Psychological Factors and Atopic Dermatitis: A Narrative Review of the Bidirectional Relationship

Psychological Factors and Atopic Dermatitis: A Narrative Review of the Bidirectional Relationship Introduction Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by intense itching, dry skin, and a compromised skin barrier. It typically starts in early childhood and is often linked to other allergic conditions like asthma and hay fever. While allergies are a key cause, AD also has a strong, bidirectional connection with psychological distress, including anxiety and depression. This review explores the clinical and biological aspects of this complex relationship. Methods This narrative review gathered information from major scientific databases like PubMed, Scopus, and Google Scholar. The search used keywords such as "atopic dermatitis," "stress," "anxiety," "depression," "brain-skin axis," "inflammation," and "bidirectional relationship." Articles published up to ۲۰۲۴ focusing on the psychological and physiological links in AD, as well as those examining stress, inflammatory skin diseases, and neuro-immunological mechanisms, were included. Discussion The Brain-Skin Connection There's a strong link between skin conditions and the central nervous system (CNS), partly because both originate from the same embryonic layer, the ectoderm. This shared origin helps explain their mutual influence on health and disease. Additionally, skin plays a vital role in body image, and how someone perceives their body can significantly impact their mental well-being. Stress and Underlying Mechanisms of Inflammation Stress and psychological distress can affect the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. This can lead to increased production of inflammatory chemicals in the body while reducing anti-inflammatory hormones like glucocorticoids. Stress also boosts inflammatory mediator production through both the CNS and the peripheral nervous system (PNS). Clinical studies consistently support this physiological link between stress and inflammation. Research shows that even stress during or after pregnancy, including postpartum depression, can be associated with AD. Various family, financial, and emotional stressors experienced by children or their families can also influence the course of AD. Psychological stress and distress are even considered factors in the progression of allergic diseases, known as the Atopic March. Conclusion Atopic dermatitis isn't just an inflammatory skin condition linked to other allergies. Beyond the roles of allergy and barrier dysfunction, stressors are crucial in both its onset and worsening. Therefore, effective AD treatment and management must include careful attention to the patient's psychological well-being.

کلیدواژه ها:

atopic dermatitis ، stress ، anxiety ، depression ، brain-skin axis ، inflammation ، bidirectional relationship