Stress-Induced Changes of the Skin: A Narrative Review

Adaptation to physical and psychological stress is a fundamental biological process aimed at restoring homeostasis and maintaining health. While acute stress responses are developed for short-term survival, chronic stress has increasingly been recognized as an important trigger to a wide spectrum of systemic and dermatological disorders. Stress can exacerbate inflammatory and autoimmune dermatological conditions - such as acne, psoriasis, and atopic dermatitis. This narrative review highlights the function of the hypothalamic-pituitary-adrenal (HPA) axis, neurogenic inflammation, pigmentation disorders, and immune dysregulation of the skin as a result of the interaction between the nervous system and skin during stress. Particular attention was paid to the list of skin symptoms observed in participants exposed to prolonged stress. It also provides an overview of the limitations in modelling stress and skin interactions. By integrating molecular pathophysiology with clinical observations from a large cohort, this review presents the skin not only as a barrier protecting against adverse external influences, but as an organ actively involved in multiple systemic responses.