Psychological stress may contribute to the development of vitiligo. Vitiligo is a skin condition characterized by the loss of skin pigment due to autoimmunity. When a person has an autoimmune disorder or disease, their immune system mistakenly attacks its own healthy tissue. A combination of risk factors, both genetic and environmental, play a role in whether a person develops vitiligo, and evidence suggests that psychological stress may influence its onset and development.
While psychological or emotional stress affects everyone from time to time, scientists believe that persistent or high levels of stress could contribute to different health conditions, particularly chronic and autoimmune diseases such as vitiligo.
Not everyone with vitiligo has experienced high or consistent levels of stress, so it cannot be said outright that stress causes vitiligo. Rather, stress may interact with other factors to trigger or cause flaring of vitiligo. There are many skin conditions that seem to worsen during times of stress, but a clear link between stress and skin diseases has not been established.
As one member of MyVitiligoTeam wrote, “I always suspected a connection between stress and the worsening of this condition.” Another said, “In my experience, stressful times have caused flare-ups.”
Stress is a highly individual experience — the same life event can arouse stress reactions in some people but not others. Stress responses are biological reactions that prime the body to answer external threats or challenges. A stress response produces symptoms like sweating or increased heart and breathing rates. Stress-related symptoms are usually temporary; when your challenge has subsided, symptoms should go away. Chronic stress does not necessarily produce the same symptoms as an immediate stress response, but it can still have an impact on health.
Various events — bad and good, too — can cause stress. Some stressors include:
Experiencing a stress response when faced with a challenging situation is normal. Very severe or chronic, persistent stress, however, isn’t normal, and it can be dangerous for your physical and mental health. Severe or chronic stress is the type that could potentially contribute to vitiligo.
Studies have found that some people develop an autoimmune disorder after experiencing a stressful life event. Research has also found that very stressful events sometimes occur before flare-ups of autoimmune disorders in general. This possible connection between stress and other autoimmune disorders has led scientists to question if stress might play a role in the development of different types of vitiligo.
Vitiligo can be triggered by various environmental factors — such as stress — in people who have other genetic risk factors associated with the condition. In these susceptible people, an environmental factor triggers them to have an autoimmune response, one in which their immune system mistakenly attacks melanocytes.
Melanocytes are cells that produce melanin, the pigment that gives the skin its color. The destruction of melanocytes means they can’t produce melanin. Lack of melanin causes depigmentation — white patches of skin that stem from the loss of pigment.
Some studies have assessed how psychological stress could contribute to the development of vitiligo. While these studies examine correlations — or associations — between stress and vitiligo, they do not prove causation, or that stress causes vitiligo.
A study from 2015 looked at over 1,500 adults with vitiligo to study the participants’ history of stressful events and their vitiligo symptoms. Results of questionnaires showed that people in the pool had a high frequency of stressful events, like the death of a loved one, in the two years before the onset of their condition. The study also found a correlation between a history of multiple stressors and a person experiencing more frequent vitiligo symptoms.
These results indicate that psychological stress could be associated with the onset of vitiligo and how often a person gets symptoms.
Levels of stress are difficult to measure, so some researchers examine perceived stress — the amount of control a person feels over the events and stressors in their lives. A study from 2020 evaluated both perceived stress and clinical, physiological measures of stress in people with and without vitiligo.
People with vitiligo reported higher levels of perceived stress as compared to people without vitiligo. The study found that females with vitiligo reported higher levels of perceived stress as compared to males with the condition, although the prevalence of vitiligo is the same for males and females. Results supported an association between stress and the onset of a person’s vitiligo. However, they didn’t report a relationship between stress and the worsening or severity of their symptoms.
A study from 1998 published in Clinical and Experimental Dermatology also supports the idea that stress plays a role in the onset of vitiligo. This study compared people with vitiligo and people with other skin disorders by setting up both groups to evaluate their recent stressful life events with a questionnaire.
People with vitiligo reported more stressful life events as compared to people with other skin conditions, indicating stress as a potential factor in developing vitiligo.
Studies like this one that ask people to recall their history of stressful events from the past are subject to bias. Peoples’ memories of stressful events are not always accurate, and recalling the timing of certain events can be difficult — for example, whether a major stressful life event happened before or after being diagnosed with vitiligo, another potentially stressful event. When evaluating research studies, it's important to note the potential biases as well as strengths.
If you’re living with vitiligo and believe that stress has triggered or worsened your symptoms, talk to your dermatologist. Ask them about treatments for the condition and for stress management tools and resources, which can include referral to a mental health professional.
The National Institute of Mental Health recommends people:
On MyVitiligoTeam, the social network for people with vitiligo and their loved ones, more than 10,000 members come together to ask questions, give advice, and share their stories with others who understand life with vitiligo.
Do you think your vitiligo is connected to how you react to stress? Share your experience in the comments below, or start a conversation by posting on MyVitiligoTeam.
In partnership with the Global Vitiligo Foundation, which strives to improve the quality of life for individuals with vitiligo through education, research, clinical care, and community support