How Is Stress Linked to Atopic Dermatitis?

Reviewed by: HU Medical Review Board | June 2017

Atopic dermatitis (AD) is caused by a combination of factors, including genetic predisposition, environmental factors, and dysfunctions in the skin barrier and the immune system. One of the environmental factors that plays a role in the development of atopic dermatitis is emotional stress.

Stress and the immune system

Stress affects the immune system and the neuroendocrine system, which is responsible for releasing hormones that act as chemical messengers to regulate various systems like digestion, respiration, blood pressure, and heart rate.1

How are stress and eczema related?

In addition to the development of atopic dermatitis, stress can also trigger a relapse. Several research studies have demonstrated an association between stressors and worsening atopic dermatitis or onset of flares. In addition, living with a chronic skin condition like AD can increase stress and negatively impact an individual’s quality of life.1

Stress and immune system dysfunction

One of the key characteristics of atopic dermatitis is a dysfunction in the immune system, which leads to chronic inflammation in the skin. Stress seems to worsen this dysfunction of the immune response, creating more of the inflammatory reaction.

Eczema and an increased response to stress

People with atopic dermatitis have an increased response to stress, including a higher amount of cortisol released in the body. Cortisol is known as the “stress hormone” and is best known for its involvement in the “fight-or-flight” response of the body. Early exposure to stress in children can lead to a persistent sensitization, which increases a vulnerability to stress later in life.

Stress and skin barrier dysfunction

Stress negatively affects the skin barrier function, which can lead to more moisture loss and an increased susceptibility to infection. People with AD already have a compromised skin barrier due to the reduced amount of the protein filaggrin, which plays an important role in the structure and formation of the skin layers. Stress in people with eczema can further reduce the skin’s ability to keep germs out and keep water in.1

Managing stress to reduce eczema flares

Because of the impact of stress on atopic dermatitis, interventions that lower stress or increase relaxation have been used as adjuncts to standard topical treatments. In addition to teaching relaxation techniques and improving stress management, several strategies aim to reduce the distress around the itch of eczema, which is persistent and distressing.

Reducing the eczema itch

The itch with atopic dermatitis can cause people to scratch their skin until they bleed, which increases the chance of infection. In addition, the scratching maintains the skin lesions and can lead to lichenification, or a thickening of the skin that is always itchy. Therapies that help people prevent scratching and increase their ability to handle the distress that is associated with itchiness can help treat atopic dermatitis.2

Psychological approaches to eczema treatment

Psychological approaches that have been studied in people with AD include:

  • Relaxation techniques
  • Psychotherapy (also known as “talk therapy”)
  • Stress management
  • Habit reversal training (aimed at reducing the frequency of scratching)
  • Relaxation with imagery2

Some research studies have shown that people with AD who receive psychological therapy along with standard medical care have significantly larger improvements in their skin condition than those who just received standard medical care or skin care education. The addition of psychological treatment also reduces the amount of topical steroids needed.1,2

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