{
  "abstract": "Background: Chronic inflammatory skin diseases (CISD) affect 20-25% of the population. Psychological stress is considered a modifiable risk factor, yet epidemiologic evidence remains inconsistent, partly due to challenges in capturing stress through clinical documentation.\n\nObjective: To investigate whether clinically documented psychological stress is associated with altered risk of incident CISDs.\n\nMethods: Retrospective cohort study. Individuals with ICD-coded psychological stress diagnoses propensity score-matched to controls on demographics, comorbidities, and healthcare utilization. Incident CISD risk was evaluated using Cox proportional hazards models over a median follow-up of 7.1 years. Robustness was assessed through seven sensitivity analyses, positive and negative control outcomes, model triangulation using multivariable Cox models, and quantitative bias analysis for exposure misclassification and empirical calibration of all primary estimates against 22 negative control outcomes.\n\nResults: Among 399, 615 matched pairs, ICD-coded stress showed no consistent association with incident atopic dermatitis, psoriasis vulgaris, vitiligo, lichen planus, alopecia areata, acne vulgaris, or rosacea. A modest association was observed for hidradenitis suppurativa (HR 1.20, 95% CI 1.13-1.27), which did not persist after empirical calibration (calibrated HR 1.17, 95% CI 1.00-1.37, calibrated p=0.049). Negative control outcomes revealed a small systematic upward shift, centred at HR 1.02. Bias analysis showed that incomplete documentation of stress among comparators could not account for the null associations.\n\nLimitations: Incomplete capture of psychological stress in electronic health records, potential diagnostic miscoding, residual unmeasured confounding, differential outcome ascertainment between cohorts, and lack of causal inference.\n\nConclusion: After empirical calibration, ICD-coded stress diagnoses were not associated with incident CISD in US electronic health records, suggesting that stress documentation may not be a robust population-level predictor of CISD onset.",
  "abstract_shown": true,
  "affiliations": [
    "Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet",
    "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet",
    "Dermato-Venereology Clinic, Karolinska University Hospital",
    "Lübeck Institute of Experimental Dermatology, University of Lübeck",
    "University of Lübeck",
    "QIMA Life Sciences, QIMA Monasterium GmbH",
    "Gifu University Graduate School of Medicine",
    "Department of Dermatology, Allergology and Venerology, University Medical Center Schleswig-Holstein",
    "Department of Cardiology, University Heart Centre Frankfurt, University Hospital Frankfurt",
    "Department of Psychiatry and Psychotherapy , University Medical Center Schleswig-Holstein",
    "Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0,
        1,
        2,
        3
      ],
      "name": "Philip Curman"
    },
    {
      "affs": [
        4
      ],
      "name": "Emelie Fischer"
    },
    {
      "affs": [
        3,
        5
      ],
      "name": "Jasmina Golaboska"
    },
    {
      "affs": [
        4
      ],
      "name": "Kaya Harms"
    },
    {
      "affs": [
        4
      ],
      "name": "Johanna Borowik"
    },
    {
      "affs": [
        4
      ],
      "name": "Julica Huckshold"
    },
    {
      "affs": [
        4
      ],
      "name": "Clara-Elisabeth Löscher"
    },
    {
      "affs": [
        4
      ],
      "name": "Marjam Nadjmabadi"
    },
    {
      "affs": [
        6
      ],
      "name": "Ayumi Maeda"
    },
    {
      "affs": [
        4
      ],
      "name": "Khashayar Pourrahimi"
    },
    {
      "affs": [
        3,
        7
      ],
      "name": "Sören Dräger"
    },
    {
      "affs": [
        8
      ],
      "name": "Hatim Kerniss"
    },
    {
      "affs": [
        9
      ],
      "name": "Jan Philipp Klein"
    },
    {
      "affs": [
        3
      ],
      "name": "Katja Bieber"
    },
    {
      "affs": [
        3,
        7,
        10
      ],
      "name": "Ralf J. Ludwig"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dy2w83s2f6nhh.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1951015",
  "fulltext_url": "https://europepmc.org/articles/PMC13710232",
  "id": "dy2w83s2f6nhh",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1951015/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2708|Dermatology and Skin Diseases"
    ]
  ],
  "openalex": "W7221680839",
  "pdf_url": "https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1951015/pdf",
  "pmcid": "PMC13710232",
  "pmid": "42947986",
  "published": "2026-10-13",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/dy2w83s2f6nhh.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:15Z",
      "native_id": "10.3389/fimmu.2026.1951015",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1951015/full"
    },
    {
      "first_seen": "2026-10-31T00:20:34Z",
      "native_id": "MED:42947986",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42947986"
    },
    {
      "first_seen": "2026-10-31T12:21:14Z",
      "native_id": "PMC13710232",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fimmu.2026.1951015"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "issn:1664-3224",
      "subfield": "immunology"
    }
  ],
  "title": "Psychological stress documentation and subsequent risk of chronic inflammatory skin diseases: a large-scale real-world cohort study",
  "title_text": "Psychological stress documentation and subsequent risk of chronic inflammatory skin diseases: a large-scale real-world cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:21:14Z",
  "url": "https://research.draconitic.com/paper/dy2w83s2f6nhh",
  "venue": "Frontiers in Immunology",
  "versions": []
}