Can stress cause skin disease?

It may seem obvious that stress worsens inflammatory skin conditions like psoriasis and atopic dermatitis. But proving this assumption has been anything but simple.

For one thing, stress is difficult to measure: Nobody has no stress at all, and levels go up and down day by day. For another, randomized double-blind studies are a difficult proposition. If one group of psoriasis patients take part in stress reduction via mindfulness meditation and another group doesn’t, for example, blinding is impossible.

Another approach is to see how people with a condition fare after tremendous stress. A study tried to do just that by following Japanese survivors of a major earthquake.¹ Individuals closest to the quake had more stress and more atopic dermatitis symptoms. But they may have been distracted from taking care of themselves or had trouble finding the medications they needed. 

READ: Psychological problems impact skin disease

Now, we’re getting more insight from science. New research is finally offering confirmation of the role of stress,  Richard D. Granstein, M.D., tells Dermatology Times. “It’s establishing physiologic mechanisms to explain how stress can make skin disease worse. We knew it was true, but nobody knew why it was true.”

Dr. Granstein, chairman of Dermatology at Weill Cornell Medicine, spoke in an interview prior to making a presentation about stress and skin disease at the summer meeting of the American Academy of Dermatology in Boston.

“A number of pathways have been delineated that show stress can really affect inflammatory skin disease,” he says.

The nervous system appears to be especially important. Stress seems to affect the peripheral nervous system and disrupt immunity levels in the skin, he says. His team is examining whether stress works through the sympathetic nervous system to worsen inflammatory skin disease.

How can this kind of research be helpful? The uncovering of these pathways can reveal ways to help people recover with the help of medication, he says.

What should doctors do now? Dr. Granstein tells dermatologists to remember that stress isn’t a one-way street: “Not only does it appear that stress makes these diseases worse, but having these diseases causes stress.”

As a result, dermatologists should consider stress in their patients. “Sometimes we refer people for psychotherapy, and we have support groups for people with skin disease,” he says. “They feel better knowing that other people have the same problem they have.”

Disclosure: Dr. Granstein is an advisor to Elysium Health and Velius. He has served on advisory boards for Galderma and Castle Biosciences.

References:

1. Kodama A, Horikawa T, Suzuki T, et al. Effect of stress on atopic dermatitis: investigation in patients after the great hanshin earthquake. J Allergy