Psychological Stress: Effects of Cortisol on Skin Health

Cortisol is one of the primary stress hormones and plays a significant role in numerous physiological functions, including the body’s fight-or-flight response. When the brain perceives stress, the hypothalamus releases corticotropin-releasing hormone (CRH), which subsequently stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH). This hormone then signals the adrenal glands to release cortisol into the bloodstream.

Skin, being the largest organ in the body, suffers the impact of stress just like other vital organs such as heart, gut, brain, and lungs. Prolonged exposure to cortisol takes a toll on the health and appearance of the skin through various neurologic, hormonal, and immunological mechanisms. It prevents cell differentiation and renewal, reduces collagen production, and decreases protein uptake required for cell growth. As a result of these mechanisms, skin becomes weak and loses its thickness.

Visible Changes Under Stress

Emotional stress can lead to various skin conditions ranging from simple ones like acne, chronic itch, and hives to autoimmune disorders like psoriasis, vitiligo, and alopecia areata. Skin disorders and mental health often go hand in hand and research suggests that psychological stress worsens almost one-third of all skin disorders. As mentioned earlier, skin reacts to stress through immunological pathways by producing skin immune cells which facilitate tissue inflammation. Some noticeable symptoms of stress-induced skin problems include increased skin inflammation, infections, impaired wound healing & skin barrier functions, and suppressed immunity.

A research study revealed that the skin undergoes some considerable changes when exposed to increased levels of cortisol. It has been proved that it triggers skin aging along with appearance of fine lines and skin roughness. Exposure to stress hormones (cortisol and epinephrine) led to DNA damage, decreased capacity of antioxidants, weakening of skin barrier function, and delayed wound healing.

Therapies

Psychiatric treatment in the form of drugs and psychotherapy can have a positive impact on stress induced skin diseases. Dietary supplements or foods containing active flavonoids and proteoglycans can help reduce skin inflammation. Berries, apples, grapes, broccoli, and green tea are rich in flavonoids, whereas proteoglycans can be found in pork, beef, chicken, cabbage, mushrooms, okra, and avocados.

Mind Body Therapies: These therapies target the healing of both mind and body, especially with the intent of using the mind to heal the body. This is a cost-effective approach, and studies have shown that these therapies often benefit those with stress-induced skin disorders. It primarily involves hypnotherapy, biofeedback, meditation, mindfulness-based stress reduction (MBSR), and guided imagery.

Biofeedback: In biofeedback therapy, the patient is made aware of their own parameters through devices, so that they can be mindful and control these parameters. This approach has been helpful to patients to successfully control how their skin conducts and responds.

Cognitive Behavioral Therapy: Habit Reversal therapy approach allows a person to become aware of their habits (such as skin scratching) and teach them to practice alternate strategies to overcome their habit. It also comprises of other treatment aspects like social support, relaxation training, and stimulus control. This therapeutic method has been effective for patients with habitual disorders like hair pulling and skin scratching.

Meditation & Hypnosis: Similar to previous approaches, meditation engages the practice of “intentional attention training” where the patient is asked to be mindful of the present moment and stay aware of the stimulus without judgement. Patients with psoriasis have reported significant improvement in quality of life and decrease in severity of the disease with this method when compared to those who received the usual therapy alone.

Hypnosis is used to influence the person’s mind through the power of suggestion to alter bodily responses. By doing so, anxiety and harmful behaviors are reduced, thereby boosting skin healing.

References

1.       Kaur, J., Gandhi, J., & Sharma, S. (2025, December 1). Physiology, cortisol. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK538239/

2.       JDDonline - Journal of Drugs in Dermatology. (1970, January 1). Psychosocial Stress and Mechanisms of Skin Health: A Comprehensive update - JDDOnline - Journal of Drugs in Dermatology. https://jddonline.com/articles/psychosocial-stress-and-mechanisms-of-skin-health-a-comprehensive-update-S1545961621P0062X

3.       Pondeljak, N., & Lugović-Mihić, L. (2020). Stress-induced interaction of skin immune cells, hormones, and neurotransmitters. Clinical Therapeutics, 42(5), 757–770. https://doi.org/10.1016/j.clinthera.2020.03.008

4.       Graubard, R., Perez-Sanchez, A., & Katta, R. (2021). Stress and Skin: An overview of mind body therapies as a treatment strategy in Dermatology. Dermatology Practical & Conceptual, 11(4), e2021091. https://doi.org/10.5826/dpc.1104a91

5.       Pujos, M., Chamayou‐Robert, C., Parat, M., Bonnet, M., Couret, S., Robiolo, A., & Doucet, O. (2024). Impact of chronic moderate psychological stress on skin aging: Exploratory clinical study and cellular Functioning. Journal of Cosmetic Dermatology, 24(1), e16634. https://doi.org/10.1111/jocd.16634

6.       Chen, Y., & Lyga, J. (2014). Brain-Skin connection: Stress, inflammation and skin aging. Inflammation & Allergy - Drug Targets, 13(3), 177–190. https://doi.org/10.2174/1871528113666140522104422

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