The role of psychological stress in skin disease

Background: 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.