Advertisement

Psychological stress and epidermal barrier function

      Abstract

      The skin is the organ that acts as a barrier between the outer and inner environments of the body. It is thus exposed not only to a wide variety of physical, chemical, and thermal insults from the outside world but also to inner endogenous stimuli. Stress, once an abstract psychologic phenomenon, has taken research's center stage in recent years. The “mind–body connection” is now less of an obscure New Age term and more of an elaborate physiologic pathway by which bilateral communication occurs between body and brain. Dermatologists and dermatologic patients have long acknowledged the effect of stress on the skin and its capability to initiate, maintain, or exacerbate several skin diseases. Because disruption of epidermal barrier integrity may be important in the development of some common skin diseases, it is crucial to understand its vulnerability to psychologic stress.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Elias P.M.
        • Feingold K.R.
        Lipids and the epidermal water barrier metabolism, regulation and pathophysiology.
        Semin Dermatol. 1992; 11: 176-182
        • Elias P.M.
        • Menon G.K.
        Structural and lipid biochemical correlates of the epidermal permeability barrier.
        Adv Lipid Res. 1991; 24: 1-26
        • Aberg K.M.
        • Radek K.A.
        • Choi E.H.
        • et al.
        Psychological stress downregulates epidermal antimicrobial peptide expression and increases severity of cutaneous infections in mice.
        J Clin Invest. 2007; 117: 3339-3349
        • Altemus M.
        • Rao B.
        • Dhabhar F.S.
        • Ding W.
        • Granstein R.D.
        Stress-induced changes in skin barrier function in healthy women.
        J Invest Dermatol. 2001; 117: 309-317
        • Denda M.
        • Tsuchiya T.
        • Hosoi J.
        • Koyama J.
        Immobilization-induced and crowded environmental-induced stress delay barrier recovery in murine mice.
        Br J Dermatol. 1998; 138: 780-785
        • Denda M.
        • Tsuchiya T.
        • Elias P.M.
        • Feingold K.R.
        Stress alters cutaneous permeability barrier homeostasis.
        Am J Physiol Regul Integr Comp Physiol. 2000; 278: R367-R372
        • Garg A.
        • Chren M.M.
        • Sands L.P.
        • et al.
        Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-associated skin disorders.
        Arch Dermatol. 2001; 137: 53-59
        • O’Sullivan R.L.
        • Lipper G.
        • Lerner E.A.
        The neuro-immuno-cutaneous-endocrine network: relationship of mind and skin.
        Arch Dermatol. 1998; 134: 1431-1435
        • Slominski A.
        A nervous breakdown of the skin: stress and the epidermal barrier.
        J Clin Invest. 2007; 117: 3166-3169
        • Farber E.M.
        • Lanigan S.W.
        • Boer J.
        The role of cutaneous sensory nerves in the maintenance of psoriasis.
        Int J Dermatol. 1990; 29: 418-420
        • Van Eck M.
        • Berkhof H.
        • Nicolson N.
        • Sulon J.
        The effects of perceived stress, traits, mood states, and stressful daily events on salivary cortisol.
        Psychosom Med. 1996; 58: 447-458
        • Pruessner J.C.
        • Gaab J.
        • Hellhammer D.H.
        • et al.
        Increasing correlations between personality traits and cortisol stress responses obtained by data aggregation.
        Psychoneuroendocrinology. 1997; 22: 615-625
        • Tsuchiya T.
        • Horil I.
        Epidermal cell proliferative activity assessed by proliferating cell nuclear antigen (PCNA) decreased following immobilization-induced stress in male Syrian hamsters.
        Psychoneuroendocrinology. 1996; 21: 111-117
        • Allen P.I.
        • Batty K.A.
        • Dodd C.A.
        • et al.
        Dissociation between emotional and endocrine responses preceding an academic examination in male medical students.
        J Endocrinol. 1985; 107: 163-170
        • Laurence E.B.
        • Christophers E.
        Selective action of hydrocortisone on promitotic epidermal cells in vivo.
        J Invest Dermatol. 1976; 66: 222-229
        • Sheu H.M.
        • Tai C.L.
        • Kuo K.W.
        • Yu H.S.
        • Chai C.Y.
        Modulation of epidermal terminal differentiation in patients after long-term topical corticosteroids.
        J Dermatol. 1991; 18: 454-464
        • Kao J.S.
        • Fluhr J.W.
        • Man M.Q.
        • et al.
        Short term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: inhibition of epidermal lipid synthesis accounts for functional abnormalities.
        J Invest Dermatol. 2003; 120: 456-464
        • Menon G.K.
        • Feingold K.R.
        • Elias P.M.
        Lamellar body secretory response to barrier disruption.
        J Invest Dermatol. 1992; 98: 279-289
        • Choi E.H.
        • Brown B.E.
        • Crumrine D.
        • et al.
        Mechanisms by which psychological stress alters cutaneous permeability barrier homeostasis and stratum corneum integrity.
        J Invest Dermatol. 2005; 124: 587-595
        • Ghadially R.
        • Brown B.E.
        • Sequeira-Martin S.M.
        • Feingold K.R.
        • Elias P.M.
        The aged epidermal permeability barrier. Structural, functional, and lipid biochemical abnormalities in humans and senescent murine model.
        J Clin Invest. 1995; 95: 2281-2290
        • Maggi C.A.
        • Meli A.
        The sensory-efferent function of capsaicin-sensitive sensory neurons.
        Gen Pharmacol. 1998; 19: 1-43
        • Giannetti A.
        • Girolomoni G.
        Skin reactivity to neuropeptides in atopic dermatitis.
        Br J Dermatol. 1989; 121: 681-688
        • Anand P.
        • Springall D.R.
        • Blank M.A.
        • et al.
        Neuropeptides in skin disease: increased VIP in eczema and psoriasis but not axillary hyperhidrosis.
        Br J Dermatol. 1991; 124: 547-549
        • Eedy D.J.
        • Johnston C.F.
        • Shaw C.
        • Buchanan K.D.
        Neuropeptides in psoriasis: an immunocytochemical and radioimmunoassay study.
        J Invest Dermatol. 1991; 96: 434-438
        • Naukkarien A.
        • Nickoloff B.J.
        • Farber E.M.
        Quantification of cutaneous sensory nerves and their substance P content in psoriasis.
        J Invet Dermatol. 1989; 92: 126-129
        • Wilkinson D.I.
        Mitogenic effect of substance P and CGRP on kertinocytes.
        J Cell Biol. 1989; 107: 509
        • Haegerstrand A.
        • Jonzon B.
        • Dalsgaard C.J.
        • Nilsson J.
        Vasoactive intestinal polypeptide stimulates cell proliferation and adenylate cyclase activity of cultured human keratinocytes.
        Proc Natl Acad Sci U S A. 1989; 86: 5993-5996
        • Hosoi J.
        • Murphy G.F.
        • Egan C.L.
        • et al.
        Regulation of Langerhans cell function by nerves containing calcitonin gene-related peptide.
        Nature. 1993; 363: 159-162
        • Elias P.M.
        Stratum corneum defensive function: an integrated view.
        J Invest Dermatol. 2005; 125: 183-200
        • Glaser R.
        Stress-associated immune dysregulation and its importance for human health: a personal history of psychoneuroimmunology.
        Brain Behav Immun. 2005; 19: 3-11
        • Rein M.
        Stress and genital herpes recurrences in women.
        JAMA. 2000; 283: 1394
        • Hunzeker J.
        • Padgett D.A.
        • Sheridan P.A.
        • Dhabhar F.S.
        • Sheridan J.F.
        Modulation of natural killer cell activity by restraint stress during an influenza A/PR8 infection in mice.
        Brain Behav Immun. 2004; 18: 526-535
        • Tausk F.
        • Elenkov I.
        • Moynihan J.
        Psychoneuroimmunology.
        Dermatol Ther. 2008; 21: 22-31
        • Ghadially R.
        • Reed J.T.
        • Elias P.M.
        Stratum corneum structure and function correlates with phenotype in psoriasis.
        J Invest Dermatol. 1996; 107: 558-564
        • Leung D.Y.
        • Boguniewicz M.
        • Howell M.D.
        • Nomura I.
        • Hamid Q.A.
        New insights into atopic dermatitis.
        J Clin Invest. 2004; 113: 651-657
        • Sator P.G.
        • Schmidt J.B.
        • Honigsmann H.
        Comparison of epidermal hydration and skin surface lipids in healthy individuals and in patients with atopic dermatitis.
        J Am Acad Dermatol. 2003; 48: 352-358
        • Arnetz B.B.
        • Fjellner B.
        • Eneroth P.
        • Kallner A.
        Stress and psoriasis: psychoendocrine and metabolic reactions in psoriatic patients during standardized stressor exposure.
        Psychosom Med. 1985; 47: 528-541
        • Weigi B.A.
        Immunoregulatory mechanisms and stress hormones in psoriasis.
        Int J Dermatol. 1998; 37: 350-357
        • Aberg K.M.
        • Man M.Q.
        • Gallo R.L.
        • et al.
        Co-regulation and interdependence of the mammalian epidermal permeability and antimicrobial barriers.
        J Invest Dermatol. 2008; 128: 917-925
        • Sugarman J.L.
        • Fluhr J.W.
        • Fowler A.J.
        • et al.
        The objective severity assessment of atopic dermatitis score: an objective measure using permeability barrier function and stratum corneum hydration with computer-assisted estimates for extent of disease.
        Arch Dermatol. 2003; 139: 1417-1422
        • Elias P.M.
        Skin barrier function.
        Curr Allergy Asthma Rep. 2008; 8: 299-305
        • Aly R.
        • Maibach H.I.
        • Shinfield H.R.
        Microbial flora of atopic dermatitis.
        Arch Dermatol. 1977; 113: 780-782
        • Ong P.Y.
        • Ohtake T.
        • Brandt C.
        • et al.
        Endogenous antimicrobial peptides and skin infections in atopic dermatitis.
        N Eng J Med. 2002; 347: 1151-1160
        • Farber E.M.
        • Nall M.L.
        The natural history of psoriasis in 5600 patients.
        Dermatologica. 1974; 148: 1-18
        • Farber E.M.
        • Bright R.D.
        • Nall M.L.
        Psoriasis: a questionnaire of 2144 patients.
        Arch Dermatol. 1968; 98: 248-259
        • Elias P.M.
        • Wood L.C.
        • Feingold K.F.
        Epidermal pathogenesis of inflammatory dermatoses.
        Am J Contact Dermat. 1999; 10: 119-126