Psychological stress perturbs epidermal permeability barrier homeostasis -Implications for the pathogenesis of stress-associated shin disorders

Background: A large number of skin diseases, including atopic dermatitis an d psoriasis, appear to be precipitated or exacerbated by psychological stre ss. Nevertheless, the specific pathogenic role of psychological stress rema ins unknown. In 3 different murine models of psychological stress, it was r ecently shown that psychological stress negatively impacts cutaneous permea bility barrier function and that coadministration of tranquilizers blocks t his stress-induced deterioration in barrier function. Objectives and Methods: The relationship between psychological stress and e pidermal permeability barrier function was investigated in 27 medical, dent al, and pharmacy students without coexistent skin disease. Their psychologi cal state was assessed with 2 well-validated measures: the Perceived Stress Scale and the Profile of Mood States. Barrier function was assessed simult aneously with the stress measures at periods of presumed higher stress (dur ing final examinations) and at 2 assumed, lower stress occasions (after ret urn from winter vacation [approximately 4 weeks before final examinations] and during spring vacation [approximately 4 weeks after final examinations] ). Results: The subjects as a group demonstrated a decline in permeability bar rier recovery kinetics after barrier disruption by cellophane tape strippin g, in parallel with an increase in perceived psychological stress during th e higher vs the initial lower stress occasions. During the follow-up, presu med lower stress period, the subjects again displayed lower perceived psych ological stress scores and improved permeability barrier recovery kinetics, comparable to those during the initial lower stress period. Moreover, the greatest deterioration in barrier function occurred in those subjects who d emonstrated the largest increases in perceived psychological stress. Conclusion: These studies provide the first link between psychological stat us and cutaneous function in humans and suggest a new pathophysiological pa radigm, ie, stress-induced derangements in epidermal function as precipitat ors of inflammatory dermatoses.