Psychological Stress in Atopic Dermatitis

  • Mayuko Nakano-TaharaEmail author
  • Hiroyuki Murota
  • Ichiro Katayama


Accurately evaluating the factors that exacerbate atopic dermatitis is helpful in management of this skin condition. Psychological stress is a major exacerbating factor and often aggravates atopic dermatitis. The most common symptoms of atopic dermatitis themselves can also act as secondary stressors and lead to a deterioration in quality of life. Moreover, patients with atopic dermatitis may also suffer from other mental disorders such as depression and anxiety. It is known that psychological stress is associated with abnormal skin barrier function and a shift toward cytokine expression in T-helper 2 cells. The stress response affects three systems: the hypothalamic-pituitary-adrenal axis, which regulates the release of adenocorticotropin and cortisol; the sympathoadrenal medullary axis, which regulates the release of catecholamines; and the neurotrophin neuropeptide axis, which regulates the release of substance P. Therefore, treatment for psychological stress is quite important for controlling skin barrier function and inhibiting immune activation in cases of atopic dermatitis. Treatments for psychological stress include pharmacotherapy, such as topical corticosteroids, and psychotherapy, such as relaxation exercises, coping skills training, and stress management instruction.


Atopic dermatitis Psychological stress Hypothalamic-pituitary-adrenal axis Sympathoadrenal medullary axis Neurotrophin neuropeptide axis 


  1. 1.
    Leung DY. New insights into atopic dermatitis: role of skin barrier and immune dysregulation. Allergol Int. 2013;62(2):151–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Kijima A, Murota H, Takahashi A, et al. Prevalence and impact of past history of food allergy in atopic dermatitis. Allergol Int. 2013;62:105–12.CrossRefGoogle Scholar
  3. 3.
    Lammintausta K, Kalimo K, Raitala R, et al. Prognosis of atopic dermatitis. A prospective study in early adulthood. Int J Dermatol. 1991;30:563–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Morren MA, Przybilla B, Bamelis M, et al. Atopic dermatitis: triggering factors. J Am Acad Dermatol. 1994;31:467–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Chida Y, Hamer M, Steptoe A. A bidirectional relationship between psychosocial factors and atopic disorders: a systematic review and meta-analysis. Psychosom Med. 2007;70:102–16.CrossRefPubMedGoogle Scholar
  6. 6.
    Kijima A, Murota H, Matsui S, et al. Abnormal axon reflex-mediated sweating correlates with high state of anxiety in atopic dermatitis. Allergol Int. 2012;61:469–73.CrossRefPubMedGoogle Scholar
  7. 7.
    Higaki Y, Kawamoto K, Kamo T, et al. The Japanese version of Skindex-16: a brief quality-of-life measure for patients with skin diseases. J Dermatol. 2002;29:693–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Shirata K, Nishitani Y, Fujino Y, et al. The importance of mental support to the patients with adult atopic dermatitis. Osaka City Med J. 1996;42:45–52.PubMedGoogle Scholar
  9. 9.
    Hashizume H, Horibe T, Ohshima A, et al. Anxiety accelerates T-helper 2-tilted immune responses in patients with atopic dermatitis. Br J Dermatol. 2005;152:1161–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Ando T, Hashiro M, Noda K, et al. Development and validation of the psychosomatic scale for atopic dermatitis in adults. J Dermatol. 2006;33:439–50.CrossRefPubMedGoogle Scholar
  11. 11.
    Turkoglu O, Mutlu HH. Evaluation of stress scores throughout radiological biopsies. Iran J Radiol. 2016;13:e37978.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Santos MA, Nakano TC, Mendes FA, et al. Emotional stress evaluation of patients with moderate and severe sleep apnea syndrome. Int Arch Otorhinolarygol. 2017;21:28–32.Google Scholar
  13. 13.
    Kuhlmann SM, Huss M, Burger A, et al. Coping with stress in medical students: results of a randomized controlled trial using a mindfulness-based stress prevention training (MediMind) in Germany. BMC Med Educ. 2016;16:316.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4:92–100.CrossRefPubMedGoogle Scholar
  15. 15.
    Faulstich ME, Willamson DA. An overview of atopic dermatitis: toward a bio-behavioural integration. J Psychosom Res. 1985;29:647–54.CrossRefPubMedGoogle Scholar
  16. 16.
    Aioi A, Okuda M, Matsui M, et al. Effect of high population density environment on skin barrier function in mice. J Dermatol Sci. 2001;25:189–97.CrossRefPubMedGoogle Scholar
  17. 17.
    Garg A, Chren MM, Sands LP, et al. Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the pathogenesis of stress-assiciated skin disorders. Arch Dermatol. 2001;137:53–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Arck PC, Slominski A, Theoharides TC, et al. Neuroimmunology of stress: skin takes center stage. J Invest Dermatol. 2006;126:1697–704.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Tausk F, Elenkov I, Moynihan J. Psychoneuroimmunology. Dermatol Ther. 2008;21:22–31.CrossRefPubMedGoogle Scholar
  20. 20.
    Elnekov IJ. Glicocorticoids and the Th1/Th2 balance. Ann N Y Acad Sci. 2004;1024:138–46.CrossRefGoogle Scholar
  21. 21.
    Dillon SR, Sprecher C, Hammond A, et al. Interleukin 31, a cytokine produced by activated T cells, induces dermatitis in mice. Nat Immunol. 2004;5:752–60.CrossRefPubMedGoogle Scholar
  22. 22.
    Sonkoly E, Muller A, Lauerma AI, et al. IL-31: a new link between T cells and pruritus in atopic skin inflammation. J Allergy Clin Immunol. 2006;117:411–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Elias PM, Sun R, Eder AR, et al. Treating atopic dermatitis at the source: corrective barrier repair therapy based upon new pathogenic insights. Expert Rev Dermatol. 2013;8:27–36.CrossRefGoogle Scholar
  24. 24.
    Toyoda M, Nakamura M, Makino T, et al. Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol. 2002;147:71–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Pavlovic S, Liezmann C, Blois SM, et al. Substance P is a key mediator of stress- induced protection from allergic sensitization via modified antigen presentation. J Immunol. 2011;186:848–55.CrossRefPubMedGoogle Scholar
  26. 26.
    Fukudo S. Hypothalamic-pituitary-adrenal axis in gastrointestinal physiology. Chapter 28, section II: neuro-gastroenterology. Wood JD Section Editor. In: Johnson L, editor. Physiology of the gastrointestinal tract. 5th ed. Oxford, UK: Elsevier; 2012. p. 795–815.Google Scholar
  27. 27.
    Asadi S, Alysandratos KD, Angelidou A, et al. Substance P (SP) induces expression of functional corticotropin-releasing hormone receptor-1 (CRHR-1) in human mast cells. J Invest Dermatol. 2012;132:324–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Baldwin AL. Mast cell activation by stress. Methods Mol Biol. 2006;315:349–60.PubMedGoogle Scholar
  29. 29.
    Senra MS, Wollenberg A. Psychodermatological aspects of atopic dermatitis. Br J Dematol. 2014;170:38–43.CrossRefGoogle Scholar
  30. 30.
    Arck PC, Handjiski B, Kuhlmei A, et al. Mast cell deficient and neurokinin-1 receptor knockout mice are protected from stress-induced hair growth inhibition. J Mol Med. 2005;83:386–96.CrossRefPubMedGoogle Scholar
  31. 31.
    Ehlers A, Stangier U, Gieler U. Treatment of atopic dermatitis: a comparison of psychological approaches to relapse prevention. J Consult Clin Psycho. 1995;63:624–35.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Mayuko Nakano-Tahara
    • 1
    Email author
  • Hiroyuki Murota
    • 1
  • Ichiro Katayama
    • 1
  1. 1.Department of DermatologyOsaka University Graduate School of MedicineOsakaJapan

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