteries happening listening inside and out. Today, we're going to talk about stress and its effect on our skin. I know for me, when things get to be too much, whether it's a stressful day at work or there's a lot going on at home, I can see it on my body. I can wake up feeling inflamed, I break out, and my skin can seem dull and lifeless. And then you know how it goes. Seeing a physical response to stress just causes more stress, and it ends up feeling like a vicious cycle. This episode is going to be very personal because I will be bringing in my husband, nick Moskowitch, to share his journey with plaxeriasis. If you don't know what that is, it's a chronic disease that can affect the skin.

Your immune system becomes overactive, which causes skin cells to multiply quickly, and that can show up all over your body. There can be patches of skin that become scaly and inflamed, and it's often seen on the scalp, elbows, and knees. Stress is such a big when it comes to psoriasis, so much so that the National Psyriasis Foundation recommends managing stress must be part of your treatment plan. We'll also be talking to Nick's dermatologist who's going to explain why stress manifestsates physically on our skin and how to manage it. So let's get into it. So we are back here with the one and only nick, my husband.

A lot of pressure here.

nick and I have been married for almost 10 years. Next year will be our 10th anniversary. It's a long time. Yes. And we have two little ones. And I remember when right after we had Jude, we were living in New Jersey with my mom, and things were just really stressful. And you started to notice something happening with your hands, right? They got really dry and cracked, and we were figuring out what is this, which eventually we came to discover that it was psoriasis, but that took a long time for us to figure out. So Do you remember when you first started noticing something going on with your hands?

Yeah. So by the way, you look beautiful. Oh, thanks. Very nice. Nice to see you from this side. All the light. Yeah. We were in New Jersey living with the in-laws, and I was helping out actually with relocating some items for your mom from the storage and then working on the house here. And it was a really stressful time because we were dealing with so many different factors of the house not being done, our son being born.

Jude was six months old. Yeah.

So all of that started to snowball on me, and I could just tell that it was more and more stressful. And I thought it was just me using my hands a little bit too much. And I was like, Oh, I'll just put some lotion on it. It's just a guy thing. Maybe the soap I'm using is not good or something. My hands are just can't keep up with my mind and everything else that's going in my life. And yeah, they started to get chapped, a little worn in, almost like a callus is a situation. And then the more work I was doing, the more it would just spread and continue to evolve and never really healing fully.

I do remember you were complaining about your calloused hands, and I noticed that's what I thought it was. It looked like calloused dry hands. Were they itchy? Was it painful?

So it started with just annoying. Honestly, it wasn't even that discomforting. I was like, Oh, maybe they'll get better. I'll just keep putting lotion on. I found a couple of brands that seem to help, but in the end, they were doing anything. They were just moisturizing it for that moment, but not continually doing anything for that condition. That's when I realized it was something more serious because it went from my thumb to my pointing finger to the finger to the left of it. And then it started to go on the other hand, and it just kept going and going. There was just no relief of any kind. And that's when I started to get start to panic.

What is this? You felt in panic?

Yeah. It was really stressful because I was like, I've never I would literally squeeze my hands, just like make a fist, and I could feel those calluses breaking, and it would just become really difficult to grip anything, to lift the kids up, to walk. And then after that, as it continued to get worse and flare up more and more, as it went to my feet on my heel. It almost felt like somebody just stabbing my heel all the time. It was really, really painful. So uncomfortable. That's awful. It would peel. It would just... It was a little I thought, absolute worst.

I think when someone is going through something, even if you live with them, even if you are incredibly close, you don't truly understand the struggle that they're going through until it starts to affect your relationship with them. And that's what happened with me and nick.

I'm out and I see a lot of people and I meet people. It became pretty uncomfortable for me. Just if somebody wanted to shake my hand or if I wanted to greet somebody, it just didn't feel right. It's self-consciousness. Self-conscious about the whole situation. And insecurity. That's when I was like, I need to really take care of this and address what's going on here.

Honestly, neither of us really knew what exactly was going on, but we knew something had to change.

I don't have the most fantastic diet like you do. You're very good at it.

We're working on it.

We're working on it. Yeah, I'm your lifelong project. But I was drinking these juices, and I thought I found something. It had a cleaner sugar in it, but my body was not reacting well to it. I remember I went on a two, three week, absolutely no sugar thing during that time as well. Might have helped. It might have been too late at that point, too, but it didn't hurt. I'll say that.

So when you finally decided that you You've had enough with home treatments and trying to use lotions and potions, what was your journey in finding the right doctor? Did you find it right away?

I spoke to a few specialists, quote, unquote. Like you say, I could take on just about anything, and then I can work through most things. And in my time talking to those doctors, I'll be like, Oh, it's just annoying. It's this and that. But it's really inside. I'm just screaming about, Man, this is driving me crazy.

After a long time of searching and coming up with a lot of dead ends, a friend recommended we go to Dr. Mitchell Klein, a dermatologist based in New York. You'll be hearing from him later. But when nick walked into his office...

He literally looks at me and he goes, You're a poor, poor guy. He's like, I am so I'm so sorry that you have to go through this. And I literally almost cried. I mean, he just really felt and could see the pain and discomfort that I was going through. And I've never had anybody react that way in terms of... Not only did he care, but he understood. We talked, and we talked actually at length. And he said, I have other clients who have this condition. There's different things we can do. And he knew right away that it was psoriasis, what version of psoriasis it was. And he said that you're obviously in in a very stressful situation. He's like, This does not typically happen with just a healthy 30-year-old. So I told him, I have a stressful job. I have two kids. We have run a business together. There was a lot of things going on at the same time. And he said, Listen, you got to find time for yourself to let go of someone of those things. Take some deep breaths and go for a walk. And whatever time you can find, you have to let go of some of the things that you're doing that you're carrying, and that will help with your medical issue.

Dr. Klein prescribed a treatment for Nick's plexoriasis.

And within 48 hours, it was magic. He said it was going to be like magic, and it was just that.

What was the feeling that you had when he said, I know what this is, and I know how we're going to fix it?

Disbelief. I could not believe him. Just because of dealing with the condition for two years plus minus, you just think that this is it. I'm going to live with this for the rest of my life. And that was really scary to me because I was really uncomfortable and really not happy with what I was faced with. And the more he talked, the more I was like, I'm on board. Let's try. I'm willing to try anything at this point. And when he told me about some of the options and how he's treated patients before, the more I began to feel a relief and comfort in everything that he was saying. And that was honestly the first time I had somebody who was like, I got the answer for it. We just got to figure out how do we get you to continue to improve once I set you on this path of treatment.

It's interesting. I've always perceived nick as our rock. He is the foundation when it comes to our family, our friends, and also at work. So seeing how much he was suffering physically and mentally was extremely painful for us to see. At the time, I really was not realizing how much stress was playing a huge factor in Nick's flare-ups. And once I found out that stress can be a major trigger for psoriasis, I actually felt a lot of guilt. I started to think of all the ways that I personally was adding to the stresses of his life and felt a little shameful and hopeless. Obviously, the feeling of shame and guilt around Nick's diagnosis were irrational. Of course, it wasn't my fault. And thankfully, we found Dr. Klein, who was a life savor for nick and myself, not only because we could get to the root of the physical problem, but the compassion and the understanding he met us with was such a relief and also very essential. After Dr. Klein helped nick reset his system, they worked together to develop better ways for him to manage his stress and his flare-ups. We'll get into that later.

First, let's talk to the one and only Dr. Klein about the relationship between stress and skin and how you can protect yourself from the effects of stressors in your life right after this break.

Here's your fitting room. Let me know if you need any help.

Thanks. This plaquesuriasis is so itchy. It's just a little patch, but so annoying. Did I hear my name? You again? That's right. I'm your plaquesuriasis. I know. As soon as I think all my topical treatments are working, you keep showing up to ruin my outfit. Those greasy creams are really making a mess of that dress. They might help your symptoms on the surface, but they're not treating the inflammation beneath the skin that causes me. Cycling through topical treatments for itchy flaky skin, treat p laxeriasis from inside the body where it starts. Everything okay in there? Just a minute.

Maybe long sleeves is a better look.

Don't Can the plaques oriasis treatments wipe out your wardrobe? Break the cycle with a pill that treats beneath the skin.

Ask your doctor about something different and visit beneaththeskin.

Com. Welcome back to Skinquarees. Let's unravel how stress shows up on our skin and What You Can Do to Manage It. I'd like to introduce Dr. Mitchell Klein, Nick's personal dermatologist and an academic with a private practice in New York City. Hi, Dr. Klein. How are you?

Hi, Nicole. How's everything? Great.

Thank you for joining us. I feel a little guilty because the person that we met through is my husband, nick, who's not here to defend himself, but you're Nick's doctor and dermatologist. And then he also recommended our daughter, C, who's now five years old. And you really had a profound impact on Nick's life and his quality of skin as well as our daughter. I'm so excited for you to join us today.

Oh, thanks. It's my pleasure. My pleasure to be here for all of you.

Do you mind telling us a little bit about yourself and your practice?

Sure. I'm a Clinical Assistant Professor in Dermatology at Weil, New York Presbyterian. I trained in internal medicine at the University of Pennsylvania after medical school there, and then switched to Dermatology at Cornell Memorial Song Kettering in Rockefeller. Started private practice immediately after, and I've been in practice for a long enough time that I don't want to say how long. I like all aspects of it. Dermatology has general, cosmetic, medical, and So I enjoy engaging people. I do it for the people that I treat.

I love that. And that really comes through as a patient in your practice. I'm so interested to hear your take on how things like stress, and this is something that I actually learned later in life, that stress can really affect your physicality, specifically your skin. So can you talk a little bit about the relationship between stress, which essentially is a mental thing, and it manifesting as a physical thing?

Sure. Let's start with a mind-body connection. It's the same. The brain is an organ, the skin is an organ. It's connected through all of the body chemistries that all the other organs are connected with. I don't really distinguish. I think that you understand that just as the brain and stress affect the heart, and people know that well, it affects the skin. And in so many ways, there's well-known science behind all of it. I think that it was a lack of understanding in the medical community for a long time, that there was a brain out there and that there was this body and this skin, and that these two things were not connected. And how could that not be?

It's so refreshing to hear you say that. As far as dress manifesting itself in the body on the body, what can that look like? What have you seen in your practice?

Well, if you think about the conventional problems that people talk about, like eczema, psoriasis, which we'll talk about a little bit today, and all of the dermatoses, all of those things get worse or flare when you're stressed. That's because people think of the immune system as being strong or weak, but it's very complex, and it's that the immune system changes, and it activates all kinds of proteins and chemicals in the body. Sometimes through nerves and sometimes actually through circulating chemicals. It can be hormones, cytokines, interferons, and all of those things have an effect on the immunity of the skin, which causes blood vessels to dilate. It causes the skin to get thicker or thinner. It causes the skin to maybe get spots, to be more susceptible to spots and wrinkles and also rashes. It changes those rashes very often, much, much worse. We always see this dramatic effect when we see somebody coming from a place of great stress, emotional or physical or both, because physical causes emotional stress, but emotional stress as well. And you see all of these things occur on the skin, and you see these breakouts of all sorts. And then it's apparent, and you know somehow that it just doesn't look right.

Do you think that there, or have you been able to identify certain triggers when it comes to a flare up, whether that is eczema or psoriasis psoriasis or other skin inflammation?

The story usually goes that I didn't have anything, and now I suddenly have spots. That's called guttate psoriasis, and it's often from a strep throat. It can be stress, but also strep And so usually you ask questions about a sore throat because infections, infections that run through the body, viral, bacterial, cause stress, and they also can cause a flare of psoriasis. So that's guttate psoriasis. Then you can go to other forms of psoriasis that affect other parts of the body. And again, you see this and you hear from the patient, well, I've had this chronic condition of my scalp, or I've had this rash on my elbows, or maybe my hands have been uncomfortable, but suddenly it's so much worse. I'm uncomfortable. And that immediately begs the question, well, what have you been through? Has there been through a life stress? Has somebody been ill? Somebody passed away? Are there family stresses? Do you have job stress or personal stress? And once you elicit It's it, that history, it helps you because you're giving somebody insight into the fact that what they're going through is causing some of the problem. And we all know that we don't go through what we go through forever.

And that eventually, as the stress settles down, the skin will settle down. You see this. Everything's worse. The skin's redder, the spots are scalier, they're more numerous, they're covering new areas of the body. Sometimes you feel like it's taking over your body because previously it was maybe one or two patches, and now it's widespread or on your scalp, which can happen with people with psoriasis. So all important questions and always important to reassure someone, again, that this is not going to remain this way, not with the medications and not with the treatments we have these days, and not with the fact that the stress is going to go away.

You mentioned treatments. What are the types of treatments that you treat psoriasis with?

There really are a thousand. And so first and foremost, reassurance. And then you move to, well, what's easy? Well, there are topical creams. Sometimes they're steroid creams. People are terrified of that. No reason to be. We know how to control how much steroid goes into your body with the cream. And sometimes we move after that into light therapy. But that's a little more evolved, but it also covers more of the body surface area before we get into systemic drugs, oral drugs, or injectable drugs. Interesting. Each one affects different arm of the immune system, and all of them work to slow or diminish the inflammation in the body. Not just psoriasis, but psoriasis comes with arthritis. Souriasis, believe it or not, comes with heart disease and stroke, and All of these things which are risks, if you have severe versions, are managed and controlled with these biologics, which is why they're so popular.

When you do talk to your patients, do you recommend or ask them questions about how to treat their stress in a nonmedical You have to get into that because when you have something that's really profound and you're dealing with something that needs something that goes beyond the medicines you're applying, leaving that out of the concoction is a mistake.

If you're not talking about addressing depression, which can be addressed with therapy and help and sometimes medication, you're talking about what are the social circumstances that you're in that are problematic that you might be able to do something about. Then also, again, very broadly, thinking about how do you get to those blue zones? How do you get a piece of nature? Where I love meditation and exercise as a way of burning off that anxiety and stress.

Shifting back to specifically psoriasis or other skin inflammation, I feel that, at least for nick, he and many other people, they usually run to the drug store and try everything on the shelf and become their own treatment guru until it comes to a point where he said, I need to see someone. My perception was that natural is better, but in certain cases it's not. What would you say to people who are at a loss Right.

So you try things, and I don't think there's anything wrong with that. In general, for skin, things that hydrate and moisturize are always going to help all aspects of the skin. And then if you think about it in a really basic common sense way. It's when you say to yourself, I'm not getting any better, maybe worse, but not getting any better. And who is it out there who has some expertise or training? It might even not align with my way of thinking. Maybe I think of only traditional Eastern methods and natural methods, but I need to find somebody who's going to give me something that's going to give me relief and put me in a different direction because I'm uncomfortable, I hurt, I itch, or I just don't feel good about the situation, or I don't feel good about the fact that my child has a rash over their body, and it's just not coming under control. And the child is itching and scratching. And all right, it's time. Let's see if we can find somebody professionally who will put us in the direction and not just immediately give us something that conflicts with what we believe in.

How about maybe just doesn't dismiss us for how we feel as people?

Dr. Klein, thank you so much. This was such an enlightening and great conversation. I really appreciate you taking the time.

Oh, thanks for bringing me in. And that's why we do what we do. It feels great.

Honestly, having someone who hears you and sees you can be life-changing. It made such a difference that Dr. Klein was compassionate and present during his appointment with nick. I think that's essential, especially when you're dealing with something that's not only physical but mental. Let's bring back my husband now to talk about how he's currently dealing with his psoriasis flare-ups.

I'm still discovering new things what does help me, what does trigger me, and what does not. I try to space things out that I know will stress me out. And if I'm like, okay, I got to address these three major things that I hate working on or hate facing, I'll say, okay, I'll do one today. I'll do one in two days. I'll do another one later down the line. In the past, I would have done all of them at one time. One day, one hour. I also tried to make time for myself with grabbing a sandwich or a coffee and just sitting in the park and just staring at a tree, just finding time to do that. Continued to take just those small moments for myself really made a huge difference. And being able to do that and just creating time for myself in that way has really helped out. If you're dealing with this, you're not alone. There are people out there that understand your condition and keep at it. There's people that will help you and you'll get through it.

That's so important.

Thanks, babe. Love you.

Love you, too. For me, this is such a healing episode because we really got to ask with nick about how he's feeling, which is not something we often talk about. I think nick is actually really quiet when it comes to his own emotions. He's really strong and really good at getting things done. But here, he was so honest and vulnerable, and I just want to honor him for that. It also really helped having someone like Dr. Klein who was very patient and open-minded when it came to my own approach to alternative healing. When it comes to my own philosophy, I don't discount mainstream medicine, but I also don't solely rely on holistic medicine either. I really want to see what's going to work for someone with a specific situation. But I think it's really important to find a doctor who understands you and sees you and has the compassion in patients so that they can meet you wherever you are. Another big thank you to our guests, nick Moskowitz and Dr. Mitchell Klein, for sharing their experiences. Skinqueries is hosted by myself, Nicole Berry, an executive produced by Yvonne Sheehan. Our senior producer is Tori Weldon.

Our junior producers are Reem El Magrabbi and Jenny Cunningham. The show is mixed and features original music by Sam Seguet. If you enjoy the show, share it with your friends. You can also listen and follow on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. We'd love to know what you think, so make sure you leave a review. Until next time. I had fun tonight. See you again Wednesday?

That sounds great.

I'll be there Wednesday, too. Who is that? Girl, I'm your poxriasis.

No, I have a date.

You know what? By Wednesday, I'll be down there.

Okay, I'm nervous enough already.

I'm calling my doctor. Tired of plexoriasis third wheeling? Learn about treating beneath the skin with something different at beneaththeskin. Com.