Numerous case reports and studies have suggested that psychological stress may have a role in the onset or exacerbation of a variety of skin diseases.
Objective:
We review the literature pertaining to the role of psychological stress in the exacerbation of psoriasis, urticaria, eczematous dermatitis, herpesvirus infections, and other skin diseases; discuss potential mechanisms of stress-induced skin disease; and review studies and case reports of psychotherapeutic interventions that have been found helpful in the therapy of skin diseases.
Conclusions:
There is evidence linking psychological stress to exacerbation of certain skin diseases. Both the clinical and the basic science evidence, however, can be hard to interpret in light of the difficulty of defining and quantifying psychological stress as well as the questions regarding the etiologic significance of neuroimmunologic findings in skin diseases.
Get full access to this article
View all access options for this article.
References
1.
ShafiiMShafiiSL. Exploratory psychotherapy in the treatment of psoriasis: Twelve hundred years ago. Arch Gen Psychiatry1979; 36:1242–1245.
2.
Al'AbadieMSKentGGGawkrodgerDJ. The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions. Br J Dermatol1994; 130:199–203.
3.
SevilleRH. Stress and psoriasis: The importance of insight and empathy in prognosis. J Am Acad Dermatol1989; 20:97–100.
4.
GilbertARRodgersDARoenigkHH. Personality evaluation in psoriasis. Cleveland Clin Q1973; 40:147–150.
5.
FarberEMBrightRDNallML. Psoriasis: A questionnaire survey of 2144 patients. Arch Dermatol1968; 98:248–259.
6.
PolenghiMMMolinariEGalaC. Experience with psoriasis in a psychosomatic dermatology clinic. Acta Derm Venereol Suppl (Stockh)1994; 186:65–66.
7.
GuptaMAGuptaAKWatteelGN. Early onset (<40 years age) psoriasis is comorbid with greater psychopathology than late onset psoriasis: A study of 137 patients. Acta Derm Venereol1996; 76:464–466.
8.
HarvimaRJViinamakiHHarvimaIT. Association of psychic stress with clinical severity and symptoms of psoriatic patients. Acta Derm Venereol1996; 76:467–471.
9.
ParkBSYounJI. Factors influencing psoriasis: An analysis based upon the extent of involvement and clinical type. J Dermatol1998; 25:97–102.
10.
GastonLLassondeMBernier-BuzzangaJ. Psoriasis and stress: A prospective study. J Am Acad Dermatol1987; 17:82–86.
11.
GastonLCrombezJCLassondeM. Psychological stress and psoriasis: Experimental and prospective correlational studies. Acta Derm Venereol Suppl (Stockh)1991; 156:37–43.
12.
ArnetzBBFjellnerBEnerothP. Stress and psoriasis: Psychoendocrine and metabolic reactions in psoriatic patients during standardized stressor exposure. Psychosom Med1985; 47:528–541.
13.
SevilleRH. Psoriasis and stress. Br J Dermatol1977; 97:297–302.
14.
GuptaMAGuptaAKKirbyS. A psychocutaneous profile of psoriasis patients who are stress reactors: A study of 127 patients. Gen Hosp Psychiatry1989; 11:166–173.
15.
PerlmanHH. Remission of psoriasis vulgaris from the use of nerve-blocking agents. Arch Dermatol1972; 105:128–129.
16.
PincelliCFantiniFMagnoniC. Psoriasis and the nervous system. Acta Derm Venereol Suppl (Stockh)1994; 186:60–61.
17.
FarberEMLaniganSWReinG. The role of psychoneuroimmunology in the pathogenesis of psoriasis. Cutis1990; 46:314–316.
18.
HarvimaITViinamakiHNaukkarinenA. Association of cutaneous mast cells and sensory nerves with psychic stress in psoriasis. Psychother Psychosom1993; 60:168–176.
19.
Schmid–OttGJacobsRJagerB. Stress-induced endocrine and immunological changes in psoriasis patients and healthy controls: A preliminary study. Psychother Psychosom1998; 67:37–42.
20.
KantorSD. Stress and psoriasis. Cutis1990; 46:321–322.
21.
FarberEMNallL. Psoriasis: A stress-related disease. Cutis1993; 51:322–326.
22.
WinchellSAWattsRA. Relaxation therapies in the treatment of psoriasis and possible pathophysiologic mechanisms. J Am Acad Dermatol1988; 18:101–104.
23.
BenhardJDKristellerJKabat-ZinnJ. Effectiveness of relaxation and visualization techniques as an adjunct to phototherapy and photochemotherapy of psoriasis. J Am Acad Dermatol1988; 19:572–574.
24.
ZachariaeROsterHBjerringP. Effects of psychologic intervention on psoriasis: A preliminary report. J Am Acad Dermatol1996; 34:1008–1015.
25.
PriceMLMottahedinIMayoPR. Can psychotherapy help patients with psoriasis?Clin Exp Dermatol1991; 16:114–117.
26.
HughesHHEnglandRGoldsmithDA. Biofeedback and psychotherapeutic treatment of psoriasis: A brief report. Psychol Rep1981; 48:99–102.
27.
GoodmanM. An hypothesis explaining the successful treatment of psoriasis with thermal biofeedback: A case report. Biofeedback Self Regul1994; 19:347–352.
28.
BenoitLJHarrellEH. Biofeedback and control of skin cell proliferation in psoriasis. Psychol Rep1980; 46:831–839.
29.
FrankelFH. Hypnosis as a treatment method in psychosomatic medicine. Int J Psychiatry Med1975; 6:75–85.
30.
FrankelFHMischRC. Hypnosis in a case of long-standing psoriasis in a person with character problems. Int J Clin Exp Hypn1973;21:121–130.
31.
SengTKNeeTS. Group therapy: A useful and supportive treatment for psoriasis patients. Int J Dermatol1997; 36:110–112.
32.
SchulteMBCormaneRHvan DijkE. Group therapy of psoriasis. Duo formula group treatment (DFGT) as an example. J Am Acad Dermatol1985; 12:61–66.
33.
WalshD. Using aromatherapy in the management of psoriasis. Nurs Stand1996; 11:53–56.
34.
TauskFWhitmoreSE. A pilot study of hypnosis in the treatment of patients with psoriasis. Psychother Psychosom1999; 68:221–225.
35.
LearyMRRappSRHerbstKC. Interpersonal concerns and psychological difficulties of psoriasis patients: Effects of disease severity and fear of negative evaluation. Health Psychol1998; 17:530–536.
36.
FortuneDGMainCJO'SullivanTM. Quality of life in patients with psoriasis: The contribution of clinical variables and psoriasis-specific stress. Br J Dermatol1997; 137:755–760.
37.
AbelEAMooreUSGlatheJP. Psoriasis patient support group and self-care efficacy as an adjunct to day care center program. Int J Dermatol1990; 29:640–643.
38.
SevilleRH. Psoriasis and stress. II. Br J Dermatol1978; 98:151–153.
39.
GuptaMAGuptaAKHabermanHF. Psoriasis and psychiatry: An update. Gen Hosp Psychiatry1987; 9:157–166.
40.
CzubalskiKRudzkiE. Neuropsychic factors in physical urticaria. Dermatologica1977; 154:1–4.
ArnetzBBFjellnerBEnerothPKallnerA. Endocrine and dermatological concomitants of mental stress. Acta Derm Venereol1991; 156:9–12.
55.
GilKMKeefeFJSampsonHA. The relation of stress and family environment to atopic dermatitis symptoms in children. J Psychosom Res1987; 31:673–684.
56.
EdwardsAEShellowWVWrightET. Pruritic skin diseases, psychological stress, and the itch sensation: A reliable method for the induction of experimental pruritus. Arch Dermatol1976; 112:339–343.
57.
ElyNEVerneyJWHolmesTHG. Experimental studies of skin inflammation. Psychosom Med1963; 25:264–283.
58.
Buske-KirschbaumAJobstSPsychD. Attenuated free Cortisol response to psychosocial stress in children with atopic dermatitis. Psychosom Med1997; 59:419–426.
59.
GrahamDTWolfS. The relation of eczema to attitude and vascular reactions of the human skin. J Lab Clin Med1953; 42:238–254.
60.
WestonWLHuffJC. Atopic dermatitis: Etiology and pathogenesis. Pediatr Ann1976; 5:759–762.
61.
KoldysKWMeyerRP. Biofeedback training in the therapy of dyshidrosis. Cutis1979; 24:219–221.
62.
HaynesSWilsonCJaffeeP. Biofeedback treatment of atopic dermatitis: Controlled case studies of eight cases. Biofeedback Self Regul1979; 4:195–209.
63.
KoblenzerCS. Psychotherapy for intractable inflammatory dermatoses. J Am Acad Dermatol1995; 32:609–612.
64.
ScottMJ. Hypnosis in skin and allergic diseases. Springfield, IL: Charles C. Thomas, 1960.
65.
FaulstichMEWilliamsonDA. An overview of atopic dermatitis: Toward a bio-behavioral integration. J Psychosom Res1985; 29:647–654.
66.
RatliffRGSteinNH. Treatment of neurodermatisis by behavior therapy: A case study. Behav Res ther1982; 20:251–260.
67.
BarLJHKuypersBRM. Behavior therapy in dermatological practice. Br J Dermatol1973; 88:582–598.
68.
LongoDKoehnK. Psychosocial factors and recurrent genital herpes: A review of prediction and psychiatric treatment studies. Int J Psychiatry Med1993; 23:99–117.
69.
SchmidtDDZyzanskiSEllnerJ. Stress as a precipitating factor in subjects with recurrent herpes labialis. J Fam Pract1985; 20:359–366.
70.
GreenJKocsisA. Psychological factors in recurrent genital herpes. Genitourin Med1997; 73:253–258.
71.
HoonEFHoonPWRandKH. A psycho-behavioral model of genital herpes recurrence. J Psychosom Res1991; 35:25–36.
72.
RandKHHoonEFMasseyJK. Daily stress and recurrence of genital herpes simplex. Arch Intern Med1990; 150:1889–1893.
73.
PadgettDASheridanJFDorneJ. Social stress and the reactivation of latent herpes simplex virus type 1. Proc Natl Acad Sci USA1998; 95:7231–7235.
74.
BlondeauJMAokiFYGlavinGB. Stress-induced reactivation of latent herpes simplex virus infection in rat lumbar dorsal root ganglia. J Psychosom Res1993; 37:843–849.
75.
SchmidtDDSchmidtPMCrabtreeBF. The temporal relationship of psychosocial stress to cellular immunity and herpes labialis recurrences. Fam Med1991; 23:594–599.
76.
GlaserRKiecolt-GlaserJK. Chronic stress modulates the virus-specific immune response to latent herpes simplex virus type 1. Ann Behav Med1997; 19:78–82.
77.
VanderPlateCKerrickG. Stress reduction treatment of severe recurrent genital herpes virus. Biofeedback Self Regul1985; 10:181–188.
78.
KooJYSmithLL. Psychologic aspects of acne. Pediatr Dermatol1991; 8:185–188.
79.
Kiecolt-GlaserJKMaruchaPTMalarkeyWB. Slowing of wound healing by psychological stress. Lancet1995; 346:1194–1196.
80.
TamirAOphirJBrennerS. Pemphigus vulgaris triggered by emotional stress. Dermatology1994; 189:210.
