Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology

Abstract

Stress has multiple and wide-ranging physiologic and clinical impacts on skin disease. This has led to an interest in mind body therapies as potential adjunct treatments for skin disease. The stress response results in the activation of the endocrine, neurologic, and immune systems, with a resulting cascade of impacts, that are both systemic and cutaneous. The 2 main arms of the stress response are the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The resultant release of cortisol, catecholamines, and neuropeptides has multiple effects. Clinically, these have been shown to increase skin inflammation, increase itching, impair skin barrier function, impair wound healing, and suppress immunity.Mind body therapies are those that focus on the interaction between the mind and the body, with the goal to influence physical function and impact health. These have been shown to ameliorate some of the harmful physiologic changes attributed to stress or to reduce harmful behaviors. In some cases, such as with biofeedback, they may also result in beneficial physiologic changes. Treatments such as meditation, biofeedback, hypnosis, guided imagery, and others have been evaluated in the treatment of skin disease and have shown some benefits. Although randomized controlled trials are limited, these interventions have shown beneficial effects on itching, psychosocial outcomes, and even skin severity. These interventions have been evaluated in diseases such as atopic dermatitis, psoriasis, trichotillomania, and others. Given the potential benefits, improvements in psychosocial outcomes, and a low risk profile, referral to qualified practitioners or multidisciplinary clinics should be considered for some patients.

Release of Cervical Muscle Tension Improves Psychological Stress and Symptoms of Moderate-to-Severe Atopic Dermatitis: a Case Series with 20 Patients

“…Reduction of stress improves the atopic symptoms, and mind–body therapies, such as PMR and acupuncture, have been highlighted as adjunctive therapies [ 36 ]. In a study of PMR in AD, EASI scores and stress markers were reported to improve [ 37 ].…”

The skin‐brain connection and pleasant touch as supportive care for psychocutaneous disorders

“…Holistic care incorporating complementary and alternative medicine with a low risk profile, for example, yoga, the use of chiropractic and osteopathic practices, meditation and massage therapy, is increasingly being used as an adjunct to conventional medicine to address biological, psychological and psychosocial factors 11 . Although randomized controlled trials (RCT) are limited, holistic approaches may have beneficial effects on the skin disorder, pruritus and pain, as well as on anxiety, stress, and sleep disorders to improve patients' well‐being 10 . Furthermore, treatment adherence may be improved if both the psychiatric disorder and dermatological disorder are managed in everyday dermatologic practice 12 …”

Further Understanding of Neuro-Immune Interactions in Allergy: Implications in Pathophysiology and Role in Disease Progression

“… 168 Further evidence suggests that the peripheral HPA axis in the skin also plays a vital role in the etiopathogenesis of CU via inflammatory and neurotransmission disturbances. 153 , 164 , 169 Mast cells and epidermal and hair follicle keratinocytes are effector cells in this axis expressing CRH receptor 1 (R1) receptors and produce CRH and IL-18 in response to stress. 170 The neuroendocrine, behavioral, and autonomic responses to stress are all orchestrated by CRH-R1, whereas IL-18 contributes to severe cutaneous inflammation.…”