Hypothalamic-pituitary-adrenal axis, hair, and sebum: Stress-mediated dermatologic disasters of the pandemic era

The coronavirus pandemic has raised unprecedented awareness of the impact of psychological stress on dermatological health. Psychological stress triggers the release of several hormones that alter hair follicle cycles, increase sebum production, and disrupt skin barrier function. As a result, dermatological diseases such as telogen effluvium, alopecia areata, seborrheic dermatitis, and “maskne” – acne associated with extended use of face masks and alterations in the skin microclimate are on the rise. Chronic stress also overactivates the peripheral skin-based hypothalamic-pituitary-adrenal (HPA) axis, which is similar to the central system, further exacerbating inflammatory skin responses. This study focuses on the HPA axis and summarizes the most recent data on the neuroendocrine control of skin and hair during the pandemic. Chronic mask use alters the balance of sebum and microbiota, aggravating inflammatory skin disorders, while stress hormones encourage early catagen transition in hair follicles and decrease follicular proteoglycans. Although there are restrictions, new diagnostic techniques, in particular hair cortisol concentration, have the potential to be non-invasive chronic stress biomarkers. Early detection is improved by clinical techniques such as trichoscopy and the severity of alopecia tool score; nonetheless, research gaps still exist in underrepresented areas. Integrative models are becoming more prevalent in management techniques. Cognitive behavioral therapy and other stress reduction methods have been shown to increase psychological well-being and reduce skin symptoms in patients with atopic dermatitis, psoriasis, and acne. The utilization of stem cell-based hair follicle regeneration and nanoparticle-based drug delivery systems is an example of precision therapy approaches being investigated on the therapeutic frontier. However, robust regulatory frameworks are required for the safe application of these developments in clinical settings. These findings underline the necessity of diagnosing and treating stress-related dermatological problems using a thorough, psychoneuroendocrine-informed approach. Standardization of biomarkers, inclusivity in international research, and the incorporation of mental health techniques into dermatological treatment should be the top priorities for future developments.