Stress, Skin Disorders, and Psychoneuroimmunology

With a history of about 30 years, psychoneuroimmunology (PNI) studies the interactions among psychological activities, the nervous system, and the immune system. In the area of dermatology, many dermatologic diseases have been found to be related to mental and psychological mechanisms. Psychological mediated pathogenesis may be involved in the development of skin lesions. Acute and chronic emotional stressors and various psychiatric disorders have been connected to a broad range of skin disorders, including acnes, alopecia, atopic dermatitis, herpes simplex, lichen planus, pruritus, psoriasis, seborrheic dermatitis, urticaria, viral warts, and vitiligo (Lugović-Mihić et al., 2013; Reich et al., 2010).

The psycho-neuro-immuno-cutaneous complex system may play a critical role in the interactions between the mind and the skin, including the brain activities involving neuropeptides and neurotrophins, the immune functions involving lymphokines and interleukins, and the skin tissues (Lugović-Mihić et al., 2013). These different systems (e.g., the skin, nervous, and immune system) need to be studied as a multidirectional complex to elucidate the communications and interactions among them.

For example, associations have been found between dermal mast cells and sensory nerve endings, with the production of proinflammatory mediators. Various cytokines and mediators generated in the skin may participate in the pathogenesis of skin diseases. In addition, the hypothalamic-pituitary-adrenal (HPA) axis may have a significant role in the pathogenic processes of the inflammation in these skin disorders.


Lugović-Mihić L, Ljubesić L, Mihić J, Vuković-Cvetković V, Troskot N, Situm M. Psychoneuroimmunologic aspects of skin diseases. Acta Clin Croat. 2013 Sep;52(3):337-45.

Reich A, Wójcik-Maciejewicz A, Slominski AT. Stress and the skin. G Ital Dermatol Venereol. 2010 Apr;145(2):213-9.

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