Stress and the skin: exploring the associations between perceived stress and self-reported skin symptoms and signs

Abstract

Background & Aims: A connection between psychological stress and the skin has been recognised for many years. Although laboratory-based research has uncovered sound pathogenic mechanisms and clinical research has successfully linked stress with a number of skin diseases, less has been made of the skin symptoms and signs that are experienced in the non-healthcare seeking population in association with stress. This thesis aims to assess whether increased levels of perceived psychological stress are associated with presence of skin symptoms and signs in Australian university students. Methods: A comprehensive review of the literature on the associations between stress and established skin diseases was undertaken. This review examined proposed underlying pathologic mechanisms as well as clinical studies investigating the relationships between perceived stress and skin disease. After institutional approval, an electronic cross-sectional survey using the validated Perceived Stress Questionnaire and a modified Self-Reported Skin Questionnaire, was distributed to 5000 students at a single university. The results of these questionnaires were analysed using logistic regression to assess whether increased levels of perceived psychological stress are associated with presence of the studied skin symptoms and signs. Results: 471 participants successfully completed the survey and were included in the study. Subjects with higher levels of stress were statistically significantly more likely to report the presence of itch (p<0.001), dry/sore rash (p<0.001), scaly skin (p<0.001), hair loss (p<0.001), other rashes on face (p<0.001), itchy rash on hands (p<0.001), troublesome sweating (p=0.003) or hair-pulling (p<0.001). No association was found between stress and: pimples, oily/waxy patches on scalp or flakey scalp, warts, or nail-biting. The results are discussed with reference to the existing literature on skin symptoms, signs and diseases. Conclusion: The results support the hypothesis that an increase in perceived stress is associated with an increased likelihood of self-reporting a number of skin symptoms and signs in a nonhealthcare-seeking population. These findings may have significant implications for the self-management of skin morbidity with coexistent stress. The utility of perceived stress- and skin symptom- and sign-based tools in psychodermatology research is not yet fully elucidated.