The role of emotional distress in disfiguring skin diseases: A view from brain-skin axis

Zhuofan Wen; Xi Stellan Chen; Hengxi Zeng; Yang Chen; Nieng Zhang; Qiuyun She; Xuzheng Zuo; Yujie Wang; Kai Gao; Mi Wang; Zhongrong Liu

doi:10.1016/j.yfrne.2026.101253

The role of emotional distress in disfiguring skin diseases: A view from brain-skin axis

Front Neuroendocrinol. 2026 May 8:82:101253. doi: 10.1016/j.yfrne.2026.101253. Online ahead of print.

Authors

Zhuofan Wen¹, Xi Stellan Chen¹, Hengxi Zeng¹, Yang Chen², Nieng Zhang¹, Qiuyun She¹, Xuzheng Zuo¹, Yujie Wang¹, Kai Gao³, Mi Wang⁴, Zhongrong Liu⁵

Affiliations

¹ Department of Dermatology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
² Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
³ Furong Laboratory, Central South University, Changsha 410078, China. Electronic address: gaokai@csu.edu.cn.
⁴ Department of Mental Health Center, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. Electronic address: mi.wang@csu.edu.cn.
⁵ Department of Dermatology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China. Electronic address: pfklzr@163.com.

PMID: 42107661
DOI: 10.1016/j.yfrne.2026.101253

Abstract

Disfiguring skin diseases refer to skin diseases that significantly affect one's appearance. The development of disfiguring skin diseases is multifactorial, such as genetic, immune, and endocrine factors. However, recent research suggests that emotional distress (such as anxiety, depression, and sleep disorders) has been implicated as a key contributing factor to the onset and progression of disfiguring skin diseases, including acne, rosacea, and vitiligo; in turn, the psychosocial burden imposed by these conditions exacerbates emotional disturbances, thereby creating a self-perpetuating vicious cycle. Therefore, understanding the relationship between emotional distress and disfiguring skin diseases is essential. In recent years, the proposed concept of the "brain-skin axis" has framed the nervous, endocrine, and immune systems as an intricate regulatory network, highlighting the multilayered connections between the brain and the skin. Within the mechanistic framework of the brain-skin axis, emotional distress may alter neural and endocrine signaling, potentially disrupt normal skin homeostasis, exacerbate inflammatory responses and immune dysregulation, and impair skin barrier function; based on experimental and observational evidence, these changes may elevate susceptibility to disfiguring skin diseases. In this review, we examined the complex relationship between emotional distress and three disfiguring skin diseases (acne, rosacea, and vitiligo) from the perspective of the brain-skin axis. We also discussed the potential value of various psychosomatic interventions, including psychotherapy, pharmacotherapy and integrated therapy in improving both dermatological symptoms and psychiatric comorbidities. Understanding the interactions and mechanisms linking emotional distress and disfiguring skin diseases through the lens of the brain-skin axis can provide new insights into the diagnosis and treatment of these skin conditions.

Keywords: Brain-skin axis; Disfiguring skin diseases; Emotional distress.

Publication types

Review