Role of stress in skin diseases: A neuroendocrine-immune interaction view

Social Isolation, Loneliness, Anxiety, and Quality of Life in a Chronic Ulcer Population With and Without Stigma: An Observational Trial

Chronic leg ulcers impact millions worldwide, causing visible symptoms including discoloration, swelling, scarring, and requiring bulky bandaging, which often leads to stigma. Stigma may worsen other psychosocial impairments. This observational study examined stigma, social isolation, loneliness, anxiety, and quality of life (QOL) in adults aged 50+ receiving clinic-based wound care. Participants provided sociodemographic information and completed validated assessments. Among the 26 completers (13 with stigma/S+, 13 without stigma/S-), the average age was 63.2 years; 38% were female, and 58% Black/African American. Most (73%) had ≥high school education, 77% were single, and 42% were employed. Mean BMI was 38.7 kg/m², with 3.7 comorbidities. Stigma scores were higher in S+ (9.8 ± 4.6) versus S- group (6.0 ± 0.0). Loneliness was ≥40 for 15% (S-) versus 53% (S+). Social support was higher in S+ (77.0 ± 21.9) versus S- (64.5 ± 22.3), as was anxiety (50.5 ± 7.6 vs 43.3 ± 8.5). S+ reported lower QOL in appearance (2.8 ± 1.6) and clothing (2.4 ± 1.3). Findings underscore stigma's impact on health, warranting further research on protective and resilience interventions.

Comprehensive single-cell transcriptomic reveals different destinies of melanocytes and dynamic changes of immune microenvironment in a psychological stress-induced leukoderma and leukotrichia mouse model

BACKGROUND

Vitiligo is an acquired skin depigmentation disorder often accompanied by leukoderma and leukotrichia. Half of vitiligo patients experience episodes of stress.

METHODS

We established a chronic unpredictable mild stimulation (CUMS) model in C57BL/6 J mice to simulate chronic mental stress-induced leukoderma and leukotrichia. Single-cell RNA sequencing was performed to determine the immune landscape and to characterize the relationship between immune-stromal cells. Immunohistochemistry was employed for validation.

RESULTS

We discovered a similar pro-inflammatory micro-environment composed of keratinocytes and fibroblasts similar to that in human vitiligo. Macrophages in CUMS mice expressed high levels of inflammatory factors and were inclined to an M1 pro-inflammatory phenotype. Two distinct clusters of melanocytes were also identified: Mel2, defined as melanocyte stem cells, and Mel3, defined as mature melanocytes. Mel2 cells were prone to pyroptosis and necroptosis, while Mel3 cells were susceptible to oxidative stress, mitochondrial dysfunction, and ferroptosis. Compared with control mice, higher expression of CXCL16 on dendritic cells and of the CXCL16 ligand, CXCR6, on γδT cells were observed in leukoderma. Dendritic cells and natural killer T cells in the CUMS mouse spleen exhibited elevated levels of CXCL16 and CXCR6, respectively. Activation of the CXCL16-CXCR6 axis and a non-specific immune response in our CUMS model might imitate chronic mental stress-induced vitiligo in humans better than CD8 + cytotoxic T lymphocyte-mediated models.

CONCLUSIONS

We discovered two melanocyte clusters with distinct fates and a pro-inflammatory micro-environment with CXCL16-CXCR6 axis activation of antigen-presenting cells and other innate immunocytes that might provide new insights into the pathogenesis of stress-induced vitiligo.

Interventions in cytokine signaling: novel horizons for psoriasis treatment

Intricate interactions between immune cells and cytokines define psoriasis, a chronic inflammatory skin condition that is immunological-mediated. Cytokines, including interleukins (ILs), interferons (IFNs), tumor necrosis factors (TNFs), chemokines, and transforming growth factor-β (TGF-β), are essential for controlling cellular activity and immunological responses, maintaining homeostasis and contributing to the pathogenesis of psoriasis. These molecules modulate the immune microenvironment by either promoting or suppressing inflammation, which significantly impacts therapeutic outcomes. Recent research indicates that treatment strategies targeting cytokines and chemokines have significant potential, offering new approaches for regulating the immune system, inhibiting the progression of psoriasis, and reducing adverse effects of traditional therapies. This review consolidates current knowledge on cytokine and chemokine signaling pathways in psoriasis and examines their significance in treatment. Specific attention is given to cytokines like IL-17, IL-23, and TNF-α, underscoring the necessity for innovative therapies to modulate these pathways and address inflammatory processes. This review emphasizes the principal part of cytokines in the -pathological process of psoriasis and explores the challenges and opportunities they present for therapeutic intervention. Furthermore, we examine recent advancements in targeted therapies, with a particular focus on monoclonal antibodies, in ongoing research and clinical trials.

Psychosocial work exposures as risk factors for skin problems in a general working population: cross-sectional and prospective associations

OBJECTIVE

The potential contribution of psychosocial work exposures to skin problems is largely overlooked in the occupational health literature. To address this knowledge gap, we examined cross-sectional and prospective associations between six psychosocial work exposures (i.e., quantitative demands, job control, social support, emotional demands, role conflict, and interpersonal conflict) and self-reported skin problems.

METHODS

Data came from a probability sample of the general working population in Norway surveyed in 2016 (N = 7833) and 2019 (N = 8038). The prospective sample comprised 3430 participants. Data were analysed with ordered logistic regression, adjusting for age, sex, occupation, and exposure to cleaning products, water, and dry indoor air.

RESULTS

Cross-sectional analyses indicated statistically significant associations with skin problems for emotional demands, role conflict, and interpersonal conflict in 2016 and 2019, and for social support in 2019. In prospective analyses, emotional demands (OR 1.12, 95% CI 1.01-1.23), role conflict (OR 1.14, 95% CI 1.00-1.29), and interpersonal conflict (OR 1.24, 95% CI 1.01-1.52) significantly predicted subsequent skin problems. Interpersonal conflict (OR 1.26, 95% CI 1.01-1.57) was a significant predictor above and beyond baseline levels of skin problems. Quantitative demands and job control was generally non-significant, except for a significant interaction in the 2019 sample.

CONCLUSION

Exposure to certain psychosocial work stressors may be a risk factor for experiencing skin problems, particularly if you are exposed to interpersonal conflict. Preventive efforts to reduce the occurrence of skin problems in work settings should also target psychosocial stressors.

Evaluation of the Environmental Risk Factors and Comorbidities in Patients with Lichen Planopilaris: A Case-Control Study

Introduction

Lichen planopilaris (LPP) is an uncommon cicatricial alopecia clinically characterized by follicular hyperkeratosis, perifollicular erythema, and permanent hair loss. The association of LPP with certain underlying diseases and environmental factors has been evaluated but there are limited data about this association. This study was designated to evaluate the environmental risk factors and comorbidities in LPP patients.

Method

This case-control study was performed on LPP patients referred to two dermatology referral centers from 2019 to 2022. A group of non-LPP healthy individuals referring for cosmetic concerns was recruited as control group. Data collection was performed using two questionnaires: a general questionnaire, including demographic information, comorbidities, environmental risk factors, and disease-related information, and the lichen planopilaris activity index (LPPAI) questionnaire.

Results

One hundred LPP patients as case group were compared with 100 healthy people without LPP as control group. Unemployment, history of major stressful events, thyroid disorder, history of hair dyeing, using face soaps, taking supplements, postmenopausal status, and family history of LPP or other types of alopecia had significant relationship with LPP (all p values <0.05).

Conclusion

LPP has associations with environmental and non-environmental risk factors and, also, genetic component.

Effectiveness of Extracellular Vesicle Application in Skin Aging Treatment and Regeneration: Do We Have Enough Evidence from Clinical Trials?

In recent years, there has been a dynamic development in therapies utilizing extracellular vesicles (EVs) including exosomes. Therefore, we have conducted an analysis of the scientific literature to verify the current state of knowledge about these therapies. A total of 12 clinical studies were analyzed, covering the use of EVs in treating skin aging, acne scars, alopecia, and wound healing. The results indicate that EVs and exosomes hold potential in regenerative skin therapies, offering innovative and non-invasive therapeutic approaches. At the same time, significant challenges related to the standardization of their production and the lack of large-scale randomized studies were identified. Thus, we also evaluated the investigated clinical trials in regard to the MISEV (Minimal Information for Studies of Extracellular Vesicles) criteria. This review provides a comprehensive overview of the contemporary applications of EVs in skin therapy and regenerative medicine, highlighting directions for further research.

[Happiness-A concept for holistic person-centered healthcare in dermatology]

BACKGROUND

Happiness is a concept in positive psychology. Studies have shown links between happiness, courses of diseases and health. In dermatology the role of happiness has not yet been sufficiently investigated.

RESEARCH QUESTION

What impact do skin diseases have on individual happiness and what contribution can happiness make to holistic dermatological care?

MATERIAL AND METHODS

Processing of the current literature for a selective overview of primary scientific studies on happiness based on heuristic happiness and subjective well-being measured by positive and negative affects as well as satisfaction with life in dermatology.

RESULTS

Patients with skin diseases show significant impairments in happiness, especially in the positive affect and satisfaction with life compared to the healthy population. The impairments appear to be expressed differently for different dermatoses; for example, patients with skin cancer show significantly higher life satisfaction than other dermatological patients. Influencing factors vary in their strength and direction depending on the operationalization of happiness and the skin disease.

DISCUSSION

Dermatological diseases appear to be associated with impairments in happiness, particularly in the positive affect. Integrating happiness into dermatological care could help to have a better understanding of patients' individual needs in the context of holistic, person-centered healthcare. Future research and specific interventions to improve happiness should be developed to promote positive health outcomes.

'A boy actually said I looked like a fire victim': Exploring the psychosocial impacts of psoriasis, eczema and acne amongst young women in the UK through thematic analysis

Our knowledge of the psychosocial implications of skin conditions continues to broaden, as research identifies multiple psychological morbidities relating to psoriasis, eczema and acne. This includes findings of poor body image, as a result of the change in physical appearance to the skin. However, there is limited qualitative research in the UK that explores how young women with skin conditions experience unique psychosocial impacts, including body image issues. The present study explored the experiences of seven young women with psoriasis, eczema and acne. Four main themes were developed: Embarrassment over appearance related symptoms; An unrealistic female beauty standard; Change in appearance attacking personal identity; and Lack of support. The implications of these findings are discussed, including a call for a biopsychosocial approach to skin condition treatment, that prioritises the psychological and social well being of young female skin condition patients, as well as their physical health.

Understanding the Intricate Pathophysiology of Psoriasis and Related Skin Disorders

Psoriasis is a chronic inflammatory condition that is polygenic and multisystemic, impacting approximately 2-3% of the global population. The onset of this disease is influenced by an intricate interplay of genetic and environmental factors, predisposing individuals to the psoriasis phenotype. The complex pathogenesis of psoriasis contains certain key aspects found in other autoinflammatory and autoimmune dermatological diseases. Among these, vitiligo, alopecia areata, hidradenitis suppurativa, vitiligo, connective tissue diseases, bullous dermatoses, and atopic dermatitis are conditions that share overlapping immune system dysfunction, making their relationship with psoriasis particularly significant. For our research, we explored various terms including "shared", "concomitant", "coincident", "overlap", "coexist", and "concurrent", in relation to conditions such as "psoriasis", "alopecia areata", "hidradenitis suppurativa", "atopic dermatitis", "vitiligo", "bullous pemphigoid", "pemphigus vulgaris", "lupus erythematosus", "dermatomyositis", and "systemic sclerosis." Additionally, we used specific search queries like "atopic dermatitis overlapping syndrome" and "psoriasis and vitiligo concomitant disease" in the PubMed and Web of Science databases. While distinct in their clinical presentation, the skin diseases related to psoriasis may become associated, complicating diagnosis and treatment. In this narrative review, the complex pathophysiology of psoriasis is described, along with its close relationship to other skin conditions. This review provides an exhaustive description of both immunological and non-immunological pathways contributing to their development. Understanding the intricate interconnection between psoriasis and these conditions is of interest to scientists in developing novel research directions and to clinicians in providing holistic care, as managing one condition may influence the course of others.

Potentially traumatic events, posttraumatic stress symptoms, and skin-related quality of life among adults with self-reported skin disease symptoms

The connection between stress and skin disease has been extensively documented; however, there are no empirical studies investigating the incidence of traumatic event exposure and posttraumatic stress (PTS) symptoms among dermatology patients. To address this gap in the literature and begin to understand the associations between PTS symptoms and skin disease symptoms, this study used a sample of adults with self-reported skin disease symptoms to examine: (1) rates of potentially traumatic event (PTE) exposure and PTS symptoms; and (2) the association between PTS symptoms and skin-related quality of life, controlling for relevant covariates. Data were collected online through Cloud Research, and participants completed a battery of self-report measures. The sample included 310 participants (68.4% female) who endorsed current skin disease symptoms. Results indicated that 47.1% of participants endorsed clinical levels of PTS symptoms. Consistent with hypotheses, greater levels of PTS symptoms were associated with worse skin-related quality of life, and this association was particularly robust for arousal-related symptoms. Results shed light on the occurrence of trauma-related experiences among individuals with self-reported skin disease and indicate a link between PTS symptoms and the perceived burden of skin disease symptoms on daily living. However, this study was cross-sectional and relied on self-report measures; therefore, findings should be interpreted with caution, particularly since diagnoses could not be verified. Replication of this work in dermatology patients is needed to further understand these connections.

Prevention of Melasma During Pregnancy: Risk Factors and Photoprotection-Focused Strategies

Melasma is a benign but emotionally distressing skin condition that reduces patients' quality of life, with prevalence rates during pregnancy ranging from 36.4% to 75%. Troublingly, up to 30% of cases are reported to persist after delivery, even ten years later. And recurrence and aggravation are common in subsequent pregnancies. This review examines the risk factors and mechanisms associated with melasma during pregnancy and summarized corresponding preventive strategies. We emphasize the critical role of photoprotection, including the use of sunscreens from the first trimester, in reducing the incidence of melasma.

Mind the GAPS: Glia associated with psychological stress

Glial cells are an integral component of the nervous system, performing crucial functions that extend beyond structural support, including modulation of the immune system, tissue repair, and maintaining tissue homeostasis. Recent studies have highlighted the importance of glial cells as key mediators of stress responses across different organs. This review focuses on the roles of glial cells in peripheral tissues in health and their involvement in diseases linked to psychological stress. Populations of glia associated with psychological stress ("GAPS") emerge as a promising target cell population in our basic understanding of stress-associated pathologies, highlighting their role as mediators of the deleterious effects of psychological stress on various health conditions. Ultimately, new insights into the impact of stress on glial cell populations in the periphery may support clinical efforts aimed at improving the psychological state of patients for improved health outcomes.

Vitis vinifera L. Leaf Extract, a Microbiota Green Ally against Infectious and Inflammatory Skin and Scalp Diseases: An In-Depth Update

The skin microbiota, with its millions of bacteria, fungi, and viruses, plays a key role in balancing the health of the skin and scalp. Its continuous exposure to potentially harmful stressors can lead to abnormalities such as local dysbiosis, altered barrier function, pathobiont overabundance, and infections often sustained by multidrug-resistant bacteria. These factors contribute to skin impairment, deregulation of immune response, and chronic inflammation, with local and systemic consequences. In this scenario, according to the needs of the bio-circular-green economy model, novel harmless strategies, both for regulating the diverse epidermal infectious and inflammatory processes and for preserving or restoring the host skin eubiosis and barrier selectivity, are requested. Vitis vinifera L. leaves and their derived extracts are rich in plant secondary metabolites, such as polyphenols, with antioxidant, anti-inflammatory, antimicrobial, and immunomodulatory properties that can be further exploited through microbe-driven fermentation processes. On this premise, this literature review aims to provide an informative summary of the most updated evidence on their interactions with skin commensals and pathogens and on their ability to manage inflammatory conditions and restore microbial biodiversity. The emerging research showcases the potential novel beneficial ingredients for addressing various skincare concerns and advancing the cosmeceutics field as well.

Psychodermatology of Chronic Pruritus: An Overview of the Link Between Itch and Distress

Chronic pruritus (CP) is defined as an unpleasant sensation causing a desire to scratch and lasting > 6 weeks. It has a multifactorial etiology but is more frequently associated with chronic inflammatory dermatoses and systemic disorders. Psychogenic pruritus and neurological disorders are other less common etiologies, while, in some patients, it is idiopathic. CP appears to be processed by non-histaminergic pathway, contributing to its complexity and therapeutic challenge. Moreover, regardless of the etiology, it is multidimensional, including cognitive, motivational and affective components. There is a close link between psychological distress and pruritus, with particular clinical expression in chronic inflammatory dermatoses, involving the activation of the hypothalamic-pituitary-adrenal axis (and its cutaneous equivalent), the sympathetic nervous system, the release of hormones and peptides, the role of immune cells (T and B cells, macrophages) and immune-related cells in the skin (mast cells, dendritic cells and keratinocytes). Moreover, there is strong evidence that psychological factors influence the experience of pruritus. CP can also cause psychiatric disorders, including but not limited to anxiety and depression, and also lead to significant quality of life (QoL) impairment. Thereby, although a psychodermatological assessment should ideally be carried out in the context of a specific psychodermatology consultation, a brief mental health assessment could be part of the general dermatological approach to these patients. Considering that mental health, QoL and pruritus are closely linked, psychotherapeutic interventions and/or psychotropic drugs should thus be considered in some patients as an adjunct to the pharmacological treatment of CP.

T cell-mediated skin-brain axis: Bridging the gap between psoriasis and psychiatric comorbidities

Psoriasis, a chronic inflammatory skin condition, is often accompanied by psychiatric comorbidities such as anxiety, depression, suicidal ideation, and other mental disorders. Psychological disorders may also play a role in the development and progression of psoriasis. The intricate interplay between the skin diseases and the psychiatric comorbidities is mediated by the 'skin-brain axis'. Understanding the mechanisms underlying psoriasis and psychiatric comorbidities can help improve the efficacy of treatment by breaking the vicious cycle of diseases. T cells and related cytokines play a key role in the pathogenesis of psoriasis and psychiatric diseases, and are crucial components of the 'skin-brain axis'. Apart from damaging the blood-brain barrier (BBB) directly, T cells and secreted cytokines could interact with the hypothalamic-pituitary-adrenal axis (HPA axis) and the sympathetic nervous system (SNS) to exacerbate skin diseases or mental disorders. However, few reviews have systematically summarized the roles and mechanisms of T cells in the interaction between psoriasis and psychiatric comorbidities. In this review, we discussed several key T cells and their roles in the 'skin-brain axis', with a focus on the mechanisms underlying the interplay between psoriasis and mental commodities, to provide data that might help develop effective strategies for the treatment of both psoriasis and psychiatric comorbidities.