Current Allergy and Asthma Reports

, Volume 8, Issue 4, pp 312–317 | Cite as

Stress and atopic dermatitis



Atopic dermatitis (AD) is a complex disease traditionally involving interaction of genetic, environmental, and immunologic factors. Recent studies suggest psychoneuro-immunologic factors and emotional stress are important in its evolution. The observations that internal (bacterial infections) or external (psychologic) stressors may induce AD flares is explained by studies showing that stress impairs the skin barrier function and favors a shift in immunity toward a T helper type 2 cell/allergic response. Furthermore, those with AD appear to have an inherited hypothalamic deficiency that impairs normal hypothalamic-pituitary-adrenal axis function. Neuropeptides released in the skin may also mediate neurogenic inflammation, including mast cell degranulation. AD causes significant stress and impaired quality of life in patients and their family members. Psychologic and stress-reduction interventions were recently shown to improve patient well-being, and to significantly improve cutaneous manifestations.


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References and Recommended Reading

  1. 1.
    Leung DY, Bieber T: Atopic dermatitis. Lancet 2003, 361:151–160.PubMedCrossRefGoogle Scholar
  2. 2.
    Rajka G: Atopic Dermatitis. London: WB Saunders; 1975.Google Scholar
  3. 3.
    Laughter D, Istvan JA, Tofte SJ, et al.: The prevalence of atopic dermatitis in Oregon schoolchildren. J Am Acad Dermatol 2000, 43:649–655.PubMedCrossRefGoogle Scholar
  4. 4.
    Simpson EL, Hanifin JM: Atopic dermatitis. J Am Acad Dermatol 2005, 53:115–228.PubMedCrossRefGoogle Scholar
  5. 5.
    Beattie PE, Lewis-Jones MS: A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol 2006, 155:145–151.PubMedCrossRefGoogle Scholar
  6. 6.
    Rapp SR, Exum ML, Reboussin DM, et al.: The physical, psychological, and social impact of psoriasis. J Health Psychol 1997, 2:525–537.CrossRefGoogle Scholar
  7. 7.
    Wittkower E, Russell B: Emotional factors in skin disease. London: Cassell; 1953.Google Scholar
  8. 8.
    King RM, Wilson GV: Use of a dietary technique to investigate psychosomatic relations in atopic dermatitis. J Psychosom Res 1991, 35:697–706.PubMedCrossRefGoogle Scholar
  9. 9.
    Leung DY, Boguniewicz M, Howell MD, et al.: New insights into atopic dermatitis. J Clin Invest 2004, 113:651–657.PubMedGoogle Scholar
  10. 10.
    Hamid Q, Boguniewicz M, Leung DY: Differential in situ cytokine gene expression in acute versus chronic atopic dermatitis. J Clin Invest 1994, 94:870–876.PubMedCrossRefGoogle Scholar
  11. 11.
    Uehara M, Izukura R, Sawai T: Blood eosinophilia in atopic dermatitis. Clin Exp Dermatol 1990, 15:264–266.PubMedCrossRefGoogle Scholar
  12. 12.
    Yabuhara A, Macaubas C, Prescott SL: Th-2 polarised immunological memory to inhalant allergens in atopics is established during infancy and early childhood. Clin Exp Allergy 1997, 27:1261–1269.PubMedCrossRefGoogle Scholar
  13. 13.
    Wright RJ, Finn PW, Contreras JP, et al.: Chronic caregiver stress and IgE expression, allergen-induced proliferation and cytokine profiles in a birth cohort predisposed to atopy. J Allergy Clin Immunol 2004, 113:1051–1057.PubMedCrossRefGoogle Scholar
  14. 14.
    Buske-Kirschbaum A, Gierens A, Hollig H, et al.: Stress-induced immunomodulation is altered in patients with atopic dermatitis. J Neuroimmunol 2002, 129:161–167.PubMedCrossRefGoogle Scholar
  15. 15.
    Stephan M, Jaeger B, Adamek C, et al.: Alterations of stress-induced expression of membrane molecules and intracellular cytokine levels in patients with atopic dermatitis depend on serum IgE levels. J Allergy Clin Immunol 2004, 114:977–978.PubMedCrossRefGoogle Scholar
  16. 16.
    Elenkov IJ: Glucocorticoids and the Th1/Th2 balance. Ann N Y Acad Sci 2004, 1024:138–146.PubMedCrossRefGoogle Scholar
  17. 17.
    Hashizume H, Horibe T, Ohshima T, et al.: Anxiety accelerates T-helper 2-tilted immune responses in patients with atopic dermatitis. Br J Dermatol 2005, 152:1161–1164.PubMedCrossRefGoogle Scholar
  18. 18.
    Raap U, Kapp A: Neuroimmunological findings in allergic skin diseases. Curr Opin Allergy Clin Immunol 2005, 5:419–424.PubMedCrossRefGoogle Scholar
  19. 19.
    Peters EM, Kuhlmei A, Tobin DJ, et al.: Stress exposure modulates peptidergic innervation and degranulates mast cells in murine skin. Brain Behav Immun 2005, 19:252–262.PubMedCrossRefGoogle Scholar
  20. 20.
    Pavlovic S, Daniltchenko M, Tobin DJ, et al.: Further exploring the brain-skin connection: stress worsens dermatitis via substance P-dependent neurogenic inflammation in mice. J Invest Dermatol 2008, 128:434–446.PubMedCrossRefGoogle Scholar
  21. 21.
    Miller GE, Ritchey AK, Cohen S: Chronic psychological stress and regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health Psychol 2002, 21:531–541.PubMedCrossRefGoogle Scholar
  22. 22.
    Wright RJ, Cohen RT, Cohen S: The impact of stress on the development and expression of atopy. Curr Opin Allergy Clin Immunol 2005, 5:23–29.PubMedGoogle Scholar
  23. 23.
    Heim C, Newport DJ, Heit S, et al.: Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 2000, 284:592–597.PubMedCrossRefGoogle Scholar
  24. 24.
    Buske-Kirschbaum A, Fischbach S, Rauh W, et al.: Increased responsiveness of the hypothalamus-pituitary-adrenal (HPA) axis to stress in newborns with atopic disposition. Psychoneuroendocrinology 2004, 29:705–711.PubMedCrossRefGoogle Scholar
  25. 25.
    Buske-Kirschbaum A, Jobst S, Hellhammer DH: Altered reactivity of the hypothalamus-pituitary-adrenal axis in patients with atopic dermatitis: pathologic factor or symptom? Ann N Y Acad Sci 1998, 840:747–754.PubMedCrossRefGoogle Scholar
  26. 26.
    Shanks N, Windle RJ, Perks PA, et al.: Early-life exposure to endotoxin alters hypothalamic-pituitary-adrenal function and predisposition to inflammation. Proc Natl Acad Sci U S A 2000, 97:5645–5650.PubMedCrossRefGoogle Scholar
  27. 27.
    Dunn AJ, Berridge CW: Physiological and behavioral responses to corticotropin-releasing factor administration: is CRF a mediator of anxiety or stress responses? Brain Res Rev 1990, 15:71–100.PubMedCrossRefGoogle Scholar
  28. 28.
    Joachim RA, Kuhlmei A, Dinh QT, et al.: Neuronal plasticity of the “brain-skin connection”: stress-triggered up-regulation of neuropeptides in dorsal root ganglia and skin via nerve growth factor-dependent pathways. J Mol Med 2007, 85:1369–1378.PubMedCrossRefGoogle Scholar
  29. 29.
    Arck PC, Slominski A, Theoharides TC, et al.: Neuroimmunology of stress: skin takes center stage. J Invest Dermatol 2006, 126:1697–1704.PubMedCrossRefGoogle Scholar
  30. 30.
    Paus R, Theoharides TC, Arck PC: Neuroimmunoendocrine circuitry of the ‘brain-skin connection.’ Trends Immunol 2006, 27:32–39.PubMedCrossRefGoogle Scholar
  31. 31.
    Lotti T, Bianchi B, Ghersetich I, et al.: Can the brain inhibit inflammation generated in the skin? The lesson of gamma-melanocyte-stimulating hormone. Int J Dermatol 2002, 41:311–318.PubMedCrossRefGoogle Scholar
  32. 32.
    Parkkinen MU, Kiistala R, Kiistala U: Baseline water loss and cholinergic sweat stimulation in atopic dermatitis: a gravimetric measurement of local skin water loss. Arch Dermatol Res 1991, 283:382–386.PubMedCrossRefGoogle Scholar
  33. 33.
    Tausk FA, Nousari H: Stress and the skin. Arch Dermatol 2001, 137:78–82.PubMedGoogle Scholar
  34. 34.
    Kao JS, Fluhr JW, Man MQ, 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.PubMedCrossRefGoogle Scholar
  35. 35.
    Garg A, Chren MM, Sands LP, et al.: Psychological stress perturbs epidermal permeability barrier homeostasis. Arch Derm 2001, 137:53–59.PubMedGoogle Scholar
  36. 36.
    Howlett S: Emotional dysfunction, child-family relationships and childhood atopic dermatitis. Br J Dermatol 1999, 140:381–384.PubMedCrossRefGoogle Scholar
  37. 37.
    Bick E: The experience of the skin in early object relations. Int J Psychoanal 1968, 49:484–486.PubMedGoogle Scholar
  38. 38.
    Lawson V, Lewis-Jones MS, Finlay AY, et al.: The family impact of childhood atopic dermatitis: the Dermatitis Family Impact Questionnaire. Br J Dermatol 1998, 138:107–113.PubMedCrossRefGoogle Scholar
  39. 39.
    Long CC, Funnell CM, Collard R, et al.: What do members of the National Eczema Society really want? Clin Exp Dermatol 1993, 18:516–522.PubMedCrossRefGoogle Scholar
  40. 40.
    Moore K, David TJ, Murray CS, et al.: Effect of childhood eczema and asthma on parental sleep and well being: a prospective comparative study. Br J Dermatol 2006, 154:514–518.PubMedCrossRefGoogle Scholar
  41. 41.
    Mozaffari H, Pourpak Z, Pourseyed S, et al.: Quality of life in atopic dermatitis patients. J Microbiol Immunol Infect 2007, 40:260–264.PubMedGoogle Scholar
  42. 42.
    Lewis-Jones MS, Finlay AY, Dykes P: The Infants’ Dermatitis Quality of Life Index. Br J Dermatol 2001, 144:104–110.PubMedCrossRefGoogle Scholar
  43. 43.
    Emerson RM, Williams HC, Allen BR, et al.: How much disability does childhood atopic eczema cause compared to other common childhood problems [abstract]. Br J Dermatol 1997, 137:19.Google Scholar
  44. 44.
    Lewis-Jones S: Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract 2006, 60:984–992.PubMedCrossRefGoogle Scholar
  45. 45.
    Ganemo A, Svensson A, Lindberg M, et al.: Quality of life in Swedish children with eczema. Acta Derm Venereol 2007, 87:345–349.PubMedCrossRefGoogle Scholar
  46. 46.
    Sarti MG: Biofeedback in dermatology. Clin Dermatol 1998, 16:711–714.PubMedCrossRefGoogle Scholar
  47. 47.
    Horne DJ, White AE, Varigos GA: A preliminary study of psychological therapy in the management of atopic eczema. Br J Med Psychol 1989, 62:241–248.PubMedGoogle Scholar
  48. 48.
    Chida Y, Steptoe A, Hirakawa N, et al.: The effects of psychological intervention on atopic dermatitis. A systematic review and meta-analysis. Int Arch Allergy Immunol 2007, 144:1–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Shenefelt PD: Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: is it all in your mind? Dermatol Ther 2003, 16:114–122.PubMedCrossRefGoogle Scholar
  50. 50.
    Ehlers A, Stangier U, Gieler U: Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention. J Consult Clin Psychol 1995, 63:624–635.PubMedCrossRefGoogle Scholar
  51. 51.
    Tausk FA: Alternative medicine: is it all in your mind? Arch Dermatol 1998, 134:1422–1425.PubMedCrossRefGoogle Scholar
  52. 52.
    Sarti MG: Biofeedback in dermatology. Clin Dermatol 1998, 16:711–714.PubMedCrossRefGoogle Scholar
  53. 53.
    Spiegel H, Spiegel D: Trance and Treatment: Clinical Uses of Hypnosis. New York: Basic Books; 1978.Google Scholar
  54. 54.
    Tausk FA, Whitmore SE: A pilot study of hypnosis in the treatment of patients with psoriasis. Psychother Psychosom 1999, 495:1–9.Google Scholar
  55. 55.
    Noll RB: Hypnotherapy for warts in children and adolescents. J Dev Behav Pediatr 1994, 15:170–173.CrossRefGoogle Scholar
  56. 56.
    Twerski AJ, Naar R: Hypnotherapy in a case of refractory dermatitis. Am J Clin Hypn 1974, 16:202–205.PubMedGoogle Scholar
  57. 57.
    Stewart AC, Thomas SE: Hypnotherapy as a treatment for atopic dermatitis in adults and children. Br J Dermatol 1995, 132:778–783.PubMedCrossRefGoogle Scholar
  58. 58.
    Linden W: Autogenic training: a narrative and quantitative review of clinical outcome. Biofeedback Self Regul 1994, 19:227–264.PubMedCrossRefGoogle Scholar
  59. 59.
    Schachner L, Field T, Hernandez-Reif M, et al.: Atopic dermatitis symptoms decreased in children following massage therapy. Pediatr Dermatol 1998, 15:390–395.PubMedCrossRefGoogle Scholar
  60. 60.
    Staab D, Diepgen TL, Fartasch M, et al.: Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ 2006, 332:933–938.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of DermatologyUniversity of Rochester School of Medicine and DentistryRochesterUSA

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