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Moderate-to-Severe Stress Associated With Skin Aging Manifestations


Patients more commonly reported skin aging manifestations when they experienced higher levels of stress.

Individuals experiencing mild-to-severe levels of psychological stress may also experience a direct link to certain skin aging manifestations.

Syda Productions/AdobeStock
Syda Productions/AdobeStock

In one study,1 researchers sought to determine a possible association between an individual’s perception of their stress level and any subsequent signs of skin aging.

Researchers conducted cross-sectional market research in China and Japan via noninterventional, nonclinical, low-risk online consumer research surveys. All survey responses were kept anonymous and were unable to be linked with individual respondents.

Prospective participants identified as women and were between the ages of 18 to 34. Researchers invited women of this demographic to participate if they were members of an IQVIA online market research panel. Other eligibility criteria included residence in a major city, a self-reported medical history free of illnesses and skin disorders, and a lack of affiliation or previous participation in skin product research.

The survey, which consisted of 24 questions, included opportunities for both open-ended and structured responses. It was split into 3 parts, each covering topics such as skin health, mental health and stress, and participant demographics.

Researchers evaluated the mental health and stress responses using the Depression Anxiety Stress Scale (DASS-21) and the World Health Organization Five Well-Being Index (WHO-5).

Additionally, researchers also invited members of a healthcare professional online market research panel, specifically dermatologists and psychologists, to participate in a secondary survey. Physician eligibility criteria included residence in a major city, cumulative healthcare experience of 3 years or greater, a cumulative caseload of 30 or more patients per month, and a total of at least 75% of time spent engaging in direct patient care.

This survey consisted of up to 21 questions related to patient concerns about stress and skin-related factors, such as skin triggers, cycle, issues, aging, and more.

As the surveys were reliant on participant data and cooperation, researchers conducted data quality control in order to eliminate the possibility of duplicate responses. 

In total, researchers were able to collect data from 403 young women and 120 health care professionals, which included 60 dermatologists.

The majority of female respondents indicated that their stress level was in the normal range (58% of women ages 18 to 25 and 47% of women ages 25-34). However, at least 10% of women in both age groups reported mild, moderate, and severe levels of stress, with less than 10% in both age groups reporting extremely severe stress.

In regard to skin manifestations, the most frequently-reported were dark eye circles, enlarged/stretched pores, dry skin, dull skin, slower recovery from acne marks, and rough skin. The rates of these manifestations were significantly higher in women with mild to extremely severe stress than in women who reported normal stress levels.

Researchers also asked the question, “Thinking of how stress may impact somebody’s life, how strong do you think the connection between stress, psychological and emotional pressure and premature skin aging is?” 92.3% of female respondents reported a perceived moderate to very strong association.

Dermatologists and other physician respondents associated certain aging and other skin manifestations with elevated stress levels, including acne, changing skin type, clogged pores, dark eye circles, dry skin, dull skin,flat lines around the eyes, poor elasticity,rough skin, sagging skin/lack of firmness, skin rash, thin skin, and wrinkles. Health care professionals who responded to the survey more strongly associated skin manifestations with stress.

Potential study limitations noted by the authors included the geographic restrictions of the data and of potential respondents.

“The stronger perceptions of healthcare professionals than young women may be unsurprising considering their education and knowledge about the biology of stress and skin aging. Indeed, healthcare professionals identified skin signs that are associated with sensitive skin (e.g., acne, dryness, rash) and aging (e.g., wrinkles, sagging, poor elasticity), and they may be aware of the impact of stress on sensitive skin through their expertise and knowledge of research in this setting,” study authors wrote. “However, further research on how stress contributes to aging or preaging of skin is needed, particularly in the context of inflammation.”


  1. Anwar SS, Apolinar MA, Ma L. Perception, understanding, and association between psychological stress and skin aging: Quantitative surveys of Asian women aged 18–34 years, dermatologists, and psychologists in China and Japan. Journ Cosm Dermatol. 2023. doi:10.1111/jocd.15732
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