The Impact of Stress on Epidermal Barrier Function — An Evidence‐Based Review

Abstract

Introduction

The epidermal barrier functions to limit skin infection and inflammation by inhibiting irritant and immunogen invasion. Abundant evidence suggests that psychological stress stemming from crowding, isolation, nicotine smoking, insomnia, mental arithmetic tasks, physical pain, real life‐stressors (examinations and marital strain), and lack of positive personality traits may impart both acute and chronic epidermal dysfunction.

Materials/Methods

A review of PubMed and EMBASE databases was conducted to identify all English case‐control, cross‐sectional, and randomized control trials that report the effect of stress on epidermal barrier function. The authors' conclusions are based on available evidence from 21 studies that met the inclusion and exclusion criteria.

Results

Psychological stressors upregulate the hypothalamic‐pituitary‐adrenal axis to stimulate local and systemic stress hormone production, ultimately leading to aberrant barrier dysfunction, characterized by decreased epidermal lipids and structural protein production, decreased stratum corneum hydration, and increased transepidermal water loss.

Discussion

This evidence‐based review explores the adverse effects of psychological stressors on epidermal barrier function. Future investigations using more real‐life stressors are needed to further elucidate their impact on skin physiology as well as to identify practical stress‐relieving therapies that minimize and restore epidermal barrier dysfunction, particularly in at‐risk populations.

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