Stress & Psoriasis
Stress, the immune response, and inflammatory skin conditions
Stress—we all experience it. How much it bothers us, which of our systems
is most upset by it, how long before its effects become apparent—in these
and countless other ways, the toll stress exacts on us varies widely from person
to person. Unfortunately for many, its impact shows up worst on our largest and
most outwardly visible organ, the skin. For people with psoriasis, acne, dermatitis
and other chronic inflammatory skin conditions with an emotional component, distressing
flare-ups may seem to appear overnight in response to increased anxiety and pressure.
We've known for decades that stress can cause or aggravate skin conditions such
as psoriasis, eczema, rosacea, acne, hives, dermatitis and herpes, though stress
is not the sole antagonist of skin health. Heredity and environment too have a role
to play, but the focus of this article is on how the molecules of stress contribute
to inflammatory skin conditions by way of our immune systems. Research is shedding
new light on the mechanisms underlying this immune-mediated response. This knowledge
is accompanied by the hope that by understanding and managing stress in our lives,
we can reduce outbreaks and improve the skin's appearance.
Let's take a look at stress from the skin's point of view, then delve a little more
deeply into stress-induced exacerbations of skin conditions like psoriasis and dermatitis.
Once we gain a better understanding of the process, we can take steps to strengthen
the immune response and counteract the damaging effects of stress.
The stress response and skin—too much of a good thing
At the dawn of ages, humans evolved a physiological system for dealing with danger
called the "fight or flight" response. This system, which is mediated
through the sympathetic division of our autonomic nervous system, enables us to
react quickly to any challenge—to battle our foes, to outwit them or, alternatively,
to flee rapidly in the opposite direction.
Once the brain sounds the alarm, the hypothalamic-pituitary-adrenal (HPA) axis leaps
into action, cueing the adrenal glands to pump out cortisol, adrenaline (epinephrine),
and noradrenaline (norepinephrine). These stress hormones target certain organs,
priming them to produce and utilize the burst of energy needed to engage in violence
or flee from it. Once the danger's passed, the body is meant to return to homeostasis,
and the mind to a state of calm.
While this design served us well for millennia, we rarely face the kind of overt
physical danger nowadays that requires such an intense physiological response. Regardless,
our bodies remain hardwired for action. Because our nervous systems are programmed
to respond this way whether a threat is real or simply a perceived one, we tend
to become hyperaroused to all kinds of stimuli that do not in actuality threaten
Immune function, T cells and the skin
Scientists are investigating the impact of acute (sudden) and chronic (ongoing)
stress on relevant immune functions in patients with inflammatory skin conditions
that are mediated by the immune system, such as psoriasis and dermatitis. In a series
of recent studies published in the Journal of Clinical Endocrinology & Metabolism,
Psychoneuroendocrinology, and Brain, Behavior and Immunity, German researchers evaluated
some of the differences between the effects that stress triggers in these patients.
A diminished responsiveness of the HPA axis was thought to explain susceptibility
to allergic inflammation in dermatitis patients. They also recognized that in psoriasis
patients, T1 lymphocytes tend to increase inflammation that results in epidermal
hyperproliferation and psoriatic plaques, whereas in patients with dermatitis the
same psychosocial stressor will induce more of a T2-mediated allergic response.
In one study comparing the responsiveness of the HPA axis in psoriasis patients
against a control group, both the patients and the normal group showed elevated
ACTH, a hormone produced and secreted by the pituitary gland but also secreted by
immune cells under duress, in response to stressful stimuli. In a normal stress
response, ACTH in turn stimulates the adrenal cortex to produce corticosteroids,
mainly cortisol, and in this study, cortisol levels were likewise found to be equivalent
in both psoriasis and control groups. In other words, unlike dermatitis patients
in prior studies, psoriasis patients demonstrated normal HPA axis responsiveness.
However, what was noted to be different in psoriasis patients was increased reactivity
in another portion of the nervous system known as the sympathetic adrenomedullary
In several studies, both subjects with psoriasis and those with atopic dermatitis
demonstrated elevated epinephrine and norepinephrine levels in response to the stress
test as compared to normal subjects. While more studies are needed to clarify the
pathways involved, these and other altered immune responses may explain how stress
triggers flare-ups of psoriasis, dermatitis, and other immune-mediated skin conditions.
* Buske-Kirschbaum, A., et al. 2007. Altered distribution of leukocyte subsets and
cytokine production in response to acute psychosocial stress in patients with psoriasis
vulgaris. Brain Behav. Immun. 21 (1), 92-99.
Buske-Kirschbaum, A., et al. 2006. Endocrine stress responses in TH1-mediated chronic
inflammatory skin disease (psoriasis vulgaris)—do they parallel stress-induced
endocrine changes in TH2-mediated inflammatory dermatoses (atopic dermatitis)? Psychoneuroendocrinology,
31 (4), 439-446.
Buske-Kirschbaum, A., et al. 2002. Altered responsiveness of the hypothalamus-pituitary-adrenal
axis and the sympathetic adrenomedullary system to stress in patients with atopic
dermatitis. J. Clin. Endocrin. Metab., 87 (9), 4245-4251.
This is only problematic because people in the modern world are chronically "stressed-out"—so
much so that this condition seems the norm. But for the most part, the preponderance
of today's stressors are perceptions rather than reality—the
long commute, the irksome boss, the upcoming PowerPoint presentation, the bills
to pay, the negative performance review, the incessant bark of a neighbor's dog.
Experts refer to this package of stressful perceptions in modern life as "psychosocial
stress." In fact, a new field of medicine has arisen to address how our emotional
tone affects our skin: psychodermatology.
The molecules of stress and your skin
Some people feel they have little reprieve from unremittent stress. When the body's
pathways aren't supported adequately for clearing the molecules of stress, their
detrimental effects show up on our skin.
With chronic stress, the body increases its production of cortisol, one
of two hormones responsible for elevating blood pressure and priming the body for
action. As a side effect of excess cortisol, the immune system is suppressed and
the inflammatory process increases. (See the box at left for more on the immune-mediated
effects of stress on the skin.) With this comes skin that is more sensitive and
prone to infection and troublesome outbreaks such as acne, psoriasis, hives and
During emotional stress, the blood flows to the body's fight-or-flight response
regards as critical to coping with stress: the heart, lungs and musculoskeletal
system. Lack of blood flow to the digestive system can impair digestion, which in
turns jeopardizes skin health in many ways. Without an adequate blood supply, the
digestive organs cannot fully absorb the nutrients in the food we eat.
Nor can the body under stress properly metabolize nutrients or optimally rid itself
of waste products. Other organs in the metabolic pathway, including the gallbladder,
intestines, kidneys, and liver, as well as the lymphatic system may become compromised
by chronic stress. As a result, responsibility for clearing toxins may get handed
off to the skin, contributing to outbreaks of acne, psoriasis, dermatitis, hives,
and other skin eruptions.
It is also known that stress can cause insomnia. A good night's sleep is vital for
maintaining healthy skin. The skin repairs itself best at night, especially between
the hours of 11:00 pm and 4:00 am. When we are in a state of deep sleep the body
releases growth hormone and other healing chemicals to help repair damaged cells.
These are just some of the broader physiological responses to stress that can add
up to troubled skin. Together their effects have a way of compounding one another,
but by overcoming one of these problems and by providing the body with greater support,
you can offset the adverse effects of stress on your skin's health.
How does the skin view stress?
Our skin can't readily distinguish between different kinds of stress. Like the body
as a whole, most of the key stressors that upset it—whether poor diet, a demanding
job, cigarette smoke or insufficient sleep—are viewed through much the same
lens. That means that any one or all of these various "insults" may cause
or worsen a particular skin condition.
It also means that as with other major organs, how well your skin is prepared to
deal with both daily and cumulative stress depends greatly on its organ reserve1.
Though this term is generally not applied to the skin as an organ per se, it's useful
to describe what amounts to our skin's physiological capacity to respond to stress.
Causes of stress-induced skin outbreaks—you have more control
than you think!
Resilience to the damaging effects of stress—whether we're talking about our
skin as an organ or our overall health—depends on two types of factors:
1) those over which we have no control; and
2) those in which we have a say
So while the tendency to develop skin problems is influenced to some degree by our
genetics—indeed numerous skin conditions, including psoriasis, are believed
to have a genetic component—our skin's overall health is governed by factors
we can control: namely, environmental exposures, dietary and lifestyle choices.
The key word here is choices. It's axiomatic that we're presented daily
with the opportunity to improve or compromise our skin's health. By avoiding damaging
environmental toxins, as well as by choosing a less stressful lifestyle and a diet
that supports skin physiology from the inside out, we can lessen inflammation, improve
our immune response, and make a visible difference. Studies demonstrate that all
these efforts can translate into fewer outbreaks, an improved appearance and—best
of all—a slower aging process!
Coping with stress—the DermaHarmony approach
There are many natural steps we can take to mediate the stress response and improve
our skin. Chief among these are mind-body techniques, counseling and support groups,
regular exercise, optimal nutrition and supplementation, and detoxification. You
need not adopt all the measures at once but can choose from among the steps listed
below, which are intended to offer a blueprint for reining in the stress in your
- Explore mind-body techniques. Numerous schools of mind-body
techniques exist for achieving a physical state of deep rest. These include various
types of meditation, yoga, guided imagery, and the Relaxation Response. All these
and similar techniques serve to relax the nervous system, decrease anxiety, improve
sleep, and boost the body's immune response. Additional insight into the psychological
aspects of stress can be gained through counseling, which can lead us to a better
understanding of how emotions may be at the root of skin conditions.
- Move your body! Exercise is an excellent way to blow off
stress and tension. Its physiochemical and psychological benefits are too numerous
to list here, but include better oxygenation of all body tissues, improved self-esteem
and mood regulation, improved resilience to stress and infection, and deeper, more
- Consider a detox regime. Stress, improper dieting, and
lack of exercise can all compromise the body's ability to metabolize and rid itself
of toxins. Periodic detoxification can help
the liver and other digestive organs clear toxins so they don't accumulate and show
up later in the skin. If you've never tried a cleansing diet or program, this may
be the perfect time to give it a try.
- Get a good night's sleep. During the day our bodies and
minds experience a great deal of stress, and as we explained above, the skin cannot
distinguish between all the factors that perturb it. It is hard to overstate how
important it is for people under stress —particularly those who suffer its
effects most in the form of troubled skin— to get a solid night's sleep. No
matter how difficult it may seem, turning in at a reasonable hour—preferably
by 10:00 p.m.—can work wonders on the body's overall organ reserve. It's one
of the best things you can do for your adrenal glands, and hence your immune response,
and we can promise you that getting 8 hours of sleep a night will improve your skin's
- Optimize your diet and digestion. Proper dietary intake
and good digestion are crucial for keeping the skin healthy.
Your Healing Guide by Deirdre Earls offers many great tips on how
different foods can improve conditions of the skin. Choosing high-grade
probiotic supplements will also facilitate proper digestion and optimize
absorption of the nutrients in your food.
- Don't forget your vitamins. Taking a high-quality multivitamin-mineral
complex daily is one of the least expensive and simplest ways for stressed-out people
to ensure they bridge dietary gaps and get the nutrients their bodies need to respond
to stress. It's well-known that a number of vitamins and minerals are essential
for nervous system health, particularly the vitamin-B complex.
Vitamins A, C and
E are powerful antioxidants that help fight free radicals that damage
the cells. Vitamin C is also important
for a healthy immune system; vitamin E
has healing properties, and vitamin D3
provides relief from many inflammatory conditions. In fact, vitamin D supplementation
is frequently suggested for improving skin health, where much of the population
gets inadequate sun exposure and dietary sources are limited. In addition, having
adequate calcium and magnesium on board is a prerequisite for restful sleep. These
are just some of the most important nutrients for an optimally functioning nervous
and immune system. Click here to learn more.
Healthier skin through managing stress
Every day researchers shed new light on the effects of stress on inflammatory skin
conditions such as psoriasis, eczema, and dermatitis. We hope this information helps
provide you with a better understanding of your own capacity to control stress and
its impact on your immune system and skin condition. Rather than allowing stress
to control your life and your appearance, take it one step at a time, and you will
see improvement on the outside of the work you're doing on the inside. Our skin
has a miraculous ability to heal when given the support it needs.
(For more general information and guidance, see our article on
Stress and your skin.)
1This can be defined as "the difference between basal and maximum
organ function." (Montgomery, H. 2000. Cardiac reserve: Linking physiology
and genetics. Intensive Care Med., 26 [Suppl. 1], S137-S144.)
How We Help
Visit DermaHarmony to learn more about our alternative, science-based approach to psoriasis and other common skin conditions. At DermaHarmony our goals are to educate chronic skin care sufferers about the latest alternative research in dermatology, encourage a holistic approach to healthy skin and wellness, and to support our readers in every way we can. Our programs promote healthy skin from the inside out—with pharmaceutical-grade nutritional supplements, topical treatments, expert dietary guidance, and a whole-person approach to health and wellness. Learn more about our programs or call us toll-free at 1-800-827-3730. Our support desk is open 9:00 a.m.–6:00 p.m. ET, Monday–Friday.
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Inverse psoriasis is found in skin folds such as the armpits, groin, under the breasts, around genitals and the buttocks. Inverse psoriasis is more common in people who are overweight and people with deep skin folds where friction and sweating occur.
Plaque psoriasis is the most typical form of this skin condition—4 out of 5 people with psoriasis have plaque psoriasis. The technical or scientific name for plaque psoriasis is psoriasis vulgaris (vulgaris means "common").
In pustular (PUHS-choo-ler) psoriasis, blisters of noninfectious pus appear on the skin. Attacks of pustular psoriasis may be triggered by medications, infections, stress, or exposure to certain chemicals.
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Principal Authors: M. Ofiyeva
Date of Publication: 10/05/2007