Stress has long thought to worsen inflammatory skin conditions, but proving a causal link between stress and conditions such as acne, psoriasis and rosacea, is a challenge.

The affects of stress on skin in terms of worsening some conditions and aging were discussed in an recent article by Richard D. Granstein, MD, FAAD, the George W. Hambrick Jr., professor and chairman of the department of dermatology at Weill Cornell Medical College in New York, in a press release from the American Academy of Dermatology. 

“Nearly everyone has some form of stress in their life, so it’s difficult to determine whether stress can actually make the skin’s appearance worse,” said Granstein. “However, it’s been known for a long time that the nervous system, which processes our stress, has an impact on conditions such as psoriasis.”

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Research has shown if nerve pathways to an area of a patient’s skin affected by psoriasis are interrupted, the psoriasis improves. The condition will also improve if local anesthetic is injected into psoriasis patches, said Granstein.

“This information strongly suggests that nerves play a role in how psoriasis operates,” he explained.

Experimental data support the idea that the nervous system and stress affect inflammatory skin conditions in humans. Many types of cells in the skin, including immune cells and endothelial cells, can be regulated by neuropeptides and neurotransmitters. Stress can result in the skin’s nerve endings releasing an increased level of these chemicals. When this occurs, it can affect how and at what level our body responds to many important functions and can contribute to the symptoms of stress that we feel. The release of these chemicals also can lead to inflammation of the skin.

“If we could block specific steps in certain pathways between the nervous system and the skin, without impacting the whole body, we would likely have new ways to prevent or treat some skin disorders,” Granstein said. “We’re gaining a greater understanding of the mechanisms underlying many skin conditions, which will help us develop new therapies.”

Additional research is needed in this area to further understand the role of the nervous system and stress on inflammatory skin conditions, especially because other factors can contribute to the problem, including genetics, according to Grainstein.

Patients with these conditions should be asked about stress in their lives and whether they believe stress could be impacting their condition. Stress-reduction techniques such as meditation, yoga, or tai chi, can be suggested to patients; however, they should continue their treatment plan as prescribed by their health-care provider.

Regarding stress and how it ages the skin, Granstein said research has not proven that stress causes skin aging, but there is some animal data to suggest that stress could have an impact on the development of skin cancer.

“When exposed to ultraviolet radiation, stressed mice developed skin cancers more quickly than mice that were not exposed to stress,” he said.