The Impact of Stress on Skin Perception and Self-Esteem – A Systematic Review

Stress can have a devastating impact on your skin, leading to breakouts and even hastening the aging process.

This study seeks to explore perceptions among young women and healthcare professionals regarding the link between stress and aging skin, self-esteem, perceived social support and dermatological patients at two research phases; prior and after they begin receiving medication treatment for skin diseases.

Background

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At the University of Alabama at Birmingham (UAB), a sample of medical students completed a questionnaire on skin symptoms and self-reported stress levels. Highly stressed students reported significantly more skin complaints such as oily scalp and itchy scalp, dry/sore skin and itchy hands, warts, nail biting, and pulling hairs than less stressed students.

Psychological stress has long been linked with dermatological diseases, including psoriasis and dermatitis. Psychological stress activates the HPA axis and induces neural signaling pathways, secreting stress mediators such as cortisol and neuropeptides that impact skin disease severity. Stress mediators impair epidermal barrier function while also stimulating pro-inflammatory cytokines and histamine release; additionally they skew DCs towards Th2 and Th17 responses that further worsen skin conditions — further exacerbating skin conditions further.

Methods

Psychological stress activates the neuro-endocrine-immune network to cause skin diseases, further diminishing patients’ quality of life, creating a cycle between psychological stress and skin disease. According to this study, psychological stress also may cause stigmatization as well as worsen symptoms, leading to depression and decreased self-image for young people with acquired dermatological disorders.

To assess the effects of short-term psychological stress on facial impression, we employed the Stroop color-word test to assess individual’s reactions to color words presented on slides and subsequent changes in impression of faces. Participants completed this test both under stress and rest conditions with random order for both tests; we also measured heart rate and blood flow to the face before and after each condition.

As women are less susceptible to subliminal perception than men, we exclusively utilized male volunteers for face image creation prior and following stress load. This allowed us to eliminate the influence of menstruation cycles on changes to facial impression and also facilitate subliminal recognition by our subconcious systems.

Results

In the present study, 13 volunteers provided facial images before and after they participated in a psychological stress task. We measured blood flow in their cheek skin before (“baseline”) stress as well as zero, one, and three hours post-stress (“stress,” “0H,” and “1H” conditions). Finally, participants completed an online survey rating their impressions of these facial images.

The results of our survey revealed that selection rates of facial images with improved impressions after stress were lower than baseline selection rates – this suggests even minor variations in skin color due to increases in blood flow can alter our impressions and alter perception.

As dermatological disorders such as atopic dermatitis, port wine stains, infantile hemangiomas, congenital melanocytic nevi and hidradenitis suppurativa have a direct correlation to psychological stress, physicians should discuss their effect on self-esteem with patients to minimize any negative impact these skin conditions have on daily life and encourage adherence to medical treatment regimens.

Conclusions

Studies have demonstrated how psychological stress can stimulate interactions among the neuroendocrine-immune systems to accelerate skin disease onset and progression, further intensifying patients’ psychological burden and creating an ever-worsening cycle.

Volunteers in this study were instructed to acquire facial images both before and after psychological stress to examine its effect on facial impressions. We found that those experiencing greater psychological strain had worse facial impressions compared to those without one; these differences persisted for hours afterwards.

Previous studies have also demonstrated that highly stressed medical students exhibit higher prevalences of oily or flaky scalp (dandruff), itchy skin and excessive sweating than less-stressed students. Therefore, physicians must be ready to address the psychosocial consequences of skin conditions like acne or dermatitis during clinical practice visits with patients.