‘Skin is the exterior barrier through which we have contact with the environment; it is a means of communication and also offers protection from the outer world. Skin diseases can induce emotional, social and occupational problems, affecting self‐image and also relationships with others. Stress is an abnormal or extreme physiological adjustment in animals to cope with adverse effects and management of their environment.’

(Manolache & Benea, 2007)

Vitiligo and Alopecia Areata are two auto-immune disorders which affect the skin. With vitiligo the lack of melanin (the pigment in the skin causing colour) results in white patches to develop on the skin. These may develop around the face, neck, arms and even genital areas. With regards to alopecia, hair loss is observed in patchy and unpredictable areas. Research has identified similarities between the two due to the way the condition develops and also because of the similar types of immune cells and cytokines driving the disease and common genetic risk factors.

Although there is not too much research linking stress with the onset of these conditions, a number of research has actually found that there is a relationship. According to Silverberg (2015), there is a greater chance that stressful life events occurring before the onset of vitiligo or alopecia, trigger the increase of catecholamines (stress induced hormone) and neuropeptides (proteins which act as neurotransmitters) which have been found in vitiligo patients. The studies by Manolache (2007) and Cuoertino (2017) also back this argument by suggesting that stressful events act as precipitating and aggravating factors in more than 65% of both alopecia areata and vitiligo patients. The studies quote that stress in both cases may not necessarily be a recent event, but it could have occurred in the past year also indicating chronic stress. More specifically, participants recorded high incidences of losses (death of a loved one or ending a long-term relationship) and recurrent problems, such as work, money and family.

According to Cupertion, ‘in both alopecia areata and vitiligo groups the occurrence of one event with a high impact before onset seems to be more important than multiple potential stressful situations. It may be that this event had huge consequences (like death of a family member or dismissal), or that patients with multiple life events had developed coping mechanisms that helped them to overcome problems and prevent onset of the disease.’

Why is this relationship between these autoimmune disorders and stress important to identify?

Young people and children are also susceptible to developing these disorders, and it would greatly impact their self-esteem and body image. It is important to help individuals deal and cope better with stressors in order to avoid finding themselves in more complex situations with multiple difficulties to deal with. It would also help any individual coming to terms with these radical changes in their body when trying to understand why it is happening and what is causing these changes, giving them a better sense of agency and courage to engage in its treatment.

Abigail Church is a Humanistic Integrative Counsellor who works with adults and children through counselling with Willingness. She can be contacted on abigail@willingness.com.mt or call us on 79291817. 


  • https://www.medicalnewstoday.com/articles/70956#treatment
  • Manolache, L. and Benea, V. (2007) Stress in Patients with Alopecia Areata and Vitiligo. Journal of the European Academy of Dermatology and Venereology. Volume 21 (7)  p921-928.
  • Cupertino, F., Niemeyer-Corbellini, J.P. and  Ramos-e-Silva, M. (2017) Psychosomatic Aspects of Vitiligo. Clinics in Dematology. Volume 35 (3) p292-297.
  • Silverberg, J.I. and Silverberg, N.B. (2015) Vitiligo Disease Triggers: Psychological Stressors Preceding the Onset of Disease. Psychocutaneous Medicine. Volume 95. p255-262