Clinical, cosmetic and investigational dermatology · 2026
Associations of Sleep Quality and Perceived Stress with Skin, Scalp, and Hair Health Among 1,017 Chinese Women: A Cross-Sectional Observational Study.
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Wang Shanqing, Wang Ping, Liu Juan, Chen Lihong, Sextius Peggy, Deshayes Nathalie, Ye Chengda, Flament Frederic, Nouveau Stephanie, Wu Jun, Wang Xingyuan, Sun Zeneng, Gao Yu, Mainguene Emmanuelle, Qiu Jie, Pan Meng
Аннотация
BACKGROUND AND OBJECTIVE: Psychological stress and poor sleep quality are prevalent among urban adults and have been proposed to be associated with skin, scalp, and hair health through neuro-endocrine-immune pathways. However, evidence from large real-world cohorts under chronic, naturalistic conditions remains limited. The objective of this study was to characterize the associations of sleep quality and perceived stress with a range of dermatological outcomes under real-life conditions, including self-perceived concerns, expert-scored clinical signs, and objective instrumental measurement in healthy women.
METHODS: This cross-sectional observational study enrolled 1,017 healthy women aged 18-40 years in Shanghai, China. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and perceived stress with the Perceived Stress Scale (PSS-10). Dermatological outcomes were assessed through four modalities: validated psychometric questionnaires, self-perception surveys, expert clinical scoring, and objective instrumental measurements. Associations were investigated using generalized linear models (GLMs) adjusted for age and season (regression analytical sample: n=994 after exclusion of participants with BMI>30), with Benjamini-Hochberg correction for multiple comparisons.
RESULTS: Poor sleep quality (PSQI score ≥ 6) was identified in 60% of participants and elevated perceived stress (PSS-10 score ≥ 14) in 50%. Both factors were significantly associated with lower wellbeing, happiness, and higher fatigue scores. Poor sleep quality was associated with increased likelihood of reporting sensitive scalp (OR = 1.17 [95% CI:1.08-1.27], Adj-P = 0.004), skin fatigue appearance (OR = 1.11 [95% CI:1.06-1.17], Adj-P = 0.003), and self-perceived skin yellowness (OR = 1.10 [95% CI:1.04-1.15], Adj-P = 0.013), as well as a modest but significant increase in clinically graded dark eye circle severity (β = 0.028 [95% CI: 0.012-0.044], Adj-P = 0.014). Elevated perceived stress was associated with self-reported hair loss (OR = 1.04 [95% CI:1.01-1.06], Adj-P = 0.034) and itchy scalp (OR = 1.07 [95% CI:1.03-1.11], Adj-P = 0.035). In post-hoc exploratory age-stratified analyses, poor sleep was associated with higher acne severity exclusively in participants aged 18-25 years (p = 0.016).
CONCLUSION: In this cross-sectional study of healthy urban women in Shanghai, poor sleep quality and elevated perceived stress were each associated with a range of self-perceived dermatological concerns and clinical signs. These findings are cross-sectional in nature and require longitudinal investigation to establish temporal directionality. The observed associations are consistent with the skin-brain axis hypothesis and support the relevance of sleep and stress assessment in dermatological research and practice.
METHODS: This cross-sectional observational study enrolled 1,017 healthy women aged 18-40 years in Shanghai, China. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and perceived stress with the Perceived Stress Scale (PSS-10). Dermatological outcomes were assessed through four modalities: validated psychometric questionnaires, self-perception surveys, expert clinical scoring, and objective instrumental measurements. Associations were investigated using generalized linear models (GLMs) adjusted for age and season (regression analytical sample: n=994 after exclusion of participants with BMI>30), with Benjamini-Hochberg correction for multiple comparisons.
RESULTS: Poor sleep quality (PSQI score ≥ 6) was identified in 60% of participants and elevated perceived stress (PSS-10 score ≥ 14) in 50%. Both factors were significantly associated with lower wellbeing, happiness, and higher fatigue scores. Poor sleep quality was associated with increased likelihood of reporting sensitive scalp (OR = 1.17 [95% CI:1.08-1.27], Adj-P = 0.004), skin fatigue appearance (OR = 1.11 [95% CI:1.06-1.17], Adj-P = 0.003), and self-perceived skin yellowness (OR = 1.10 [95% CI:1.04-1.15], Adj-P = 0.013), as well as a modest but significant increase in clinically graded dark eye circle severity (β = 0.028 [95% CI: 0.012-0.044], Adj-P = 0.014). Elevated perceived stress was associated with self-reported hair loss (OR = 1.04 [95% CI:1.01-1.06], Adj-P = 0.034) and itchy scalp (OR = 1.07 [95% CI:1.03-1.11], Adj-P = 0.035). In post-hoc exploratory age-stratified analyses, poor sleep was associated with higher acne severity exclusively in participants aged 18-25 years (p = 0.016).
CONCLUSION: In this cross-sectional study of healthy urban women in Shanghai, poor sleep quality and elevated perceived stress were each associated with a range of self-perceived dermatological concerns and clinical signs. These findings are cross-sectional in nature and require longitudinal investigation to establish temporal directionality. The observed associations are consistent with the skin-brain axis hypothesis and support the relevance of sleep and stress assessment in dermatological research and practice.