Association of Stress with Symptoms of Atopic Dermatitis

Abstract

Psychological stress and atopic dermatitis (AD) symptoms appear to form a vicious cycle. This study compared the degree of stress and impairment of dermatology life quality between patients with AD and healthy controls, and examined for neuropeptides and neurotrophins associated with stress in AD. Questionnaires, comprising five tests evaluating depression, anxiety, interaction anxiousness, private body consciousness, and dermatology life quality, were examined in age- and sex-matched patients with AD (n = 28) and healthy controls (n = 28). Immunohistochemical staining of nerve growth factor, substance P, corticotrophin-releasing factor receptor and neuropeptide Y was performed in the AD-involved and normal skin. Patients with AD showed high scores on all of the questionnaires, including Beck Depression Inventory, state anxiety, trait anxiety, Interaction Anxiousness Scale, Private Body Consciousness subscale, and Dermatology Life Quality Index. All of the parameters, except for Beck Depression Inventory, showed higher values in AD than healthy controls (p < 0.001). Statistically significant correlations were observed between each psychological parameter and Dermatology Life Quality Index. Among the clinical parameters, only pruritus was positively correlated with state anxiety (R = 0.573, p < 0.05) and trait anxiety (R = 0.525, p < 0.05). The Eczema Area and Severity Index score did not show any significant correlations with psychological parameters. Nerve growth factor-reactive cells were observed more abundantly and intensely in both epidermis and dermis of AD involved skin (n = 4) than in healthy controls (n = 3) (p = 0.022 and 0.029, respectively). Also, the number and intensity of neuropeptide Y-positive cells was significantly greater in the entire epidermis of patients with AD than in healthy controls (n = 3) (p = 0.029 and 0.026, respectively). We conclude that anxiety may be associated with the induction of pruritus through neuro-peptide Y and nerve growth factor.

Psychiatry outpatient visits by atopic dermatitis patients varying in the complexity of their prescriptions

“…[20] These types of stress-induced biological factors can interfere with the skin barrier system, including the epidermis, and aggravate nocturnal pruritus. [21] Thus, psychological stress and AD symptoms appear to form a vicious circle because the sleep disturbances experienced by AD patients result in inappropriate sleep quality and quantity and increase mental health problems, including psychiatric disorders. [14,22–24] …”

Brain-Skin Connection: Stress, Inflammation and Skin Aging

“…AD patients have been reported to have anxiety and depression, while psychological stress in turn can exacerbate AD pathology [130-132]. …”

“…However, there are conflicting data on NGF expression in AD patients. Some research showed increased NGF [132, 139-141], while others demonstrated no significant difference or even decreased NGF level [142, 143]. Further research is needed in this area to elucidate the differences.…”

A Review of Multidisciplinary Interventions in Atopic Dermatitis

“…Additionally, children may experience self-consciousness about physical appearance, as well as stress associated with the chronic nature of the condition [9,21,22]. Psychological stress, in turn, has been shown to be a trigger for AD, leading to a challenging cycle [23,24,25,26]. …”