How does stress affect the skin?

From the Guidelines

Stress has a significant impact on the skin, exacerbating conditions like psoriasis, acne, and pruritus, and compromising the skin barrier, which can lead to increased morbidity, mortality, and decreased quality of life 1.

Key Findings

• Stress reduction techniques, such as meditation, biofeedback, and relaxation, can improve symptoms in patients with psoriasis and other skin conditions 1.
• Acne vulgaris, a common skin condition, has a significant impact on emotional functioning, social functioning, relationships, and quality of life, and is associated with increased risks of stigmatization, bullying, depression, anxiety, and suicidal ideation 1.
• Chronic generalized pruritus, a condition characterized by intense itching, can be triggered or worsened by stress and emotional excitation, and can significantly reduce quality of life and contribute to psychosocial morbidity 1.

Recommendations

• Patients with skin conditions should be encouraged to practice stress reduction techniques, such as meditation, deep breathing, or yoga, to help manage their symptoms and improve their quality of life 1.
• Healthcare providers should consider the psychological and emotional factors that contribute to skin conditions, and provide patients with resources and support to manage stress and anxiety 1.
• Further research is needed to fully understand the relationship between stress and skin health, and to develop effective interventions to mitigate the negative effects of stress on the skin 1.

From the Research

Effects of Stress on the Skin

• Stress has multiple and wide-ranging physiologic and clinical impacts on skin disease, including increasing skin inflammation, itching, impairing skin barrier function, and suppressing immunity 2
• The stress response results in the activation of the endocrine, neurologic, and immune systems, with a resulting cascade of impacts that are both systemic and cutaneous 2
• Emotional stress can affect, reveal, or exacerbate a number of skin disorders, including psoriasis, atopic dermatitis, pruritus, alopecia areata, lichen planus, seborrheic dermatitis, rosacea, or urticaria 3

Mechanisms of Stress-Induced Skin Changes

• The skin has established a fully functional peripheral equivalent of the hypothalamic-pituitary-adrenal axis as an independent, local stress response system 4
• Stress influences disease processes and contributes to inflammation through modulating the hypothalamic-pituitary-adrenal axis and releasing neuropeptides, neurotrophins, lymphokines, and other chemical mediators from nerve endings and dermal cells 3
• Dermal mast cells play a central role in cellular skin reactivity to various stressors, as they show close connections with sensory nerve endings and may release a huge number of proinflammatory mediators 3

Clinical Impacts of Stress on the Skin

• Chronic moderate psychological stress can trigger measurable skin aging signs, including decreased antioxidant potential, impacted skin barrier integrity, and increased signs of microrelief alterations (skin texture and fine lines) 5
• Acute psychosocial and sleep deprivation stress can disrupt skin barrier function homeostasis in women, and this disruption may be related to stress-induced changes in cytokine secretion 6
• Stress-induced changes in skin barrier function can be measured by transepidermal water loss, recovery of skin barrier function after tape stripping, and stratum corneum water content (skin conductance) 6