Stressful Life Events and Skin Diseases: Disentangling Evidence from Myth

Abstract

The possibility of a causal influence of emotional stress, especially of stressful life events, on the course of various skin diseases has long been postulated. Clinical wisdom and experience, as well as many anecdotal observations and uncontrolled case series, support this opinion. We reviewed the available evidence on the role of stressful life events in triggering or exacerbating skin diseases. The role of stressful events in vitiligo, lichen planus, acne, pemphigus and seborrhoeic dermatitis was either controversial or insufficiently explored. The role of stressful events in psoriasis, alopecia areata, atopic dermatitis and urticaria was apparently clearer. However, only a few studies met acceptable methodological standards for stress measurement. Also, few studies considered common potential confounding factors (e.g. age, duration of illness, familial factors), and no study controlled adequately for the influence of other crucial factors (e.g. discontinuation of treatment, seasonal effects). Adding that the large majority of studies were retrospective, it seems wise to conclude that only preliminary evidence has been published so far on the role of stressful life events in bringing on or worsening any dermatological disease. Further research is mandatory, either in the form of prospective studies or, more feasibly, of well-designed case-control studies with adequate statistical power. Future studies should also pay more attention to protective as well as vulnerability factors in stressful events. Further, it would be important to investigate other sources of psychological stress, such as chronic stress and everyday stress. Measuring stress appraisal, although difficult, would also be important.

Personality traits and common psychiatric conditions in patients with seborrheic dermatitis

“…Stress, fatigue, androgens, microangiopathic vascular changes, seasonal atmospheric changes, dietary patterns, nutritional allergies, autoimmunity, Malassezia infections, riboflavin, pyridoxine, and biotin deficiencies play a role in its etiopathogenesis and affect disease severity 6 . SD prevalence is increased by emotional stress, fatigue and depressive conditions 7 .…”

Reasoning behind the redness – an insight to pemphigus vulgaris

“…10 The role of stressor events in aggravating vesiculobullous lesion is well established. 11 Psychological stress might alter immune function through direct innervations of lymphatic tissue, through release of hypothalamic pituitary adrenocortical axis (HPA) and sympathetic adrenal medull ary (SAM) hormones that bind to and alter the functions of immunologically active cells, or through stress-induced behavioural changes. 12 Henceforth recognizing the influence of psychological stress on the development and evolution of pemphigus is important, since the health condition of the patients can be improved through the recognition, validation and treatment of their psychological issues, associating psychological assistance to the immunosuppressive treatment.…”

Psychological Treatments for Dermatological Conditions

“…About two-thirds of patients with psoriasis and atopic eczema report that stress influences the course of their condition [3,22,23]. This influence of stress on the skin is a possible starting point for psychological interventions.…”