Stress as an Influencing Factor in Psoriasis

Misha M. Heller, BA; Eric S. Lee, BS; John Y.M. Koo, MD


Skin Therapy Letter. 2011;16(5) 

In This Article

Abstract and Introduction


Emotional stress may influence the development and exacerbation of psoriasis. The proportion of psoriasis patients who believe stress affects their skin condition (i.e., "stress responders") is considerably high, ranging from 37% to 78%. Stress may worsen psoriasis severity and may even lengthen the time to disease clearance. Although a pathogenic association appears likely, additional well-controlled studies are necessary to confirm such a causal relationship. Dysregulation of the hypothalamus-pituitary-adrenal and sympathetic adrenomedullary systems has been proposed as one possible underlying cause of stress-induced flares of psoriasis. While stress may be an exacerbating factor, psoriasis itself may contribute to significant adverse psychological sequelae. Breaking this stress cycle may be an important part of any therapeutic approach. Thus, stress reduction through psychotherapy and pharmacotherapy may be useful in treating psoriatic patients who are stress responders.


Psoriasis is a chronic, inflammatory skin disease with an approximate 2–3% prevalence in the general population.[1] The etiology of psoriasis is not fully understood, but it appears to be multifactorial, involving both genetic and environmental influences. Among these factors, emotional stress (hereafter simply referred to as "stress") is considered to play an important role in the onset and exacerbation of psoriasis.[2]

Stress has been indicated as a trigger in many dermatologic conditions, including atopic dermatitis, acne vulgaris, and chronic urticaria. With each of these conditions, one encounters both patients who experience a close chronologic association between stress and exacerbation of their skin disease, and patients for whom their emotional states seem to be unrelated to the natural course of their cutaneous disorder. These two groups are considered "stress responders" and "non-stress responders," respectively.[3]

Just as in many dermatologic conditions, psoriasis appears to worsen with stress in a significant segment of patients. Studies report that the proportion of psoriasis patients who are stress-responders ranges from 37% to 78%.[4]


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