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June 13, 2024 23 mins

What does stress look like on our skin? How do we treat the symptoms? What are the best ways to manage stress? This episode hits close to home. Host Nicole Berrie watched her husband Nick Moshkovich suffer through painful episodes brought on by itchy, flaking, and burning skin. It took a lot of trial and error until Nick finally found relief in the form of Dr. Mitchell Kline. Dr. Kline is a NYC dermatologist who immediately saw Nick’s pain and symptoms for what they were, plaque psoriasis. 


Listen in as Nick and Nicole get personal while sharing how stress manifested physically on Nick’s skin. At the same time, Dr. Kline offers insights into treatment options, emphasizing the importance of addressing both physical and mental aspects of skin issues. 

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
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 manifests 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.

Speaker 2 (00:18):
He literally looks at me and goes, your poor poor guy,
is 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 and
discomfort that I was going through.

Speaker 3 (00:36):
Hi, guys, and welcome. I'm so glad you're here.

Speaker 1 (00:38):
I'm Nicole Berry and this is Skin Queries, 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 can 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 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 than 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 Moskovich, to share his journey with plaxoriasis.
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.

Speaker 3 (01:50):
Up all over your body.

Speaker 1 (01:51):
There can be patches of skin that becomes scay and inflamed,
and it's often seen on the scalp, elbows, and knees.

Speaker 3 (01:58):
Stress is such a big.

Speaker 1 (01:59):
Factor when it comes to siiasis, so much so that
the National Psoriasis Foundation recommends managing stress must be part
of your treatment plan. We'll also be talking to Nick's dermatologists,
who's going to explain why stress manifests 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.

Speaker 4 (02:24):
A lot of pressure here.

Speaker 1 (02:25):
Yes, Nick and I have been married for almost ten years.
Next year will be our tenth anniversary 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, like,
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?

Speaker 4 (03:03):

Speaker 2 (03:04):
So, by the way, you look beautiful, very nice. Nice
to see you from this cell.

Speaker 4 (03:11):

Speaker 2 (03:11):
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.

Speaker 3 (03:29):
Jude was like six months old.

Speaker 2 (03:31):
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 you know,
it was like, oh, I'll just put some lotion on it,
just a guy thing.

Speaker 4 (03:43):
Maybe the soapa musing is not good or something.

Speaker 2 (03:45):
My hands are just kind of can't keep up with
my mind and everything else is going in my life.
And yeah, they started to get kind of chapped a
little worn in, like almost like a callus's situation. And
then the more work I was doing, the more it
would just kind of spread and continue to evolve and
never really healing fully.

Speaker 1 (04:05):
I do remember you were complaining about your callous hands,
and I noticed that's what I thought it was. It
looked like callous dry hands.

Speaker 3 (04:11):
Were they itchy? Was it painful?

Speaker 2 (04:14):
So it started with just just kind of annoying. Honestly,
it wasn't even like that discomforting. It was just I
was like, oh, maybe they'll get better, you know, I'll
just keep putting lotion on. I found a couple of
brands that seemed to help, but in the end they
were doing anything. They were just kind of moisturizing it
for that moment, but not continually doing anything for that condition.

And that's when I realized it was something more serious
because it kind of 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 kind of relief of any kind. And that's when
I started to get kind of start to panic. Is panic, Yeah, yeah,

it really. It was really stressful because I was like,
I've never experience this. I would literally squeeze my hands
just like make a fist, and I could feel those
callouses kind of breaking, and it would just become really
difficult to grip anything to lift the kids up to walk,
and then after that it has to continue.

Speaker 4 (05:15):
To get worse and flare up more and more.

Speaker 2 (05:18):
Is it went to my feet on my heel, it
was almost felt like somebody just stabbing.

Speaker 4 (05:23):
My heel all the time. It was really really painful.

Speaker 2 (05:25):
So uncomfortable, that's awful. It would peel, it would just
it was absolute worst.

Speaker 1 (05:31):
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.

Speaker 2 (05:45):
I'm out and I see a lot of people, and
I meet people, and it became pretty uncomfortable for me,
just of like somebody wanted to shake my hand or
if I, like, you know, wanted to greet somebody, it
just didn't feel right.

Speaker 3 (05:56):
It's self consciousness.

Speaker 4 (05:58):
Self conscious about the whole essageituation.

Speaker 2 (06:00):
So in insecurity, that's when I was like, I need
to really take care of this and address what's going
on here.

Speaker 1 (06:06):
Honestly, neither of us really knew what exactly was going on,
but we knew something had to change.

Speaker 4 (06:13):
I don't have like the most fantastic diet like you do.
You're very good at it.

Speaker 3 (06:17):
We're working on it. We're working on it.

Speaker 2 (06:19):
I am, yeah, I'm your lifelong project. But I was
drinking like these juices and I thought I found something
and had a cleaner sugar in it, but my body
was not reacting well to it.

Speaker 4 (06:31):
I remember I went on like.

Speaker 2 (06:32):
A two three week like absolutely no sugar thing during
that time as well.

Speaker 4 (06:37):
Might have helped. It might have been too late at
that point too, but it didn't hurt, I'll say that.

Speaker 1 (06:42):
So when you finally decided that you've had enough with
you know, home treatment and trying to like use lotions
and potions, what was your journey in finding the right doctor?
Did you find it right away?

Speaker 2 (06:54):
I spoke to a few specialists quote unquote, like you say,
I could take on just about anything, like I can.

Speaker 4 (07:00):
Work through most things in my time.

Speaker 2 (07:03):
Talking to those doctors, I'll be like, oh, it's you know,
it's just kind of annoying. It's this and that, but
it's really inside, I'm just like screaming about man, this
is driving me crazy.

Speaker 1 (07:13):
After a long time of searching and coming up with
a lot of dead ends, a friend recommended we go
to doctor Mitchell Klein, a dermatologist based in New York.
You'll be hearing from him later. But when Nick walked
into his office.

Speaker 4 (07:25):
He literally looks at me and goes, you're poor, poor guy.

Speaker 2 (07:28):
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 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 for at length, and he said, you know, I

have other clients who have this condition.

Speaker 4 (07:50):
There's different things we can do.

Speaker 2 (07:52):
And and you write away that it was ciriasis, what
version of csoriasis it was? And he said that, you know,
you're obviously in a very strong whole situation. He's like,
this does not typically happen with just like a healthy
thirty 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 some

of those things, you know, take some deep breaths and
like go for a walk and whatever time you can find.
You have to like let go of some of the
things that you're doing, that you're carrying, and that will
help with your medical issue.

Speaker 3 (08:25):
Doctor Klein prescribed a treatment for Nick's blacksriasis.

Speaker 2 (08:29):
And within forty eight hours, I mean, it was it
was magic. He said it was going to be like magic,
and it was just that what was.

Speaker 1 (08:35):
The feeling that you had when he said I know
what this is and I know how are we going.

Speaker 4 (08:40):
To fix it?

Speaker 2 (08:40):
Disbelieve I could not believe him, just because of you know,
dealing with the condition for two years plus minus. You
just kind of think that there's just 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 I'm 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 it began to like
kind of feel relief and comfort and everything that he
was saying. And that was, honestly the first time I
had somebody who was like, I got the answer for it.

Speaker 4 (09:21):
We just got to figure out how do we get.

Speaker 2 (09:22):
You to continue to improve once I set you on
this path of treatments.

Speaker 1 (09:27):
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.

Speaker 3 (09:56):
I started to think of all.

Speaker 1 (09:57):
The ways that I personally was adding to the stresses
of his life and kind of felt a little shameful
and hopeless.

Speaker 3 (10:04):
Obviously, the feeling of shame.

Speaker 1 (10:06):
And guilt around Nick's diagnosis were irrational. Of course, it
wasn't my fault, and thankfully we found doctor Klein, who
was a lifesaver 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 overlaf and also very essential. After doctor 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 doctor Klin 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, welcome back to skin Queries. Let's unravel how

stress shows up about our skin and what you can
do to manage it. I'd like to introduce doctor Mitchell Klein,
Nick's personal dermatologists and an academic with a private practice
in New York City.

Speaker 3 (11:09):
Hi, doctor Klein, how are you hi?

Speaker 4 (11:11):

Speaker 5 (11:12):
How's everything great?

Speaker 1 (11:14):
Thank you for joining us. I kind of 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, See who's now five years old. And you know,
you really had a profound impact on Nick's life and

his quality of skin, as well as our daughter. So
I'm so excited for you to join us today.

Speaker 5 (11:39):
Oh well, thanks, it's my pleasure, my pleasure to be
here for all of you.

Speaker 3 (11:43):
Do you mind telling us a little bit about yourself
and your practice?

Speaker 5 (11:46):
Sure. I'm a clinical assistant professor in dermatology at while
in New York Presbyterian. I trained an internal medicine at
the University of Pennsylvania after medical school there, and then
switched to dermatology at Cornell Memorials On Kettering and Rockfeller
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. And 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.

Speaker 1 (12:18):
I love that and that really comes through as a
patient in your practice. And 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.

Speaker 5 (12:43):
Sure, so let's start with a mind body connection. It's
the same, right, 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 so
I don't really distinguish. And I think that you under
stand 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. And I think that you know, 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 r right.

Speaker 1 (13:23):
It's so refreshing to hear you say that. As far
as dress manifesting itself in the body and on the body,
what can that look like? What have you seen in
your practice?

Speaker 5 (13:33):
Well, if you think about the conventional problems that people
talk about, like exema, psoriasis, which we'll talk about a
little bit today, and all of the dermatosis, all of
those things get worse or flair when you're stressed. And
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, cytokindes, 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. So 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 in the skin,
and you see these breakouts of all sorts, and then
you know it's apparent, and you know somehow that it
just doesn't look right.

Speaker 1 (14:51):
Do you think that there or have you been able
to identify certain triggers when it comes to a flare up,
whether that is exima or psoriasis or other kind of
skin inflammation.

Speaker 5 (15:02):
So the story usually goes that I didn't have anything,
and now I suddenly have spots. That's called guttap'soriasis, and
it's often from a strep throat. It can be stress,
but also strap 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. Okay,

so that's guttaped psoriasis, and 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 as they've been through a life stress? Has
somebody been ill, somebody passed away? Are their family stresses?
Do you have job stress or personal stress? And once
you sort of elicit 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 you know eventually as the stress
kind of settles down, the skin will settle down, and
you see this, you know, 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, and so you know,
all important questions and always important to reassure someone again
that you know, 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.

Speaker 3 (16:49):
You mentioned treatments, So what are the types of treatments
that you treat psoriasis with?

Speaker 5 (16:56):
So there really are a thousand and so and foremost
reassurance and then you move to well, what's easy. Well,
they're topical creams. Sometimes they're steroid creams. People are terrified
of that, no reason to be. We know how to
control how much stereoid 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. In each one affects a
different arm of the immune system, and all of them
work to sort of slow or diminish the inflammation in
the body, not just psoriasis, but psoriasis comes with arthritis,

ziausis believe 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.

Speaker 1 (17:52):
When you do talk to your patients, do you recommend
or ask them questions about how to treat their stress
in a non medical way.

Speaker 5 (18:00):
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. You know, if you're
not talking about addressing depression, which can be addressed with
you know, therapy and help and sometimes medication, you're talking about,

you know, what are the social circumstances that you're in
that are problematic that you might be able to do
something about. And then also again very broadly, thinking about
how do you get to those blue zones? You know,
how do you get a piece of nature where I
love meditation and exercise, you know, as a way of
burning off that anxiety and stress.

Speaker 1 (18:45):
Shifting back to specifically storisis or other skin inflammation. I
feel that at least for Nick, you know, he and
many other people, they're usually run to the drugstore and try,
you know, everything on the shelf and become their own
kind of treatment mint guru until it comes to a
point where he said, you know, I need to see someone.
And my perception was that natural is better, but in

certain cases it's not. So what would you say to
people who are kind of at a loss?

Speaker 5 (19:14):
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 you know, if you think
about it, and just in a really basic common sense way,
it's when you say to yourself, you know, 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 I even not Alie with my
way of thinking. You know, 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.

Speaker 1 (20:23):
Doctor Klin, thank you so much. This was such an
enlightening and great conversation. I really appreciate you taking the time.

Speaker 5 (20:30):
Oh thanks for bringing me in. And that's why we
do what we do.

Speaker 1 (20:34):
It feels great, honestly having someone who hears you and
sees you can be life changing. It made such a
difference that doctor 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 hysteriasis flare ups.

Speaker 2 (20:56):
I'm still kind of discovering new things about 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, you know, and if I'm like, okay,
I got address these like three major things that I
just I hate working on or I 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 that would have done all of them at one time. Yeah,
one day, one hour. I also tried to make time
for myself with like grabbing a sandwich or a coffee
and just sitting in the park and just staring at
a tree. Just finding time to do that, continue 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.

Speaker 3 (21:49):
That's so important. Thanks, babe, I love you, Love you too.

Speaker 1 (21:55):
For me, this is such a healing episode because we
really got to ask 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 doctor 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 patience so that they.

Speaker 3 (22:42):
Can meet you wherever you are.

Speaker 1 (22:45):
Another big thank you to our guests Nick Moskovich and
doctor Mitchell Klein for sharing their experiences. Skin Queries is
hosted by myself Nicole Berry, an executive produced by Evon Sheehan.
Our senior producer is Tory Weldon. Our juniors are Reem
Alma Grabi and Jenny Cunningham. The show is mixed and
features original music by Sam Sagan. 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.
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