The Skin-Brain-Exposome Axis in Stress-Sensitive Dermatoses: A Narrative Review

Background: Dermatological conditions represent a leading cause of global nonfatal disease burden, accounting for approximately 42.9 million disability-adjusted life years annually. Their complex pathogenesis is increasingly understood through the skin-brain-exposome axis, a bidirectional neuroimmunological and environmental communication network. The study aims to synthesize the neurobiological mechanisms of the skin-brain-exposome axis with macroscopic sociodemographic modifiers, clinical manifestations, and evidence-based psychodermatological interventions. Methods: A narrative review was conducted, following a structured search of PubMed, Scopus, and Web of Science (from inception to February 2026), yielding 54 sources. Mechanistic and interventional data (including randomized controlled trials and meta-analyses) were integrated with large-scale population-based epidemiological findings, anchored by a recent cross-sectional Polish cohort of 27,000 adults. Results: Psychological distress is associated with hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis and peripheral neurogenic inflammation (e.g., Substance P, corticotropin-releasing hormone), exacerbating stress-sensitive conditions such as atopic dermatitis, psoriasis, acne, and chronic pruritus. External exposome factors (urbanization, pollution) and sociodemographic variables (education, gender) may modify biological risk and diagnostic capture rates, frequently generating an epidemiological diagnostic paradox. Randomized trials support that psychotherapeutic interventions, particularly Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR), effectively disrupt the physical itch-scratch-stress cycle and improve disease-specific quality of life, serving as evidence-based adjunctive strategies in comprehensive care. Conclusions: Effective dermatological management requires targeting both the cutaneous barrier and the psychological exposome. Integrating routine psychosocial screening and stratified behavioral interventions into standard clinical care is essential for addressing the neuroimmune chronicity of inflammatory skin diseases.