The Impact of Stress on Inflammatory Dermatologic Diseases: A Narrative Review

Abstract

In this review, the effects of stress on inflammatory dermatologic diseases were examined from a psychoneuroim-imunological perspective. The mechanisms by which psychological stress influences the relationships between the immune system and the skin have been evaluated in the context of major inflammatory skin diseases supported by current literature. The role of stress in the pathogenesis of these disorders, its effect on disease exacerbations, and its importance in treatment response were presented based on current literature findings. In addition, the effects of stress management approaches on the prognosis of inflammatory dermatological diseases were discussed. Our review particularly focused on the role of psychological stress in the exacerbation and course of psoriasis, atopic dermatitis, acne vulgaris, rosacea, urticaria, seborrheic dermatitis, and lichen planus, which constitute a substantial proportion of patients attending dermatology clinics. Findings from our study and the existing literature demonstrate that dermatologic lesions, which are readily visible on the skin, may elicit feelings of shame and guilt and consequently increase psychological stress. This heightened stress level appears to play a significant role in disease flares. Therefore, clinicians should not overlook the psychological burden associated with dermatologic diseases, as addressing this bidirectional interaction is essential for breaking the vicious cycle that perpetuates disease activity. Accordingly, dermatologic and psychological treatment approaches should be integrated. In particular, performing disease-specific severity assessments, systematically screening psychological symptoms using validated instruments, and providing individualized psychiatric support interventions especially when implemented early, may contribute to improvements in patients’ quality of life and may positively influence disease progression.

Keywords

• inflammation
• stress, psychological
• immunology
• skin diseases
• disease progression

Stresin inflamatuar dermatolojik hastalıklar üzerine etkisi: Geleneksel bir derleme

Abstract

Bu derlemede, stresin inflamatuar dermatolojik hastalıklar üzerindeki etkisi psikonöroimmünolojik açıdan incelenmiştir. Psikolojik stresin bağışıklık sistemi ile deri arasındaki ilişkileri hangi mekanizmalarla etkilediği, başlıca inflamatuar deri hastalıkları özelinde literatür bilgileri eşliğinde değerlendirilmiştir. Bu hastalıkların patogenezinde stresin rolü, alevlenmeler üzerindeki etkisi ve tedaviye yanıt açısından önemi literatür bulguları eşliğinde sunulmuştur. Ayrıca stres yönetimi yaklaşımlarının inflamatuar deri hastalıklarının prognozuna etkileri değerlendirilmiştir. Çalışmamızda dermatoloji polikliniklerinde ciddi bir hasta popülasyonu oluşturan psöriazis, atopik dermatit, akne vulgaris, rozasea, ürtiker, seboreik dermatit ve liken planus hastalıklarında psikolojik stresin bu hastalık-ların alevlenmelerindeki ve seyrindeki rolleri üzerinde durulmuştur. Çalışmamızın sonuçları ve literatürdeki bulgular, ciltte kolaylıkla fark edilebilen dermatolojik lezyonların kişilerde utanç ve suçluluk duygularını tetikleyebildiğini ve psikolojik stresi artırdığını; bu artan stres düzeyinin ise hastalığın alevlenmesinde önemli bir rol oynadığını ortaya koymaktadır. Bu karşılıklı etkileşimle oluşan kısır döngünün kırılabilmesi için dermatolojik hastalıkların taşıdığı psikolojik yükün klinisyenler tarafından göz ardı edilmemesi gerektiği belirtilmiştir. Bu nedenle hem dermatolojik hem de psikolojik tedavi yaklaşımları birlikte ele alınmalıdır. Özellikle doğru hasta gruplarında, hastalığa özgü şiddet skorlamalarının yapılması ve psikolojik belirtilerin geçerli ölçeklerle taranması, ardından bireyselleştirilmiş psikiyatrik müdahalelerin uygulanması, erken dönemde gerçekleştirildiğinde hem yaşam kalitesinin iyileştirilmesine hem de hastalığın seyrinin olumlu yönde etkilenmesine katkı sağlayabilir.

Keywords

• inflamasyon
• deri hastalıkları
• psikolojik stress
• immünoloji
• hastalık alevlenmesi

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