A 30-year-old female surgical chief resident, facing the dual pressures of professional exams and hospital accreditation, discovered a circular bald patch on her scalp, about the size of a quarter. At first, she did not pay much attention to it, but as her anxiety levels increased, the hair loss rapidly expanded into multiple patches within a month, accompanied by significant redness, swelling, pain, and itching of the scalp.
After clinical examinations ruled out systemic problems such as thyroid issues, she was diagnosed with stress-induced acute alopecia areata.
Chen Wei-Ti, a member of the American Academy of Dermatology and a dermatologist at Belléesse Dermatology Clinic in Taiwan, recounted the woman’s case in an interview with The Epoch Times. The patient used medication to suppress the inflammatory response and reduce stress, he said.
“After a month, the hair loss area stopped expanding. Two months later, fine downy hairs had grown in the center of the bald patch, indicating that the hair follicles had re-entered the growth phase. With the completion of the specialist exams and her mood relaxed, the lesions were covered by new black hair.”
Our skin is a mirror of the mind, Chen said. Psychological stress is not just a feeling; it directly alters the skin’s physiology through the neuroendocrine system, primarily via the “brain-skin connection.” It’s an interconnected two-way pathway that transmits psychological stress from the brain to the skin, triggering a stress response. Conversely, environmental stress can also exacerbate psychological stress through the skin, creating a vicious cycle.
4 Types of Stress-Induced Skin Diseases
Psychological stress is a significant factor that can lead to various skin diseases. A 2024 review published in Brain, Behavior, and Immunity indicated that stress alters the immune system, disrupting the balance between immune cells and inflammatory responses in the skin, making people more susceptible to various skin problems.
Stress also affects the skin barrier function, delays wound healing, and promotes the release of inflammatory cells, thereby worsening existing skin conditions.
Among the many skin diseases seen clinically, the following four are particularly sensitive to emotions and stress, and are also the most common, according to Chen:
- Atopic Dermatitis: Stress is one of the main factors leading to acute flare-ups, exacerbating itching through neuroimmune mechanisms, creating a vicious cycle of “itch-scratch-more itching.”
- Psoriasis: Approximately 40 percent to 60 percent of patients report that symptoms worsen when they are emotionally stressed or experience increased stress.
- Alopecia Areata: Commonly known as spot baldness, alopecia areata is a typical stress-related autoimmune disease. Acute stress can disrupt the immune protection mechanisms of hair follicles, prompting the immune system to attack them and trigger hair loss.
- Adult Acne: Particularly common in women, stress-induced fluctuations in adrenal androgen levels can cause deep, cystic pimples around the chin.
Easily Overlooked Emotional Skin Diseases
There is a fairly typical but easily clinically overlooked skin problem—lichen simplex, also known as neurodermatitis, Chen said. From the outside, these skin changes often appear as localized dryness, roughness, darkening, and more pronounced lines, commonly found on the back of the neck, wrists, ankles, or the front of the lower legs. Because there is no obvious oozing or redness, it is often mistaken simply as dry skin, rubbing-related, or aging.
Etiologically, lichen simplex is closely related to psychological stress; it can be described as a “scratched out” condition. Patients often unconsciously rub or scratch the affected area repeatedly, such as while watching television, thinking, or feeling anxious.
This behavior is often an attempt to relieve inner anxiety, but over time it causes continuous skin irritation, leading to lichenification—a thickening, hardening, and darkening of the skin. Clinical observations have found that these patients often also experience anxiety, insomnia, or perfectionist tendencies.
If psychological stress is not addressed, Chen said, even with highly effective topical ointments, the skin condition is unlikely to fully recover.
Breaking the Cycle Between Skin and Emotions
Japanese traditional Chinese medicine (TCM) practitioner Ken Ritsugaku told The Epoch Times that emotional fluctuations are inevitable when facing setbacks. However, prolonged stress or negative emotions without proper relief can trigger relapses or worsening illness.
He suggests addressing the following:
- Do not bear stress alone; confide in family and friends and seek professional help when necessary.
- Give yourself time to rest and relax, and adjust your way of thinking.
- Develop regular exercise habits and ensure sufficient sleep to strengthen your immune system.
- Avoid coping with stress through negative or escapist channels such as alcohol abuse.
Furthermore, the support of family and friends is equally important. For family members, understanding and companionship are more positive than blame or questioning. They should avoid responding to the patient’s emotions and symptoms negatively or with undue criticism, and provide cooperation and support in adjusting diet and lifestyle. The patient may then feel valued and accepted, which helps stabilize emotions and the condition.
TCM: Skin Reactions Through Emotional Imbalance
The influence of emotions on the skin is not a new concept, as modern medicine has proposed, Ken said. TCM has long recognized the link between the emotional state and skin changes. TCM views skin symptoms as an external reflection of the body’s internal state, believing that excessive emotions can damage internal organs and interfere with the body’s overall regulatory mechanisms, thus manifesting as various skin symptoms.
TCM theory states that “worrying and excessive thinking damages the spleen.” TCM holds that the spleen is related to digestion, absorption, and energy conversion. If we persistently overthink, the spleen’s regulatory function may be affected, increasing metabolic burden and making the body more vulnerable to inflammation or allergic reactions, which will be reflected in the skin.
On the other hand, TCM also holds that “the lungs govern the skin and hair,” and that the lungs are closely related to the skin’s condition, responsible for the circulation of qi (vital energy) and blood, and nourishing the skin. When the body’s regulation is out of balance, skin problems such as eczema, acne, and dryness may appear. Studies have also confirmed that young children with eczema often have poor lung function.
Treatment and Prevention
Skin diseases can have a significant effect on a patient’s psychology, especially when visible skin lesions appear—patients are more likely to experience feelings of shame and even self-loathing, Ken said. In this respect, TCM emphasizes treating the body and mind together, and while addressing emotional factors, it also focuses on improving related physiological functions and assisting patients in gradually restoring a more stable physical state through adjustments to lifestyle and sleep patterns.
Eczema
From a TCM perspective, eczema is often related to internal damp-heat—an imbalance between internal inflammation and water metabolism. When skin inflammation recurs time and again, the body is considered to be in a damp-heat state, with symptoms gradually shifting to itchy skin, rashes, or oozing eczema, especially in humid and hot weather, when the interaction between internal and external dampness makes eczema more likely to recur.
For local inflammation and damp-heat symptoms, TCM sometimes uses herbs with heat-clearing and dampness-resolving effects, such as Sanhuang Xiexin Decoction, to alleviate discomfort. Sanhuang Xiexin Decoction is a TCM formula widely used clinically to treat skin inflammation due to its anti-inflammatory properties.
Eczema patients should avoid washing the affected area with hot water, soap, or other irritants, gently cleanse the skin, and avoid scratching to prevent infection. A light diet is recommended, avoiding spicy foods, seafood, beef, mutton, and other foods that may exacerbate inflammation and allergic reactions.
In addition, excessively salty foods should be avoided. A study of 210,000 people published in JAMA Dermatology found that controlling dietary salt intake can be a low-cost, low-risk adjunct for managing eczema.
Furthermore, although eczema is not contagious, it should not be ignored. A study published in “Nature Communications” in 2024 found that eczema may increase the risk of various diseases, including irritable bowel syndrome, esophagitis, thrombosis, chronic obstructive pulmonary disease, and peripheral neuropathy.
Alopecia Areata
Hair growth depends on the nourishment of qi (vital energy) and blood. Herbs with qi-tonifying and blood-nourishing effects, such as Astragalus membranaceus or Polygonum multiflorum, (fleeceflower root) are useful.
It is recommended to pay attention to relieving stress appropriately and avoid staying up late for extended periods. Reduce intake of high-oil, barbecued, fried, and spicy foods, as well as sugary and iced drinks.
Psoriasis
TCM treatment for psoriasis varies from person to person. Clinically, medications are selected based on the patient’s constitution and symptoms, such as Rehmannia glutinosa or rhubarb, which have heat-clearing and detoxifying effects.
Studies show that rhubarb is rich in anthraquinone compounds with anti-inflammatory activity, while Rehmannia glutinosa can regulate keratinocyte proliferation and immune-inflammatory responses.
It is recommended to increase intake of foods rich in vitamins, minerals, and antioxidants, reduce intake of red meat, high-sugar, high-fat, and high-calorie diets, and avoid excessive alcohol consumption and smoking to reduce the body’s inflammatory response. Regular moisturizing, gentle cleansing, moderate removal of scales, and avoiding excessive friction or irritation are also worthwhile.
Note: The Chinese medicinal herbs mentioned above may sound unfamiliar, but many can be purchased in health food stores and Asian grocery stores. Because everyone’s constitution is different, please consult a professional physician for a specific treatment plan.
Acne
In the clinical application of TCM treatment for acne, acupuncture is often used as one of the conditioning methods to help improve the inflammatory response by adjusting the flow of qi and blood according to the body’s constitution. It is recommended to maintain skin cleanliness to reduce the accumulation of sweat, grease, and dust that can clog pores. Also, manage stress and emotions, and cultivate a stable lifestyle.
In terms of diet, lighter cooking methods such as stir-frying, stewing, or steaming are suitable, while minimizing the intake of greasy foods.
Calming Acupoints
When under extreme stress and feeling emotionally unstable or restless, pressing the Neiguan (ST44) acupoint, which has a calming effect, can be used as a daily relaxation routine.
The Neiguan acupoint is located on the palm side of the forearm, about three finger-widths above the wrist crease. Gently press or tap the acupoint with your fingers for about five to 10 seconds each time, continuing for two to three minutes.