There is a well-known association between psychosocial stress and psoriasis. However, the underlying mechanism of stress-induced exacerbation of psoriasis is not well understood. Until recently, the majority of evidence has pointed to alterations of the endocrine and peripheral nervous systems, while less is known about changes in the immune system despite psoriasis being a chronic inflammatory skin disease. In the past few years, there has been an increase in data concerning evidence for the immune system as a mediator between stress and psoriasis, which we now review. Possible immunological mechanisms explored include increased leukocyte trafficking to the skin, elevations in proinflammatory cytokines, and reductions in anti-inflammatory cytokines in response to psychosocial stress.
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