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How Is Stress Linked to Atopic Dermatitis?

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 AD is emotional stress. 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

In addition to the development of AD, stress can also trigger a relapse. Several research studies have demonstrated an association between stressors and worsening AD 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

How stress affects atopic dermatitis

One of the key characteristics of AD 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. People with AD 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 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 AD can further reduce the skin’s ability to keep germs out and keep water in.1

Treating atopic dermatitis with psychological approaches

Because of the impact of stress on AD, 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 AD, which is persistent and distressing.

The itch with AD 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 AD.2

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

Emily Downward | June 2017
  1. Arndt, J., Smith, N. & Tausk, F. Stress and atopic dermatitis. Curr Allergy Asthma Rep. 2008;8:312. doi:10.1007/s11882-008-0050-6
  2. Ehlers A, Stangier U, Gieler U. Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention. J of Consulting and Clin Psych. 1995;63(4):624-635.