The skin plays an important role as an organ of communication across the life span- this role of the skin also forms a basis for the relation between skin disorders and psychosocial stress. Right after birth skin-to-skin contact between the neonate and the mother is known to have a significant beneficial impact on the infant’s capacity for autonomic regulation [13] and socialization in later life [14] – both these factors are directly associated with better capacity for managing stress. The psychosocial development of an infant with dermatologic disease may be adversely affected if the caregiver is reluctant to sufficiently touch or hold the infant. In later life, a cosmetically disfiguring dermatologic disorder, affecting the ‘emotionally charged’ body regions such as the genital region and the easily visible body regions, especially the face [15], can lead to significant stress due to feelings of stigmatization and social exclusion [16]. The overall appearance of the skin, even when minimally flawed, can have a profound effect on the body image especially during adolescence and young adulthood when the individual is especially vulnerable to peer disapproval and social exclusion including bullying [16]. The skin, especially facial skin, is one of the most easily visible indicators of chronological age. The idea that chronological age itself does not signal the beginning of old age, and that one can get older without the signs of aging, has become increasingly prevalent [17]. Over the last several decades old age has started to acquire increasingly negative connotations and often normal intrinsic aging is viewed as a medical and social problem that needs to be addressed by health care professionals and an aging appearance can be a source of significant distress [17]. Cutaneous body image dissatisfaction and resultant interpersonal sensitivity and feelings of social alienation have been associated with increased suicide risk [4].

The clinician should be sensitive to the fact that the dermatology patient’s cultural and ethnic background may have an important effect on how their skin disorder affects their quality of life and resultant disease-related stress. There are also cultural differences in the physiology of the stratum corneum barrier which plays an important role in stress reactive dermatoses. Studies have shown that a lighter skin tone is preferred by both individuals of European Caucasian descent and cultures and ethnic groups with a darker skin color [16, 18]. The term ‘ethnic skin’ has been used in the medical literature to describe skin of color, traditionally of Fitzpatrick skin types III-VI [19]. This does not define any particular race, ethnicity, or culture. The clinician should be aware that in many cultures the preference for fair or lighter colored skin is quite pervasive, as lighter skin is associated with several perceived benefits including job, beauty and marriage opportunity [20, 21], and the perception that an individual’s skin is not ‘fair’ enough can be a source of social stigmatization and stress for the individual. As a result harmful practices like skin bleaching may be carried out [16], which can further enhance the dermatologic morbidity associated with the skin condition. It is important for the clinician be sensitive to these issues and make an effort to mitigate the perpetuation of stress resulting from deep-rooted belief systems regarding preferred skin color [16, 20].