Stress appears to exacerbate certain skin conditions, according to the latest study.
College can be a time of increased psychological stress, especially given the complex social, academic and financial pressures faced by today's students.
Previous studies have suggested a link between stress and skin symptoms, but those studies were limited by small patient samples and by not using standardized tools.
They also tended to be anecdotal in nature, or focused on a single skin disease, according to corresponding author Dr. Gil Yosopovitch, chair of the department of dermatology at the Lewis Katz School of Medicine at Temple University (LKSOM) and director of the Temple Itch Center.
Researchers at LKSOM and Temple aimed to assess the relationship between perceived psychological stress and the prevalence of various skin symptoms in a large, randomly selected sample of undergraduate students.
Pruritis and alopecia aggravated by stress
The cross-sectional study was carried out at Temple University during the 2014 fall semester. A total of 5,000 undergraduate students were invited to complete a web-based questionnaire in which they reported their perceived psychological stress and any skin complaints.
The final sample size was 422 students, who were then divided into three groups: low stress, moderate stress and high stress.
Students who reported high stress levels suffered significantly more often from pruritus (itchy skin); alopecia (hair loss); oily, waxy or flaky patches on the scalp; hyperhidrosis (troublesome sweating); scaly skin; onychophagia (nail biting); itchy rash on hands; and trichotillomania (hair pulling).
The American Academy of Dermatology (AAD) explain that alopecia is usually caused by hereditary factors but can be caused by a number of environmental factors, including lack of nutrients and certain medications - including some used for depression and hormonal imbalance.
According to the American Academy of Family Physicians (AAFP), pruritis is an umbrella term for a number of dermatologic conditions, including some types of eczema and dermatitis. Pruritis is associated with histamine, which is released during an allergic response, but it can reflect an underlying systemic disease. It is often exacerbated by skin inflammation, dry or hot conditions, skin vasodilation and psychologic stressors.
Study limitations include low response rate and the fact that there was no physical assessment of respondents.
Nevertheless, the results are seen as important for dermatologists who treat undergraduate-aged patients.
Dr. Yosipovitch says:
"Our findings highlight the need for health care/dermatology providers to ask these patients about their perceived levels of psychological stress. Disease flare or exacerbation while on treatment in the setting of increased stress may not necessarily reflect treatment failure."
Dr. Yosipovitch adds that non-pharmacologic therapeutic interventions should perhaps be considered for patients presenting with both skin conditions and increased levels of psychological stress.
Medical News Today recently reported on the dramatic increase in prices for dermatologic drugs.