Our skin system is not just a physical envelope. It is a living and dynamic organ that responds to external stimuli and internal signals from the body. While in recent years the understanding of the role of genetic factors in chronic skin diseases such as eczema (atopic dermatitis) and psoriasis has deepened significantly, it is clearer today than ever that the impact of mental stress is not metaphorical talk but a meaningful part of the disease mechanism.
The stress response system (the hypothalamus–pituitary–adrenal axis, or HPA) is activated in situations of prolonged stress. This system releases hormones such as cortisol, which integrate with the body’s immune and inflammatory systems. In response to mental stress, the functions of skin cells also change, including local immune cells, which affect the balance of inflammation and the epidermal barrier – the body’s first line of defense, in the outermost layer of the skin.
In states of chronic stress, this system often triggers an increased inflammatory response. It can weaken the skin barrier, slow the repair of tissue damage, and alter the body’s balance in a way that creates a skin environment that promotes inflammation. These changes cause a more noticeable response of existing inflammatory skin diseases and make healing more difficult.
Which skin diseases are affected by stress?
Eczema – Stress is a strong trigger for flare-ups
Eczema, or atopic dermatitis, is a chronic inflammation of the skin characterized by dryness, itching, rash, and damage to the skin barrier. Beyond genetic and environmental factors, mental stress directly affects the inflammatory process. Clinical studies indicate that high production of cortisol disrupts the balance of the immune system and increases allergic and inflammatory responses in the skin. At the same time, stress alters the composition and layer of the skin’s lipids and moisture, which worsens the barrier damage and makes it easier for external irritants to penetrate. The connection between stress and eczema is not one-directional. The experience of chronic itching and the appearance of inflamed skin create additional stress, which feeds the problem and makes it harder to break the cycle.
Psoriasis – Stress as part of a complex cycle
Psoriasis is a chronic inflammatory autoimmune disease in which there are disruptions in the function of immune cells in the skin, with excessive cell production and local inflammatory responses. Many studies report that many patients perceive flare-ups during periods of stress, and sometimes significant stress alone is enough to ignite a severe outbreak. The mechanism of action includes the influence of stress hormones on receptors in skin cells and a contribution to the усилification of central inflammatory pathways associated with disease exacerbation.
The evidence shows that the relationship between stress and the disease is complex. Stress may act as an aggravating factor or a trigger for an outbreak, but it is also a result of living with a chronic disease that is limiting and painful. This process creates a “self-perpetuating cycle” in which worsening of the disease increases stress and the stress worsens the disease.
So what can be done?
In an era in which mental stress affects a range of chronic diseases, it is important to incorporate an understanding of stress mechanisms into the therapeutic approach as well. Alongside biological treatments, steroid treatment, and therapies aimed at regulating the immune system, there is room to consider interventions whose goal is reducing stress and tension.
It is important to understand that our skin is not just a physical line of defense, it is also an organ with a complex neural and immune network. It is capable of absorbing and releasing hormones and neurotransmitters that are directly linked to the stress response and tension and of exacerbating chronic skin diseases. Therefore, the goal of lifestyle changes and emotional therapies is not only to reduce the subjective feeling of stress, but to actually change the biological messages that create negative immune involvement in the skin and worsen the disease.
Dr. Muhammad Sah, Specialist in Dermatology and Venereology, Maccabi Healthcare Services, Northern District