Stress and the skin.

Emotional stress can affect, reveal or even exacerbate a number of skin disorders including psoriasis, atopic dermatitis, pruritus, alopecia areata, lichen planus, seborrheic dermatitis, rosacea or urticaria, although the direct pathophysiologic link between stress factors and cutaneous disease manifestation remains unclear. However, there is an increasing evidence that stress influences disease processes and contributes to the inflammation through modulating hypothalamic-pituitary-adrenal axis and releasing neuropeptides, neurotrophins, lymphokines and other chemical mediators from nerve endings and dermal cells. The central role in cellular skin reactivity to various stressors might be attributed to dermal mast cells, as they show close connections with sensory nerve endings and may release a huge number of proinflammatory mediators. However, many other cells also actively take part in skin response to stress. Although our knowledge is still not complete, one of the most distinct aspect is that the skin, endocrine, nervous and immune systems cannot longer be treated autonomously, but have to be considered as a large multidirectional complex of which interacting nature is still poorly understood.