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Stress-Induced Interaction of Skin Immune Cells, Hormones, and Neurotransmitters.

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eMediNexus    06 May 2020

The skin actively responds to psychological stress, with involvement of skin immune cells, hormones, neurotransmitters. Skin immune cells actively regulate tissue inflammation with their proinflammatory and anti-inflammatory effects. Stress-induced skin reactions primarily include cytokine secretion – interleukin-6, interleukin-1, interferon-γ, and activation of skins peripheral corticotropin-releasing hormone (CRH)-proopiomelanocortin (POMC)-adrenocorticotropic hormone (ACTH)-corticosteroids axis, which leads to acute/chronic secretion of corticosteroids in the skin.

The goal of a new study published in Clinical Therapeutics was to review latest findings regarding the impact of psychological stress on skin diseases—including information concerning the psycho-neuroimmune factors in stress-induced skin responses.

This narrative review selected recent articles available through PubMed database and other prominent literature.

The results revealed that stress mediators – including cortisol, ACTH and CRH from the hypothalamus-pituitary-adrenal axis activation, induce various skin immune responses. Skin cells themselves can secrete these hormones and participate in skin inflammation. Hence, the local skin CRH-POMC-ACTH-corticosteroids axis plays a prominent role in stress-induced responses.

Furthermore, keratinocytes and fibroblasts produce hypothalamic and pituitary signal peptides and express receptors for them—CRH with receptors and POMC degradation peptides with melanocortin receptors—which allow them to respond to CRH by activating the POMC gene. These events are followed by ACTH and corticosteroids excretion. While keratinocytes can express receptors for neurotransmitters – for example, adrenaline, noradrenaline, dopamine, histamine, acetylcholine, neurotrophins and neuropeptides – like substance P and nerve growth factor, which are important in linking psycho-neuroimmunologic mechanisms.

In inference, it was stated that psycho-neuroimmunology provides an understanding of the skin being a target and source of stress mediators. This locally expressed complex stress-induced network has been confirmed as active in many skin diseases – for instance, vulgar psoriasis, atopic dermatitis, chronic urticaria, human papillomavirus infections/warts, hair loss and acne. Skin reactions to stress and its influence on skin diseases may have implications for disease severity and exacerbation frequency, given the effect of locally secreted corticosteroids and other mediators that affect skin integrity, inflammation and healing potential. Studies have shown that introducing psychiatric treatment—drugs or psychotherapeutic methods—can have positive effects on dermatologic diseases influenced by psychological stress exposure.

Source: Clinical Therapeutics. 2020 Apr 7;S0149-2918(20)30171-5. doi: 10.1016/j.clinthera.2020.03.008.

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