Can Stress Cause Dermatitis (And Why)?

11.4.2025 0 comments

Author: Trisha Houghton, CNS, ASIST

What is dermatitis? Dermatitis is a general term for conditions that cause inflammation of the skin. Examples and symptoms include atopic dermatitis (eczema), contact dermatitis and seborrheic dermatitis (dandruff). These conditions cause red rashes, dry skin and itchiness among other symptoms. And, yes, according to the Cleveland Clinic, stress is an important factor in the causation of dermatitis.

In a recent study documented by the National Eczema Association, it is estimated that 16.5 million adults in the U.S. have atopic dermatitis. Let us explore the role stress has to play in the skin condition, and how we can manage the affliction.

What Are The Common Symptoms of Eczema and Dermatitis?

Dermatitis has many causes and forms and often involves itchy, dry skin or a rash. Sometimes it might cause the skin to blister, ooze, crust or flake. Dermatitis isn’t contagious, but it can be very uncomfortable. Common symptoms of the condition may include:

• Itchiness that can be painful
• Dry, cracked, scaly skin, more typical on white skin
• Rash on swollen skin that varies in color depending on skin color
• Blisters, perhaps with oozing and crusting
• Dandruff
• Thickened skin
• Small, raised bumps, more typical on brown or Black skin

The Link Between Stress and Skin Health

Stress can affect the skin barrier function, impair wound healing, and promote the release of pro-inflammatory cytokines. This will worsen existing skin diseases such as psoriasis, atopic dermatitis, acne, and urticaria and, according to a recent review, pro-inflammatory cytokines are associated with dermatitis which can appear where it once didn’t. Other links between stress and skin health include:

• Neuro-endocrine-immune activation: Stress triggers both the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system. This releases hormones (e.g. cortisol, adrenaline) and neuropeptides. These messengers can directly influence skin cells and immune responses in the skin
• Inflammation and immune dysregulation: Elevated stress can tilt the balance toward pro-inflammatory cytokines in skin, increasing inflammation. This makes skin more reactive and susceptible to dermatitis flare-ups
• Barrier dysfunction & impaired repair: Stress impairs the skin’s barrier (the outer “seal” that keeps moisture in and harmful agents out). This slows wound healing and the ability to recover from damage
• Overproduction of sebum production and acne: Cortisol and other stress hormones can stimulate sebaceous glands to produce more oil. This sebum can worsen acne or clog pores
• Behavioral & lifestyle: Stress causes people to forget or skip skincare routines and interrupts healthy, needed sleep. Diet suffers too, with people suffering from stress eating more processed and fast foods. Stress can also increase nervous habits like picking at skin. All can cause dermatitis symptoms to appear or worsen
• Stress from Dermatitis: Skin problems can themselves cause psychological distress though embarrassment or discomfort, often worsening stress. This forms a feedback loop that is difficult to break

How Stress Triggers Dermatitis

When you’re stressed, your body doesn’t just keep it in your head, it tells your skin, too. The brain, adrenal glands, and nerves launch a coordinated response called the HPA axis. This acts by releasing hormones like cortisol and adrenaline through your body. These hormones surge through the bloodstream, priming the body for survival, but in the process, they also reach the skin. The skin isn’t a passive bystander; it has its own stress sensors. These are cells that can “hear” cortisol and neurochemical signals. When those receptors light up, things begin to unravel.

According to recent studies, cortisol, meant to dampen inflammation in the short-term, becomes a problem when stress is chronic. Long exposure weakens the skin’s barrier. Studies have shown that stressed is a common trigger that can cause skin to repair itself more slowly and cause it to lose water faster, leaving it dry, itchy, and vulnerable to allergens and microbes. Once the barrier falters, the immune system steps in and overreacts, promoting immune dysregulation and inflammation which can worsen dermatitis..

Physiological Mechanisms Behind Stress-Induced Dermatitis

Stress doesn’t just make you feel on edge. It rewires your biology from the inside out. When dermatitis flares under pressure, it’s not “all in your head.” It’s in your hormones, nerves, immune system, and nervous system. All of these systems talk to your skin at once, causing a number of reactions. Here’s how that conversation goes wrong.

When the brain senses stress, it hits the panic button, activating the

hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system.

• The hypothalamus releases CRH (corticotropin-releasing hormone)
• The pituitary follows up with ACTH
• The adrenal glands fire off cortisol and adrenaline

These stress messengers flood the body and the skin, and prepare it for “fight or flight.”

Studies show that stress pushes your immune system towards a Th-2 inflammatory response, like in Atopic Dermatitis (AD). This is an allergic overreaction pathway that fuels eczema. Cytokines like IL-4 and IL-13 are central in Atopic Dermatitis (AD), driving redness, swelling, and itching while protective immune functions, like antimicrobial defense and wound healing, get dialed down causing dermatitis issues to prosper. Stress also fires up sensory nerve fibers, making the skin more sensitive and itchy. You scratch to relieve it, but that just damages the skin more, creating the viscous circle and feeding back into inflammation and restarting the loop.

In short, stress hijacks your body’s control systems. Hormones, nerves, and immune cells team up in all the wrong ways, turning your skin into a battleground.

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Types of Dermatitis Commonly Affected by Stress

But what are the types of dermatitis most commonly affected by stress? Are there ones that are more common than others? Yes. According to a focus group study by the National Library of Medicine, atopic dermatitis is said to be worsened by psychological stress.

Signs and Symptoms of Stress-Related Dermatitis

Common symptoms and signs of atopic dermatitis are:

• Intense itching. This is usually one of the first and most distressing symptoms. It often leads to scratching, which can worsen the condition
• Dry, scaly, or flaky skin. Atopic dermatitis causes the skin to lose moisture and become rough or patchy
• Small bumps (papules) that may ooze fluid or leak, especially when scratched. These can crust over
• Thickening of the skin (lichenification) from repeated scratching or rubbing. This can cause the skin to take on a leathery texture
• Skin discoloration after flare-ups. Patches of the skin may be lighter or darker than surrounding areas. Certain tones may see dusky, brown, or grey patches
• Cracked or raw skin, especially where scratching damages the surface. These abrasions can sometimes bleed
• Swelling and irritation are possible; however, marked warmth and tenderness can indicate infection rather than eczema alone
• A rash on the face, scalp (moreso in infants), hands, feet, commonly in skin folds in the flexural areas, like the inside of elbows, backs of knees. But these rashes can also be seen on hands, neck, and the ankles

Treatment Options for Stress-Induced Dermatitis

Thankfully, there are many options for the treatment of the different types of dermatitis. These range from dealing with the flare ups on the body through topics and medications, and dealing with the root cause through targeting the stress. There are also natural paths to help combat the issue. These start from your cleaning regime. Helpful tips include:

• Moisturizing often and using fragrance-free, hypoallergenic creams or ointments (e.g. petrolatum-based) at least twice daily
• Taking lukewarm showers as hot water strips oils and worsens dryness
• Using gentle cleansers and avoiding harsh soaps, fragrances, or alcohol-based products
• Patting skin dry and not rubbing. You can also apply moisturizer immediately after bathing to lock in moisture

Topical medication can also help. Approaches often come in the following ways:

• Corticosteroid creams or ointments can reduce inflammation and itching during flare-ups
• Calcineurin inhibitors (e.g. tacrolimus, pimecrolimus) are a non-steroid alternative that calm immune overreaction. These are especially good for sensitive areas like the face and groin
• Phosphodiesterase-4 inhibitors (e.g. crisaborole) can help with mild to moderate dermatitis
• Topical antibiotics are an option if there is a minor localized infection like a secondary bacterial infection from scratching

There are many oral medications that can tackle the problem. Recommendations include:

• Over the counter, oral antihistamines can help with sleep during flares
• Short-term oral corticosteroids can be taken for severe flares,but only under medical supervision. That said, routine steroid use is not supported long term due to rebound flares and side effects
• Biologic therapies (e.g. dupilumab, tralokinumab) can target specific immune pathways (IL-4, IL-13) which is useful for moderate to severe eczema

You need to consult with your medical provider on the use of any of these approaches. Do not resort to these options without medical supervision.

CBT is a type of talk therapy often used to help people with anxiety and depression and is also used for people suffering from stress. Evidence shows it can also help people living with long-term health conditions, such as atopic dermatitis. CBT-based strategies may help manage itch-scratch cycles and the stress associated with AD.

Lifestyle Changes for Healthier Skin

A thorough dermatitis management plan is key to finding lasting relief and symptom control. A major part of that plan involves implementing specific, proven strategies in your daily life. Thankfully, there has been much research conducted in the topic. Lifestyle changes include:

• Identifying and avoiding triggers such as high stress, certain fabrics (like wool), detergents, fragrances. Avoid food triggers if a clear link is established
• Managing stress through mindfulness, therapy, yoga, and breathing exercises. Keeping your nails short as this prevents skin damage and infections from scratching
• Using humidifiers at home or in an office, especially in dry climates or during winter.
• Wearing soft, breathable, organic fabrics like cotton

When to Consult a Healthcare Professional

Dermatitis is not contagious but it can cause stress, discomfort, sleepless nights and promote feelings of poor self-worth and esteem. While it is natural to feel embarrassment about the condition, there are millions of people in the USA alone who suffer daily from dermatitis, and 100% affected by some other ailment. Hopefully it helps that doctors are well informed in controlling, managing, and relieving dermatitis. If you feel over-the-counter methods and skin care routines aren’t helping you with the situation, or you feel the dermatitis is causing undue pain, stress, or harm, it is time to see your medical doctor.

Because stress is one of the biggest triggers for dermatitis flare-ups, prioritizing rest and relaxation isn’t just about feeling calm — it’s about giving your body the space to repair itself. Quality sleep supports hormonal balance, lowers inflammation, and helps your skin rebuild its natural barrier, making it an essential part of any long-term strategy for managing stress-related skin conditions.

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Frequently Asked Questions

What can be mistaken for dermatitis?

Dermatitis can be a master of disguise. Its redness, itching, and scaling make it look like half a dozen other skin conditions like psoriasis, rosacea, hives, fungal infections, scabies or cutaneous lupus. Because so many skin conditions share overlapping symptoms like redness, itchy skin and flaking, proper diagnosis usually depends on medical history, distribution, and sometimes lab tests, rather than appearances alone.

How long does it take for stress eczema to go away?

The lifespan of dermatitis depends on the type you’re dealing with and how well you can calm the factors driving it. Some rashes fade in days. Others linger for months or even become lifelong companions.

If your dermatitis stems from direct irritation or an allergic reaction to a new soap, detergent, or nickel jewelry, it often clears within a week or two once you remove the trigger. The skin just needs time to heal and rebuild its barrier. Mild steroid creams and consistent moisturizing can speed things up dramatically. But if the irritant stays in contact, or if scratching breaks the skin, recovery can drag on for much longer.

With atopic dermatitis, the timeline is less predictable. This type tends to ebb and flow. It might calm down for months and then flare up again with stress, cold weather, or allergens. You can manage it well enough that your skin looks clear for long stretches, but without ongoing care, it rarely disappears permanently. Think of it as a condition you learn how to better manage and work with, rather than one you cure.

How do I know stress is causing skin issues?

It’s not always obvious when stress is behind your dermatitis. But there are patterns and clues that can help you connect the dots. Start by paying attention to timing. Do your flare-ups seem to arrive when you’re stretched thin? If your skin calms when your life does, that’s a strong hint stress might be pulling the strings.

The next giveaway is location and intensity. Stress-induced flares often erupt in familiar hotspots like hands, neck, face, or the creases of elbows and knees but they can feel angrier and more persistent than usual. You might also find your usual treatments, like steroid creams or moisturizers, suddenly work less effectively.

Physical stress symptoms tend to accompany the flare: tense muscles, headaches, fatigue, poor sleep, or even stomach upsets. It’s all part of the same body-wide stress response of cortisol surges. The surest way to confirm it’s stress-driven is by experimenting with calming your body through meditation, breathing and so on. When you actively reduce stress through mindfulness, breathing exercises, therapy, or even a simple daily walk and your skin noticeably improves, you’ve got insight and there also may be a few factors contributing..

Of course, doctors can help rule out other triggers, from allergies to infections. But if your skin seems to mirror your mental state, flaring in chaos and clearing in calm, stress is almost certainly in the mix.

What virus or infection causes dermatitis?

Dermatitis itself isn’t caused by a single virus or infection; it’s more of an inflammatory reaction than a contagious disease. Certain infections can worsen the condition, though. For instance, Staphylococcus aureus, a common bacterium that lives harmlessly on the skin, can invade when eczema or dermatitis breaks the surface. Once inside, it fuels redness, oozing, and crusting, making flare-ups far more severe. In some cases, dermatologists call this “infected eczema.”

References

Eczema Stats 

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

Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology

Psychological Stress Perturbs Epidermal Permeability Barrier Homeostasis

Effects of Stress on Your Skin

Stress may be getting to your skin, but it’s not a one-way street

Stress and atopic dermatitis

Association between Stress and the HPA Axis in the Atopic Dermatitis

Eczema types: Atopic dermatitis diagnosis and treatment

Lifestyle Changes That Can Help Relieve the Symptoms of Eczema

Contact dermatitis

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