Corticotropin-releasing factor is secreted from the hypothalamus and transported through portal circulation to the pituitary, where it induces the release of adrenocorticotropic hormone from the anterior pituitary to the general circulation.
The identification of external stress by the brain results in activation of the paraventricular nucleus of the hypothalamus and locus ceruleus. Stress activates 2 major neuronal pathways: the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system.
The organism has the ability to adapt to acute homeostatic challenges however, chronicity leads to exhaustion, distress, and disease or flare-up of preexisting dermatoses. Stress represents an internal or external force that threatens to disrupt the homeostatic balance of the organism. To better understand the pathogenesis, course, and treatment planning of psychocutaneous disorders, knowledge of psychoneuroimmunology is needed. 2Īs our knowledge in psychoneuroimmunology is expanding, the role of neuropeptides, hormones, and neurotransmitters in psychodermatological disorders is becoming more evident. In several skin diseases, such as atopic dermatitis, the tissue levels of nerve growth factors and neuropeptides, such as substance P, have been associated with the pathogenesis of disease and markers of disease activity. 1 Research has shown that stimuli received in the skin can influence the immune, endocrine, and nervous systems at both the local and central levels. The exact prevalence of psychological factors that affect skin disease is not known however, it has been estimated to be 25% to 33% in various studies. Skin responds to both endogenous and exogenous stimuli it senses and integrates environmental cues and transmits intrinsic conditions to the outside world. There is a complex interplay between skin and the neuroendocrine and immune systems. The two disciplines are interconnected at the embryonal level through ectoderm. It is the interaction between mind and skin. Psychodermatology is a relatively new discipline in psychosomatic medicine.
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