Scientific Online Resource System

Scripta Scientifica Medica

Psychoneuroimmunology and impact of stress in chronic skin conditions

Filka Georgieva


Psychodermatology studies the relationship between skin and mind. The important starting point in most of the chronic skin conditions is the psychological factor. Acute adverse events are classic triggers for these diseases. Chronic distress plays an important role, especially in time of public professional and financial instability, combined with the characteristics of the personal profile of the individual. Patients suffering from chronic skin dermatoses are tense, anxious, and unable to relax. This article reviews the neuro-endocrine pathways in the genesis of psychodermatological conditions. The paradigm: chronic skin conditions, stress and psyche is discussed. The review is based on the data from English language literature using MEDLINE and PubMed.


psychodermatology, stress, psychoneuroimmunology

Full Text


Dimsdale JE, Irwin MR, Keefe PT, Stein MB. Stress and psychiatry. In: Saddock B, Saddock V, Ruiz P, editors. Kaplan and Saddock’s Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia, USA: 2009. p. 2407–2408.

Tobin DJ. Biochemistry of human skin--our brain on the outside. Chem Soc Rev. 2006; 35(1):52-67. doi: 10.1039/B505793K

Razali MS. Life event, stress and illness. Malays J Med Sci. 2008; 15(4): 9–18.

Wilson E. Diseases of the skin. London: Churchill; 1867.

Hunter R, MacAlpine A. Three Hundred Years of Psychiatry. London: Oxford University Press; 1963.

Shenefelt PD. Psychological interventions in the management of common skin conditions. Psychol Res Behav Manag. 2010; 3: 51–63.

Ahmed AE, Al-Dahmash AM, Al-Boqami QT, Al-Tebainawi YF. Depression, Anxiety and Stress among Saudi Arabian Dermatology Patients: Cross-sectional study Sultan Qaboos. Univ Med J. 2016; 16(2):217-23. doi: 10.18295/ squmj.2016.16.02.013

Brunsting LA. Atopic dermatitis (disseminated neurodermatitis) of young adults. Analysis of precipitating factors in one hundred and one cases and report of ten cases with associated juvenile cataract. Arch Derm Syphilol. 1936; 34(6):935–57.

Alexander F. Psychosomatic Medicine. New York: 1950.

Graham DT, Wolf S. The relationship of eczema to attitudes and to vascular reactions of the human skin. J Lab Clin Med. 1953; 42:238–54.

Dave ND, Xiang L, Rehm KE, Marshall GD. Stress and allergic diseases. Immunol Allergy Clin North Am. 2011; 31(1): 55–68. doi: 10.1016/j. iac.2010.09.009

Kálmán LJ, Gonda X, Kemény L, Rihmer Z, Janka Z. Psychological and biological background of the correlation between psoriasis and stress. Orv Hetil. 2014; 155(24):939-48. doi: 10.1556/OH.2014.29897

Manolache L, Benea V. Stress in patients with alopecia areata and vitiligo. JEADV. 2007; 21(7); 921-8. doi: 10.1111/j.1468-3083.2006.02106.x

Rashighi M, Harris JE. Vitiligo Pathogenesis and Emerging Treatments. Dermatol Clin. 2017; 35(2): 257-65. doi: 10.1016/j.det.2016.11.014

Sarkar R. Sethi S. Madan A. Pathogenesis of vitili¬go. In: Handog EB, Enriquez-Macarayo MJ, editors. Melasma and vitiligo in brown skin. Springer India; 2017. p. 191-196.

Zmijewski MA, Slominski AT. Neuroendocrinolo¬gy of the skin: An overview and selective analysis. Dermatoendocrinol. 2011; 3(1):3–10. doi: 10.4161/ derm.3.1.14617

Koo JYM, Lee CS. General approach to evaluat¬ing psychodermatological disorders. In: Koo JYM, Lee CS, eds. Psychocutaneous Medicine. New York: Marcel Dekker, Inc; 2003. p.1-29.

Basavaraj KH, Navya MA, Rashmi R. Rele¬vance of psychiatry in dermatology: Present concepts. Indian J Psychiatry. 2010; 52(3): 270–5. doi: 10.4103/0019-5545.70992

Kieć-Swierczyńska M, Dudek B, Krecisz B, Swierczyńska-Machura D, Dudek W, Garnczarek A, et al. The role of psychological factors and psychiatric disorders in skin diseases. Med Pr. 2006; 57:551–5.

Hillier T. Handbook of Skin Disease. London: Walton & Moberly; 1865.

Teshima H, Kubo C, Kihara H. Psychosomatic aspects of skin disease from the standpoint of immunology. Psychotherapy Psychosomatics. 2012; 37(3): 165-75.

Papadopoulos L, Bor R, Legg C. Psychological factors in cutaneous disease: An overview of research. Psychology, health & medicine. 1999;4(2);107-26. doi: 10.1080/135485099106261

Anargyros K, Christos C, Vasiliki E, Eftychia P, et al. Comparative study of quality of life and obsessive-compulsive tendencies in patients with chronic hand eczema and Lichen Simplex Chronicus. Dermatitis. 2016:27(3):127-30. doi: 10.1097/ DER.0000000000000180

Chodkiewicz I, Salamon M, Miniszewska J. Psychosocial impact of rosacea. Przegl Lek. 2007; 64(12):997-1001.

Halioua B, Cribier B, Frey M, Tan J. Feelings of stigmatization in patients with rosacea. JEADV 2017; 31(1):163-8. doi: 10.1111/jdv.13748

Lee CS, Accodino R, Howard J, Koo J. Psychopharmacology in dermatology. Dermatol Ther. 2008:21(1):69-82. doi: 10.1111/j.1529-8019.2008.00172.x

Ermertcan AT, Gengolgan G, Temelsan G, Horasan GD, Deveci A, Oztuk F. Sexual dysfunction in female patients with neurodermatitis. J Androl. 2011; 32(2); 165-9. doi: 10.2164/jandrol.110.010959

Slominski A, Wortsman J. Neuroendocrinology of the skin. Endocr Rev. 2000; 21(5):457–87. doi: 10.1210/edrv.21.5.0410

Shenefelt PD. Psychological interventions in the management of common skin conditions. Psychol Res Behav Manag. 2010; 3: 51–63.

Arck PC, Slominski A, Theoharides TC, Peters EM, Paus R. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006; 126(8):1697- 704. doi: 10.1038/sj.jid.5700104

Dantzer R, Wollman EE. Relationships between the brain and the immune system. J Soc Biol. 2003; 197(2):81-8.

Andrzej S. Neuroendocrine System of the Skin. Dermatology. 2005; 211(3): 199–208.

Slominski A, Wortsman J, Luger T, Paus R, Solo¬mon S. Corticotropin releasing hormone and proopiomelanocortin involvement in the cutaneous response to stress. Physiol Rev. 2000; 80(3):979-1020.

Biswas A, Manivannan M, Srinivasan MA. Vibrotactile sensitivity threshold: nonlinear stochastic mechanotransduction model of the Pacinian cor¬puscle. IEEE Transactions on Haptics. 2015; 8(1): 102–113. doi: 10.1109/TOH.2014.2369422

Patestas M, Gartner L. A textbook of neuroanatomy. Ascending sensory pathways. Blackwell publishing; 2006. p.137-169.

Jékely G. Global view of the evolution and diversity of metazoan neuropeptide signaling. Proc Natl Acad Sci U S A. 2013; 110(21): 8702–7. doi: 10.1073/ pnas.1221833110

Schneiderman N, Ironson G, Siegel SD. Stress and health: Psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005; 1: 607– 28. doi: 10.1146/annurev.clinpsy.1.102803.144141

Mills H, Reiss N, Dombeck M. Men¬tal and Emotional Impact of Stress. Disorders & Issues Stress Reduction and Manage-ment.2008. Available at: mental-and-emotional-impact-of-stress

Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008; 21(1):22-31. doi: 10.1111/j.1529-8019.2008.00166.x

Jacobs MA, Friedman S, Franklin M, Anderson L, Muller J, Eisman HD. Incidence of psychosomatic predisposing factors in allergic disorders. Psychosomatic Medicine. 1966; 28:679-95.

Janner LD, Schwartz GE, Leigh H. The relationship between repressive and defensive coping styles and monocyte, eosinophil, and serum glucose levels. Psychosom Med. 1988; 50(1):567-75.

Millard L. Psychoneuroimmunology. In: Walker C. Papadopolus L, editors. Psychodermatology. Cambridge University Press; 2005. p. 15-19.

Smith S, Vale W. The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues Clin Neurosci. 2006; 8(4): 383–95.

O’Connor TM, O’Halloran DJ, Shanahan F. The stress response and the hypothalamic‐pituitary‐adrenal axis: from molecule to melancholia. QJM. 2000; 93(6): 323-33.

Michael D. Regulation of increased blood flow (hy¬peremia) to muscles during exercise: A hierarchy of competing physiological needs. Physiol Rev. 2015; 95(2): 549–601. doi: 10.1152/physrev.00035.2013

Tache Y. Corticotrophin-releasing factor 1 activation in the central amygdale and visceral hyperalgesia. Neurogastroenterol Motil. 2015; 27(1): 1–6. doi: 10.1111/nmo.12495

Fliers E, Korbonits M, Romijn JA, editors. Clini¬cal Neuroendocrinology. Handbook of Clinical Neurology. Vol. 124. 1st ed. Elsevier: 2014. p. 2-432 (2014)

Luger TA, Lotti T. Neuropeptides: role in inflammatory skin diseases. J Eur Acad Dermatol Venereol. 1998; 10(3): 207–11.

Dhabhar FS. Acute stress enhances while chronic stress suppresses skin immunity. The role of stress hormones and leukocyte trafficking. Ann N Y Acad Sci. 2000; 917:876-93

Tian R, Hou G, Li D, Yuan T. A Possible Change Process of Inflammatory Cytokines in the Prolonged Chronic Stress and Its Ultimate Impli¬cations for Health. The Scientific World Journal 2014 (2014), Article ID 780616, 8. doi: 10.1155/2014/780616

Reiche EMV, Nunes SOV, Morimototress HK. Stress, depression, the immune system, and cancer. Lancet Oncol. 2004; 5(10):617–25. doi: 10.1016/ S1470-2045(04)01597-9

Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004; 130(4):601–30. doi: 10.1037/0033-2909.130.4.601

Suarez AL, Feramisco JD, Koo J, Steinhoff M. Psychoneuroimmunology of psychological stress and atopic dermatitis: pathophysiologic and therapeutic updates. Acta Derm Venereol. 2012; 92(1): 7–15. doi: 10.2340/00015555-1188

Lonne-Rahm SB, Rickberg H, El-Nour H, Marin P, Azmitia EC, Nordlind K. Neuroimmune mechanisms in patients with atopic dermatitis during chronic stress. J Eur Acad Dermatol Venereol. 2008; 22(1):11–8. doi: 10.1111/j.1468-3083.2007.02202.x

Tobin D, Nabarro G, Baart de la Faille H, van Vloten WA, van der Putte SC, Schuurman HJ. In¬creased number of immunoreactive nerve fibers in atopic dermatitis. J Allergy Clin Immunol. 1992; 90(4):613–22.

Järvikallio A, Harvima IT, Naukkarinen A. Mast cells, nerves and neuropeptides in atopic dermatitis and nummular eczema. Arch Dermatol Res. 2003; 295(1):2–7. doi:10.1007/s00403-002-0378-z

Schmid-Ott G, Jaeger B, Adamek C, Koch H, Lamprecht F, Kapp A, et al. Levels of circulating CD8 (+) T lymphocytes, natural killer cells, and eosinophils increase upon acute psychosocial stress in patients with atopic dermatitis. J Allergy Clin Immunol. 2001; 107:171–7. doi: 10.1067/mai.2001.111850

Lorton D, Bellinger D. Molecular Mechanisms Underlying β-Adrenergic Receptor-Mediated Cross- Talk between Sympathetic Neurons and Immune Cells. Int J Mol Sci. 2015; 16(3): 5635–65. doi: 10.3390/ijms16035635

About The Author

Filka Georgieva
Medical University of Varna

Department of Infectious Diseases, Parasitology and Dermatovenereology, Faculty of Medicine

Font Size