There is generally no question among dermatologists that psychological stress can affect the skin. This year, more than ever, the heightened stress of living through a year characterized by social isolation, illness, protests for racial justice, and divisive politics (to name a few) has made this relationship quite evident. Since the start of the pandemic, some dermatologists have reported an uptick in patients with flares of inflammatory conditions, adding to the wealth of clinical and scientific evidence indicating that a large number of skin diseases appear to be precipitated or exacerbated by stress. DermWorld examines the brain-skin connection and explores the impact of psychological stress on various skin conditions commonly treated by dermatologists.
Understanding the Brain–Skin Connection
The hypothalamic pituitary adrenal (HPA) axis is the body’s central stress response system. At a glance, stress triggers physiological responses by activating the hypothalamus, which releases corticotropin-releasing hormone (CRH) and stimulates the pituitary gland, which releases adrenocorticotropic hormone (ACTH) into the bloodstream and stimulates the adrenal glands, prompting the release of glucocorticoids and cortisol.
Despite the growing body of evidence demonstrating the impact of stress on skin conditions, the specific pathogenic role of stress is still unknown. Studies exploring the brain–skin connection have revealed that the skin is both a prominent target organ and produces neuroendocrine, neurotransmitter, and neuropeptide signals, which profoundly affect skin biology. Upon perception of stress, the skin may respond by releasing inflammatory cytokines. In turn, this may lead to mast cell activation, which promotes immune dysregulation and neurogenic inflammation, inflammation caused by a neurological event like stress.
The Role of Stress in Common Skin Conditions
Dermatological data show a strong link between emotional triggers and many inflammatory or chronic skin conditions.
In one study of more than 4,576 patients, the percentage of individuals reporting emotional stress as a trigger varied widely depending on the condition:
Conditions such as acne, eczema, and psoriasis are widely recognized to worsen under psychological stress. Flares often coincide with stressful life events, exams, illnesses, or ongoing anxiety. In the case of acne, increased cortisol levels can stimulate oil glands, leading to breakouts. Similarly, stress-induced inflammation may disrupt the skin barrier in eczema, making flare-ups more frequent and harder to control.
The associations of some skin conditions with stress are unquestioned, such as psoriasis, AD, and acne, because we see it so much in clinical practice, and it’s been well documented over the decades, Dr. Koo said. Some conditions, like AA and vitiligo, are less well accepted. “Anecdotally, patients report the association of stress and exacerbation of their condition, but dermatologists are not entirely sure how strong the relationship is.”
“We know that stress management of all kinds decreases inflammation, so we have a responsibility to our bodies to find techniques to decrease that inflammation.”
“Skin disease often insidiously robs people of the range of interaction — their degree of engagement in people, places, and things,” Dr. Fried said. “There’s never been a time where there’s a more ubiquitous stress and never been a time where our patients need us to proverbially hold their hand.”
Why Stress Management Matters for Skin Health
According to dermatological experts, managing stress is not just good for mental well-being; it’s also an important part of maintaining healthy skin.
Stress can reduce the skin’s ability to heal and increase susceptibility to infections. Practices like mindfulness, adequate sleep, balanced nutrition, and regular physical activity help regulate cortisol levels, which may prevent inflammatory responses in the skin.
Dr. Kaplan often reminds patients that stress-related skin conditions are real, and addressing both physical and psychological factors leads to the best outcomes. If symptoms worsen or interfere with daily life, it’s important to seek professional care.
When to See a Dermatologist
Persistent breakouts, eczema flare-ups, or unexplained itching can be signs that stress is taking a toll on your skin. A dermatologist can help identify whether your condition is stress-related and design a treatment plan that targets both the physical and emotional components.
At APDKC, our team provides comprehensive care for conditions such as acne, eczema, psoriasis, rosacea, and other inflammatory skin disorders. We focus on evidence-based treatments while educating patients on lifestyle and stress management techniques to improve long-term skin health.
If you’re struggling with a flare or new symptoms, contact our office to schedule an appointment.