Stress and Skin: How Chronic Stress Affects Skin Health

Erwin van den Burg
24 februari 2025

Stress can have a diverse array of effects on the skin. The skin even has a stress system built in, complete with stress hormones. Let’s find out how chronic stress affects skin health and how to avoid stress-induced skin problems.

Stress can have many negative effects on the body. One of the organs that can be affected is the skin. The skin can receive stress directly from the outside world, and is at the same time a target of the biological stress responses from within the body. As the largest organ of the body, the skin provides a barrier between the interior of the body and the external world, and plays a role in the defense against invading microorganisms.

The skin is composed of two major layers: epidermis and dermis. The epidermis is a continuously renewing layer. The outermost layer of the skin is the epidermis, with the stratum corneum (SC) on top. The stratum corneum is composed of dead and flattened cells, called corneocytes, that are embedded in a matrix of lipids. This is the layer of the skin that we can see from the outside. The dermis is the middle layer composed of other cells, called fibroblasts, and an extracellular matrix which makes the skin elastic and strong.

Skin as a Sensory Organ

The skin is the primary sensory organ for external stressors. These stressors include temperature (heat and cold), pain, and pressure. These are sensed by specialized receptors located in the skin. The receptors send the information about temperature, pain, and pressure to the spinal cord and from there to the brain. Stress reactions will be triggered there if the incoming information is perceived as threatening.

The skin also harbors sensory fibers coming down from the brain, which sense changes in temperature, acidity (pH), and inflammation. The brain responds to these signals, which causes stress responses in the skin.

The skin is not only a target of stress reactions elicited by the brain, but can also initiate stress responses by itself. These are important for inflammation and the defense against bacteria and viruses that try to invade the body.

Stress and Skin Health: Biological Pathways

The stress reactions that are elicited by the brain commence in the hypothalamus. In the hypothalamus, a substance called “corticotropin-releasing factor” (CRF) is produced during stress. CRF stimulates the release of ACTH from the pituitary gland, which in turn triggers cortisol release from the adrenal glands. This hormonal cascade is known as the hypothalamus-pituitary-adrenal (HPA) axis.

The skin has developed an essentially identical system, with local production of CRF and ACTH. These hormones promote inflammation and blood flow in the skin.

Another key stress hormone is adrenaline (epinephrine), which is also produced locally in the skin. It acts on fibroblasts in the dermis, promoting wound healing and collagen production. Other factors released from nerve endings in the skin also contribute to inflammation and local stress responses.

Stress-Related Skin Conditions

Stress can influence several inflammatory skin conditions, including psoriasis, acne, and atopic dermatitis.

Psoriasis

Stress does not cause psoriasis but can worsen its symptoms. The chronic inflammation and cell overproduction in psoriasis may be exacerbated by stress responses, both from the brain and within the skin.

Acne

Acne is linked to increased production of sebum and inflammation—both of which are regulated by stress hormones like CRF, ACTH, and substance P. Studies show a direct link between stress levels and acne severity.

Atopic Dermatitis

Stress can worsen atopic dermatitis (AD) by disrupting skin barrier function and increasing inflammation. Individuals with AD often experience a vicious cycle: stress worsens AD symptoms, which in turn cause more psychological stress.

Impact of Stress on Skin Barrier Function and Wound Repair

Stress can also impair the normal functions of healthy skin:

Skin Barrier Function

Stress reduces lipid production in the stratum corneum, weakening the skin’s barrier. This can lead to dry, flaky skin and increased susceptibility to irritation and infection.

Wound Healing

Stress delays wound healing by suppressing inflammation, slowing new cell and collagen formation, and reducing blood flow. This was shown in studies of caregivers and students under exam stress.

Long-Term Effects of Chronic Stress on Skin Health

Chronic stress has more profound and lasting impacts on skin health than acute stress:

  • Skin Aging: Chronic exposure to cortisol and UV-induced stress accelerates skin aging, leading to wrinkles, loss of elasticity, and pigmentation.
  • Immune Suppression: Chronic stress weakens skin immunity, increasing the risk of infections and allergic reactions.
  • Telomere Shortening: Chronic stress accelerates cellular aging by shortening telomeres, the protective ends of chromosomes, limiting the skin’s ability to regenerate.

8 Ways to Protect Skin from Stress

While topical products may improve appearance temporarily, they can’t replace managing the root cause of skin stress: chronic stress. Here are proven ways to protect your skin health:

Avoiding Stress:

  1. Quit smoking
  2. Limit sun exposure; use sunscreen
  3. Get enough sleep (7–9 hours per night)

Managing Stress:

  1. Learn about stress via our blog
  2. Take control over your day-to-day schedule
  3. Make time for activities you enjoy
  4. Exercise regularly
  5. Seek support—from friends, therapists, or programs like our course "Surmounting Stress"

Reducing stress is not just good for your mental well-being—it also helps maintain healthy, resilient skin.