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ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue VIII August 2025
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Work-Related Stress and Its Psychodermatological Impact on
Nursing Professionals
Melody Saquido
*
Adria Medical Centre, United Arab Emirates
DOI: https://doi.org/10.51244/IJRSI.2025.120800118
Received: 11 Aug 2025; Accepted: 17 Aug 2025; Published: 12 September 2025
ABSTRACT
Background: Occupational stress is a prevalent issue among nursing professionals, often resulting from high
workloads, shift rotations, and emotional demands. While the psychological effects of stress are well-
documented, its physical manifestations, particularly dermatological symptoms, remain underexplored.
Psychodermatology examines the bidirectional link between psychological stress and skin health, offering
insight into how chronic work stress may contribute to conditions such as eczema, psoriasis, and acne. This
study investigated the relationship between work-related stress and psychodermatological symptoms among
nurses in Dubai, United Arab Emirates.
Methods: A descriptive-correlational research design involving 92 full-time registered nurses from two
hospitals was employed. Data were collected using a structured questionnaire comprising demographic
variables, the Work-Related Stressor Scale, a psychodermatological symptom checklist, and the Dermatology
Life Quality Index (DLQI). Descriptive statistics, Pearson and Spearman correlations, and multiple linear
regression analyses were performed to identify associations and predictive factors.
Results: Nearly half (49%) of the participants reported experiencing psychodermatological conditions, with
acne, seborrheic dermatitis, and eczema being most prevalent. Moderate levels of occupational stress were
observed, especially in emotional exhaustion, job insecurity, and lack of administrative support. A strong
positive correlation was found between overall stress levels and symptom severity (r = 0.728, p < 0.001).
Regression analysis identified emotional distress exposure, job insecurity, role ambiguity, and workload as
significant predictors of symptom severity. Years of service and shift type were also associated with stress
levels and dermatological outcomes.
Conclusion: The findings demonstrate a significant link between occupational stress and stress-related skin
conditions among nursing professionals. These results highlight the need for holistic occupational wellness
programs that address stress's psychological and physical manifestations. Targeted interventions focusing on
stress management, workload regulation, and skin health promotion are recommended to enhance nurses’ well-
being and professional performance.
Keywords: Occupational Stress; Psychodermatology; Nursing Professionals; Workload; Skin Symptoms;
Nurse Wellness
INTRODUCTION
Nursing professionals occupy a central role in healthcare delivery, yet they work under conditions that often
place them at sustained risk of occupational stress. The demands of shift work, high patient acuity, chronic
understaffing, and exposure to patient suffering have been amplified by recent global health crises such as the
COVID-19 pandemic (World Health Organization [WHO], 2021). These stressors are individual challenges
and structural issues embedded within health workforce planning and governance (Chiang et al., 2022).
While the psychological consequences of occupational stress in nursing, such as burnout, anxiety, and
emotional exhaustion, are well-documented, their physical manifestations remain comparatively
underexplored. One such manifestation is the onset or exacerbation of dermatological conditions, a
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phenomenon examined within psychodermatology. This discipline highlights the bidirectional relationship
between psychological stress and skin health, recognizing that stress-related neuroendocrine responses,
particularly elevated cortisol levels, can impair skin barrier function and trigger inflammatory dermatoses such
as eczema, psoriasis, urticaria, and acne (Gupta et al., 1996; Misery et al., 2023).
Nurses may be uniquely vulnerable to such effects due to the dual demands of their professional role as
frontline caregivers and as stabilizing agents in overburdened health systems, often prioritizing patient needs
over their well-being. The skin, as a highly innervated and immunologically active organ, can become a visible
marker of this internal distress, reflecting the physiological imprint of chronic occupational stress.
Emerging evidence links sustained work-related stress to diminished quality of life and reduced workforce
sustainability (Dall’Ora et al., 2020; García-Izquierdo et al., 2021; Omotosho et al., 2025). However, the
dermatological outcomes of stress in nurses remain largely absent from occupational health discourse.
Recognizing stress-induced skin disorders as early indicators of distress offers a potential avenue for timely
intervention and more holistic wellness strategies that address both the psychological and somatic dimensions
of nurse health.
This study investigates the relationship between work-related stress and psychodermatological symptoms
among nursing professionals. By examining this connection, it seeks to inform evidence-based interventions
that integrate dermatological health into occupational wellness programs, thereby promoting individual well-
being and the long-term sustainability of the nursing workforce.
MATERIALS AND METHODS
Research Design
This study employed a descriptive-correlational research design to investigate the association between
occupational stress and psychodermatological symptoms among nursing professionals. The descriptive
component enabled detailed characterization of participants’ demographic and occupational profiles, levels of
work-related stress, and the prevalence and types of stress-related skin conditions. The correlational
component examined the strength and direction of associations between specific stress dimensions and
psychodermatological symptom severity, following established methodologies in occupational health research
(Bolton et al., Borge et al., 2025; Creswell & Creswell, 2018; Dartey et al., 2023). A cross-sectional approach
was chosen to provide a timely snapshot of the phenomenon within the hospital setting and to identify patterns
that could inform targeted interventions and future longitudinal research.
Materials and Methods
The study was conducted in two tertiary hospitals in Dubai, United Arab Emirates, serving diverse patient
populations and encompassing multiple clinical specialties. The target population comprised full-time
registered nurses with at least one year of continuous clinical service to ensure adequate exposure to workplace
stressors (WHO, 2022). Exclusion criteria included part-time employment, extended leave during the study
period, and pre-existing congenital skin disorders or dermatological conditions unrelated to stress. Purposive
sampling was used to ensure representation across various departments, including critical care, medical-
surgical, emergency, pediatrics, and outpatient services (Lilly et al., 2016).
Data were collected using a structured, self-administered questionnaire consisting of four sections: (1)
demographic and work profile, capturing age, sex, marital status, years of service, department, and shift type;
(2) the Work-Related Stressor Scale, measuring five domains of occupational stress workload, role ambiguity,
emotional exhaustion, job insecurity, and perceived administrative support (Osipow, 1998); (3) a
psychodermatological symptom checklist, recording the presence, frequency, and severity of stress-related skin
conditions such as acne, eczema, urticaria, and seborrheic dermatitis (Gupta et al., 1996; Misery et al., 2023);
and (4) the Dermatology Life Quality Index (DLQI), a validated 10-item instrument assessing the quality-of-
life impact of skin disorders across domains including symptoms, daily activities, and emotional well-being
(Finlay & Khan, 1994). Questionnaires were distributed during scheduled breaks to minimize disruption to
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patient care and returned anonymously in sealed envelopes to ensure confidentiality. Before full
implementation, the instruments were pre-tested for clarity and content validity with a pilot group of nurses not
included in the final study sample (Chhetri & Khanal, 2024).
Statistical Analysis
Data were analyzed using SPSS version 26. Descriptive statistics summarized demographic and work-related
variables. Pearson and Spearman correlation analyses examined associations between occupational stress and
psychodermatological symptoms. Multiple linear regression was used to identify significant predictors of
symptom severity. Statistical significance was set at p < 0.05.
Ethical Approval
Institutional Review Board (IRB) under Research Project No. E-25-8410 was obtained. Written informed
consent was obtained from all participants before data collection, and questionnaires were distributed and
collected anonymously to maintain confidentiality.
RESULT
The demographic characteristics of the respondents provide important context for understanding their exposure
to occupational stress and susceptibility to psychodermatological symptoms. Among the 92 participants, the
most significant proportion (28%) was aged 31–40 years, followed by 41–50 years (21%), below 30 years
(20%), 51–55 years (18%), and above 56 years (13%). Females comprised 70% of the sample, while 30% were
males. Regarding marital status, 63% were married, 21% single, 10% widowed, and 7% separated.
Regarding years of professional service, 33% had 21–30 years of experience, 32% had 11–20 years, 15% had
6–10 years, 12% had less than 5 years, and 9% had more than 30 years. Clinical assignments were distributed
across Medical–Surgical units (27%), ICU (26%), Operating Room (26%), and Emergency Department (21%).
Half the respondents worked day shifts, 28%-night, and 22% rotating shifts. Weekly working hours varied,
with 36% working 40 hours, 34% working 44 hours, 15% working 48 hours, 13% working 39 hours, and 2%
working 60 hours. Almost half (49%) reported having pre-existing skin conditions (Table 1).
Table 1. Demographic Profile of Respondents (N = 92)
Age
Frequency
Percentage (%)
< 30
18
20%
31-40
26
28%
41-50
19
21%
51-55
17
18%
> 56
12
13%
Gender
Female
64
70%
Male
28
30%
Marital Status
Married
58
63%
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Separated
6
7%
Single
19
21%
Widowed
9
10%
Year of service
<5 years
11
12%
11–20 year
29
32%
21–30 year
30
33%
6–10 years
14
15%
>30 years
8
9%
Unit
Emergency
19
21%
ICU
24
26%
Medical-Surgical
25
27%
OR
24
26%
Shift schedule
Day
46
50%
Night
26
28%
Rotating
20
22%
Average weekly working hours
39
12
13%
40
33
36%
44
31
34%
48
14
15%
60
2
2%
Pre-existing skin condition
Yes
45
49%
No
47
51%
These findings highlight a predominantly mid-career, female nursing workforce, many of whom are employed
in high-demand clinical areas and subject to varied shift schedules. Such demographic and occupational factors
provide essential context for interpreting stress exposure and the potential for dermatological manifestations in
this population.
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Table 2 shows that nurses experienced various skin conditions commonly associated with occupational stress.
The most frequently reported conditions were psoriasis (55%), hives/urticaria (53%), and eczema (49%),
followed by chronic itching or pruritus (47%), seborrheic dermatitis (46%), and acne (40%).
Table 2. Frequency and Severity of Reported Psychodermatological Symptoms (N = 92)
Eczema
Psoriasis
Hives
(Urticaria)
Acne
Seborrheic
Dermatitis
Chronic Itching
(Pruritus)
Currently Experienced
47 (51%)
41 (45%)
43 (47%)
55 (60%)
50 (54%)
49 (53%)
45 (49%)
51 (55%)
49 (53%)
37 (40%)
42 (46%)
43 (47%)
Frequency
25 (27%)
23 (25%)
23 (25%)
28 (30%)
23 (25%)
14 (15%)
13 (14%)
26 (28%)
21 (23%)
22 (24%)
19 (21%)
34 (37%)
30 (33%)
17 (19%)
23 (25%)
27 (29%)
23 (25%)
21 (23%)
24 (26%)
26 (28%)
25 (27%)
15 (16%)
27 (29%)
23 (25%)
Worsens with Workload
44 (48%)
45 (49%)
47 (51%)
42 (46%)
47 (51%)
53 (58%)
48 (52%)
47 (51%)
45 (49%)
50 (54%)
45 (49%)
39 (42%)
In terms of severity, a substantial proportion of respondents rated their symptoms as severe to very severe,
particularly for seborrheic dermatitis (50%), chronic pruritus (48%), and eczema (45%). The frequency of
occurrence was also notable, with 15–30% of nurses reporting that symptoms were experienced “always” and
an additional 14–37% reporting them “often.” For example, 30% reported always experiencing acne, while
37% often experienced chronic itching (Appendix A).
More than half of the participants indicated that symptoms worsened with increased workload, most notably
for acne (54%), eczema (52%), and psoriasis (51%). These findings indicate that psychodermatological
conditions among nurses are both prevalent and potentially aggravated by occupational demands, underscoring
the need for workplace interventions that address stress management and skin health.
Table 3 presents the descriptive statistics from the Work-Related Stressor Scale, assessing the perceived
impact of occupational stress on six core aspects of nursing performance: focus and concentration, comfort
during task execution, willingness to interact with patients, job satisfaction, physical attendance, and emotional
well-being at work. Each item was rated on a 5-point Likert scale, with mean scores ranging from 2.88 to 3.04,
indicating a moderate impact of stress across all domains.
Table 3. Levels and Dimensions of Occupational Stress Among Nurses Based on the Work-Related Stressor
Scale (N = 92)
Performance
Aspect
No
Impact
Mild
Moderate
High
Severe
Mean
Std.
Deviation
Interpretation
Focus and
concentration
17 (19%)
19 (21%)
18 (20%)
20
(22%)
18 (20%)
3.03
1.402
Moderate
Impact
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Comfort while
performing
tasks
24 (26%)
15 (16%)
15 (16%)
21
(23%)
17 (19%)
2.91
1.48
Moderate
Impact
Willingness to
interact with
patients
20 (22%)
19 (21%)
16 (17%)
16
(17%)
21 (23%)
2.99
1.479
Moderate
Impact
Job
satisfaction
18 (20%)
21 (23%)
19 (21%)
20
(22%)
14 (15%)
2.9
1.359
Moderate
Impact
Physical
attendance at
work
(absenteeism)
14 (15%)
16 (17%)
26 (28%)
24
(26%)
12 (13%)
3.04
1.257
Moderate
Impact
Emotional
well-being at
work
21 (23%)
15 (26%)
21 (23%)
24
(26%)
11 (12%)
2.88
1.349
Moderate
Impact
Mean Score Range: 1.00 – 1.74 = No Impact, 1.75 – 2.49=Mild Impact, 2.50 – 3.24=Moderate Impact, 3.25 –
4.00 = High Impact, 4.01 – 5.00 = Severe Impact
The highest mean score was recorded for physical attendance (Mean = 3.04, SD = 1.257), suggesting that
occupational stress frequently contributes to absenteeism or reduced physical presence at work. Focus and
concentration followed closely (Mean = 3.03, SD = 1.402), reflecting the cognitive strain experienced under
stressful conditions. Willingness to interact with patients (Mean = 2.99, SD = 1.479) also showed a notable
impact, indicating potential implications for patient engagement and communication quality.
Moderate effects were similarly observed in comfort during task performance (Mean = 2.91), job satisfaction
(Mean = 2.90), and emotional well-being (Mean = 2.88). Standard deviation values ranged from 1.257 to
1.480, suggesting moderate variability in perceived stress among respondents (Table 3).
Table 4 shows the act scores and Dermatology Life Quality Index (DLQI) scores. A moderate positive
correlation was found between symptom severity and work performance impact (r = 0.570, p < 0.001). This
indicates that nurses with more severe skin-related symptoms were likelier to report reduced concentration,
lower emotional resilience, discomfort during clinical tasks, and reluctance to interact with patients.
Table 4. Correlation Between Psychodermatological Symptom Severity, Job Performance Impact, and DLQI
Scores (N = 92)
Variables
Correlation
Coefficient (r /
ρ)
p-value
Interpretation
Symptom Severity × Work Performance
Impact Score
0.570
< 0.001
Moderate positive correlation;
significant
Symptom Severity × DLQI Total Score
0.330
< 0.001
Moderate to strong positive
correlation; significant
DLQI Total Score × Work Performance
Impact Score
0.537
< 0.001
Moderate positive correlation;
significant
Symptom severity was also moderately correlated with DLQI scores (r = 0.330, p < 0.001), showing that
worsening skin symptoms were associated with poorer dermatologic quality of life. In addition, a moderate
positive correlation was observed between DLQI scores and work performance impact (r = 0.537, p < 0.001),
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suggesting that lower quality of life due to skin conditions is linked to greater impairment in occupational
performance (Table 4).
All correlations were statistically significant at the p < 0.001 level, confirming that psychodermatological
symptoms impose a dual burden on nurses, affecting personal well-being and professional functioning. These
findings highlight the importance of integrated interventions that address the' psychological and physical
aspects of stress-related skin conditions.
Table 5 presents the correlation between overall occupational stress levels and the severity and range of
psychodermatological symptoms. A strong positive correlation was observed between occupational stress
scores and symptom severity scores (r = 0.728, p < 0.001), indicating that nurses with higher stress levels
experienced more intense skin-related symptoms.
A moderate positive correlation was also found between occupational stress scores and the number of distinct
skin conditions reported (ρ = 0.421, p < 0.001). This suggests that elevated stress levels were associated with
greater symptom severity and a broader range of conditions, including eczema, acne, urticaria, and contact
dermatitis (Table 5).
Table 5. Correlation of Total Occupational Stress Score with Symptom Severity and Number of Skin
Conditions (N = 92)
Variables Correlated
Correlation
Coefficient (r
/ ρ)
p-value
Statistical
Test Used
Interpretation
Occupational Stress Score × Symptom
Severity Score
0.728
< 0.001
Pearson
(normal
distribution)
Strong positive
correlation; statistically
significant
Occupational Stress Score × Number
of Skin Conditions
0.421
< 0.001
Spearman
(non-normal)
Moderate positive
correlation; statistically
significant
Both correlations were statistically significant at the p < 0.001 level, underscoring the strength and consistency
of these associations. These results highlight occupational stress as a key factor contributing to the intensity
and diversity of psychodermatological symptoms, reinforcing the importance of integrating skin health
monitoring into workplace wellness and stress management programs.
Table 6 presents a multiple linear regression analysis assessing the predictive value of occupational stress
dimensions on psychodermatological symptom severity. Four domains emerged as statistically significant
predictors: exposure to emotionally distressing situations (β = 0.502, p < 0.001), job insecurity (β = 0.501, p <
0.001), role ambiguity (β = 0.473, p < 0.001), and lack of staff resources/workload (β = 0.442, p < 0.001).
Emotional distress exposure was the strongest predictor, indicating its critical influence on worsening skin-
related symptoms.
Emotional exhaustion and lack of administrative support did not significantly predict symptom severity (p =
0.448 and p = 0.638, respectively). While these factors contribute to overall job-related distress, their
individual effects may be less direct than the more acute or structural stressors identified (Table 6).
Table 6. Predictive Influence of Occupational Stress Domains on Psychodermatological Symptom Severity
Among Nursing Professionals
Predictor
(Occupational
Stress Domain)
Unstandardized
Coefficient (B)
Standard
Error (SE)
Standardized
Coefficient (β)
t-value
p-value
Interpretation
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Emotional
Exhaustion
-0.017
0.022
-0.041
-0.762
0.448
Not statistically
significant
Lack of
Administrative
Support
-0.011
0.024
-0.026
-0.472
0.638
Not statistically
significant
Role Ambiguity
0.193
0.023
0.473
8.505
< 0.001
Strong, significant
positive predictor
Emotional Distress
Exposure
0.187
0.020
0.502
9.247
< 0.001
Strong, significant
positive predictor
Job Insecurity
0.187
0.021
0.501
8.846
< 0.001
Strong, significant
positive predictor
Lack of Resources/
Workload
0.164
0.021
0.442
7.970
< 0.001
Strong, significant
positive predictor
The regression model demonstrates a robust relationship between specific occupational stressors and the
severity of psychodermatological symptoms. These findings highlight the need for workplace strategies that
enhance role clarity, strengthen emotional resilience, ensure adequate staffing, and promote job security as part
of comprehensive nurse wellness programs.
Table 7 analyzed demographic and work-related predictors of occupational stress and psychodermatological
symptom severity. Independent samples t-tests, one-way ANOVA, and linear regression analyses were applied
based on variable type. Four factors were statistically significant: shift type, years of service, age, and presence
of pre-existing skin conditions.
A significant difference in occupational stress scores was observed across shift types (F = 3.45, p = 0.021),
with the highest stress reported among rotating nurses. Years of service were significantly associated with
symptom severity (F = 4.02, p = 0.011), with nurses with more than 10 years of experience reporting higher
scores. Age also emerged as a significant predictor (β = 0.271, p = 0.013), with older nurses reporting more
severe symptoms.
The presence of a pre-existing skin condition was strongly associated with greater symptom severity (t =
12.613, p = 0.001). In contrast, gender, clinical unit, and weekly working hours did not significantly influence
occupational stress or symptom severity (Table 7).
Table 7. Influence of Demographic and Work-Related Variables on Occupational Stress Levels and
Psychodermatological Symptom Severity Among Nurses
Independent
Variable
Group/Category
Dependent
Variable
Test Used
Test
Statistic
p-
value
Interpretation
Gender
Male vs. Female
Occupational
Stress Score
t-test
t = –
0.354
0.762
No significant
difference in
stress levels
between male
and female
nurses.
Shift Type
Day, Night,
Rotating
Occupational
Stress Score
ANOVA
F = 3.45
0.021*
Significant
difference;
nurses on
rotating shifts
reported the
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highest stress.
Years of
Service
<5, 5–10, >10
years
Psychoderma-
tological
Symptom
Severity
ANOVA
F = 4.02
0.011*
Significant;
longer service
duration was
associated with
greater symptom
severity.
Clinical Unit
ED, ICU, OR,
Med-Surg, Other
Occupational
Stress Score
ANOVA
F = 1.58
0.082
No significant
difference;
stress levels
were similar
across clinical
units.
Weekly
Working Hours
Continuous
variable
Occupational
Stress Score
Linear
Regression
β = 0.016
0.876
Not a significant
predictor of
occupational
stress.
Age
Continuous
variable
Psychoderma-
tological
Symptom
Severity
Linear
Regression
r² =
0.271
0.013*
Significant
predictor;
increasing age
associated with
higher symptom
severity.
Pre-existing
Skin Condition
Yes vs. No
Psychoderma-
tological
Symptom
Severity
t-test
t =
12.613
0.001*
Significant
difference;
nurses with pre-
existing
conditions had
higher symptom
severity.
These results indicate that shift patterns, career longevity, age, and existing dermatologic conditions influence
nurses’ stress-related skin health outcomes. Tailored interventions targeting these risk factors may help
mitigate psychological and dermatological impacts in this population.
Table 8 presents the independent samples t-test results comparing occupational stress levels between nurses
with and without pre-existing skin conditions. The analysis showed a statistically significant difference, t(90) =
12.65, p < 0.001. Nurses with pre-existing conditions (n = 45) reported a higher mean stress score (M = 3.42,
SD = 0.38) compared to those without such conditions (n = 47, M = 2.47, SD = 0.34). The mean difference
was 0.95, with a 95% confidence interval of 0.80 to 1.10 (Table 8).
Table 8. Comparison of Occupational Stress Levels Between Nurses With and Without Reported Skin
Symptoms.
Pre-existing
Skin
Condition
n
Mean
Stress
Score
SD
t
df
p-value
Mean
Differenc
e
95% CI of
the
Difference
Interpretation
Yes
45
3.42
0.3
8
12.6
5
90
< 0.001
0.95
[0.80, 1.10]
Nurses with pre-
existing skin
conditions had
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significantly higher
stress levels.
No
47
2.47
0.3
4
These results suggest that nurses with dermatological conditions are more susceptible to workplace stress,
potentially due to environmental triggers such as PPE use, frequent hand hygiene, and exposure to
disinfectants. The presence of visible or symptomatic skin conditions may also contribute to psychological
strain, compounding the demands of clinical work.
The findings highlight the importance of integrating skin health considerations into occupational wellness
programs and offering targeted support to staff with chronic conditions. Strategies such as skin-friendly
product use, scheduled relief from PPE, dermatologic consultations, and stress management initiatives may
help mitigate this group's dual physical and psychological burden.
DISCUSSION
This study provides compelling evidence for the significant association between occupational stress and
psychodermatological symptoms among nurses, reflecting both the prevalence and functional impact of these
conditions in a high-pressure clinical environment (Gupta et al., 1996; Jafferany & Pastolero, 2018; Zhang et
al., 2024). The high rates of psoriasis, urticaria, and eczema observed are consistent with international
psychodermatology research indicating that inflammatory dermatoses are among the most stress-reactive skin
disorders (Balieva et al., 2022; Ghasemi & Azadi et al., 2024). The strong positive correlation between
occupational stress scores and symptom severity underscores the physiological plausibility of this relationship,
supported by psychoneuroimmunological evidence that stress-induced activation of the hypothalamic–
pituitary–adrenal (HPA) axis disrupts immune homeostasis and impairs skin barrier function (Dhabhar, 2014;
Pondeljak & Lugović-Mihić, 2020).
The findings further reveal that rotating shift schedules, longer years of service, older age, and pre-existing
skin conditions significantly predict higher occupational stress or greater symptom severity (Alsharari et al.,
2021; Cha et al., 2022). Rotating shifts are well known to disrupt circadian rhythms, impair hormonal
regulation, and elevate systemic inflammation, all of which can exacerbate skin disease (Magnavita &
Garbarino, 2017; Wu et al., 2021). The association between years of service and symptom severity suggests a
cumulative burden of occupational exposure, consistent with Cha et al. (2022), who documented higher
dermatologic morbidity in long-tenured nursing staff. Similarly, older nurses demonstrated greater symptom
severity, in line with evidence that aging skin exhibits reduced regenerative capacity and increased
susceptibility to inflammation (Zhang et al., 2024; Tan et al., 2024).
The regression analysis identified emotional distress exposure, job insecurity, role ambiguity, and inadequate
staffing as significant predictors of symptom severity. Emotional distress, the strongest predictor, reflects the
psychological toll of repeated exposure to suffering, critical incidents, and ethical dilemmas in nursing care
(Hunda et al., 2024; Mossel et al., 2024). Job insecurity and role ambiguity, often linked to organizational
restructuring and unclear clinical expectations, are recognized triggers for chronic stress and maladaptive
coping behaviors (Dall’Ora et al., 2020; Mahfouz et al., 2023). Inadequate staffing, a longstanding concern in
nursing workforce management, increases workload and limits recovery periods, thereby sustaining
inflammatory activation (Borge et al., 2025; Werke & Weret, 2023).
Moderate stress-related impairments were observed across all job performance domains, with the most
pronounced effects on attendance, concentration, and patient interaction. These impairments mirror findings
from prior research indicating that stress compromises cognitive clarity, decision-making, and patient
engagement, ultimately threatening care quality (Mahfouz et al., 2023; Penzer-Hick & Haddad, 2021). The
significant correlation between Dermatology Life Quality Index (DLQI) scores and work performance
impairment further illustrates the dual burden of psychodermatological symptoms impacting professional
functioning and personal well-being (Finlay & Khan, 1994; Tan et al., 2024).
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Nurses with pre-existing dermatologic diagnoses reported higher stress and symptom severity, reinforcing the
bidirectional model in which skin disease and stress perpetuate one another (Basra & Shahrukh, 2009; Dalgard
et al., 2015). In healthcare environments, aggravating factors include prolonged personal protective equipment
(PPE) use, frequent hand hygiene, and chemical exposures, all of which can provoke or worsen inflammatory
dermatoses (Reebye, 2008; Wu et al., 2021). Stigma related to visible skin conditions may also contribute to
psychological distress and reduced work engagement (Koo & Lebwohl, 2001; Jafferany & Pastolero, 2018).
From a mechanistic perspective, chronic stress activates neuroendocrine and immune pathways that impair
skin barrier lipid synthesis, alter keratinocyte proliferation, and promote pro-inflammatory cytokine production
(Dhabhar, 2014; Pondeljak & Lugović-Mihić, 2020). Behavioral factors such as increased scratching, reduced
self-care, sleep disturbances, and altered dietary habits during high-stress periods may exacerbate symptom
chronicity (Jafferany & Pastolero, 2018; Cha et al., 2022).
These findings have practical implications for occupational health policy. Integrating dermatological
assessments into routine nurse health screenings, particularly for those with long tenure, rotating shifts, or pre-
existing conditions, could facilitate early detection and intervention (Magnavita & Garbarino, 2011; Borge et
al., 2025). Stress management strategies, including resilience training, role clarity initiatives, improved staffing
ratios, and ergonomic scheduling, may reduce stress levels and dermatologic burden (Mahfouz et al., 2023;
Hunda et al., 2024). Skin-protective measures, such as PPE break schedules and provision of hypoallergenic
hygiene products, could mitigate occupational triggers (Reebye, 2008; Tan et al., 2024).
Although the cross-sectional design limits causal inference meaning that no causal relationship between
occupational stress and psychodermatological symptoms can be established the reliance on self-administered
questionnaires may introduce both recall bias and reporting bias, as participants might underreport or over
report stress levels and skin symptoms due to memory inaccuracies, social desirability, or personal
interpretation of the questions. Nevertheless, the alignment of our results with established physiological
models and prior empirical studies supports their validity (Gupta et al., 1996; Dalgard et al., 2015). Future
longitudinal research incorporating biomarker-based assessments of stress and skin inflammation would
further clarify temporal relationships and evaluate the efficacy of targeted interventions (Pondeljak & Lugović-
Mihić, 2020; Zhang et al., 2024).
CONCLUSION
This study concludes that occupational stress among nursing professionals is not only a psychological burden
but also a contributing factor to the development and worsening of psychodermatological symptoms. The
findings revealed a strong correlation between elevated stress levels and the severity and variety of skin
conditions such as eczema, psoriasis, urticaria, and acne. These conditions, often exacerbated by high
workloads, rotating shifts, and emotionally demanding work environments, reflect the complex interplay
between mental and physical health in the nursing profession.
The study confirms that the presence of stress-related skin symptoms is influenced not only by individual
coping capacity but also by institutional factors, including role ambiguity, emotional distress exposure, job
insecurity, and inadequate staffing. While nurses continue to demonstrate resilience in workplace challenges,
the absence of structured wellness support systems may contribute to long-term physical and emotional strain.
These findings underscore the urgent need for healthcare institutions to implement holistic wellness programs
that go beyond mental health support to include physical manifestations of stress, particularly skin-related
concerns. Integrating psychodermatological screening, stress management training, and improved work
conditions into occupational health protocols can enhance nurse well-being and professional performance.
Creating supportive, responsive, and health-promoting environments is essential for sustaining a healthy and
productive nursing workforce.
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REFERENCES
1. Alsharari, A. F., Abuadas, F. H., Hakami, M. N., Darraj, A. A., & Hakami, M. W. (2021). Impact of
night shift rotations on nursing performance and patient safety: A cross-sectional study. Nursing open,
8(3), 1479–1488. https://doi.org/10.1002/nop2.766
2. Balieva, F., Schut, C., Kupfer, J., Lien, L., Misery, L., Sampogna, F., von Euler, L., & Dalgard, F. J.
(2022). Perceived stress in patients with inflammatory and non-inflammatory skin conditions: An
observational controlled study among 255 Norwegian dermatological outpatients. Skin Health and
Disease, 2, e162. https://doi.org/10.1002/ski2.162
3. Basra, M. K. A., & Shahrukh, M. (2009). Burden of skin diseases. Expert Review of
Pharmacoeconomics & Outcomes Research, 9(3), 271–283. https://doi.org/10.1586/erp.09.18
4. Bolton, T., Myint, M., & Hughes, J. M. (2023). Cognitive exhaustion and inflammatory response: A
biopsychological feedback model in healthcare workers. Journal of Occupational Health Psychology,
28(2), 110–124.
5. Borge, R. H., Johannessen, H. A., & Alfonso, J. H. (2025). Psychosocial work exposures as risk factors
for skin problems in a general working population: cross-sectional and prospective associations.
International archives of occupational and environmental health, 98(3), 309–319.
https://doi.org/10.1007/s00420-025-02135-w
6. Cha, Y. J., Lee, K. S., Cho, J. H., Choi, I. S., & Lee, D. (2022). Effect of Job Stress on Burnout among
Nurses Responding to COVID-19: The Mediating Effect of Resilience. International journal of
environmental research and public health, 19(9), 5409. https://doi.org/10.3390/ijerph19095409
7. Chiang, S. L., Chiang, L. C., Tzeng, W. C., Lee, M. S., Fang, C. C., Lin, C. H., & Lin, C. H. (2022).
Impact of Rotating Shifts on Lifestyle Patterns and Perceived Stress among Nurses: A Cross-Sectional
Study. International journal of environmental research and public health, 19(9), 5235.
https://doi.org/10.3390/ijerph19095235
8. Chhetri, D. B., & Khanal, Bishnu. (2024). A Pilot Study Approach to Assessing the Reliability and
Validity of Relevancy and Efficacy Survey Scale. Janabhawana Research Journal, 3(1), 35–49.
9. Dalgard, F. J., Gieler, U., Tomas-Aragones, L., Lien, L., Poot, F., Jemec, G. B. E., ... & Misery, L.
(2015). The psychological burden of skin diseases: A cross-sectional multicenter study among
dermatological out-patients in 13 European countries. Journal of Investigative Dermatology, 135(4),
984–991. https://doi.org/10.1038/jid.2014.530
10. Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review.
Human Resources for Health, 18(1), 41. https://doi.org/10.1186/s12960-020-00469-9
11. Dartey, A. F., Tackie, V., Lotse, C. W., Dziwornu, E., Affrim, D., & Akosua, D. R. D. (2023).
Occupational stress and its effects on nurses at a health facility in Ho Municipality, Ghana. SAGE
Open Nursing, 9, 1–11. https://doi.org/10.1177/23779608231186044
12. Dhabhar FS. (2014). Effects of stress on immune function: the good, the bad, and the beautiful.
Immunologic Research, 58(2-3), 193–210. https://doi.org/10.1007/s12026-014-8517-0
13. Finlay, A. Y., & Khan, G. K. (1994). Dermatology Life Quality Index (DLQI)—a simple practical
measure for routine clinical use. Clinical and Experimental Dermatology, 19(3), 210–216.
https://doi.org/10.1111/j.1365-2230.1994.tb01167.x
14. Ghasemi, Z., Shahbazi, M., & Azadi, T. (2024). Skin disorders and psychological well-being in nurses:
A cross-sectional study. Nursing & Health Sciences, 26(1), 45–52.
15. Gupta, M. A., & Gupta, A. K. (1996). Psychodermatology: an update. Journal of the American
Academy of Dermatology, 34(6), 1030–1046. https://doi.org/10.1016/s0190-9622(96)90284-4
16. Hunda, S. N., Sibiya, M. N., & Khoza, T. E. (2024). Using the transactional model of stress and coping
to explore coping strategies adopted by radiology health caregivers during the COVID-19 pandemic.
Preprints. https://doi.org/10.20944/preprints202402.0483.v1
17. Jafferany, M., & Pastolero, P. (2018). Psychiatric and Psychological Impact of Chronic Skin Disease.
The primary care companion for CNS disorders, 20(2), 17nr02247.
https://doi.org/10.4088/PCC.17nr02247
18. Koo, J., & Lebwohl, A. (2001). Psychodermatology: The mind and skin connection. American Family
Physician, 64(11), 1873–1878.
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue VIII August 2025
Page 1369
www.rsisinternational.org
19. Lilly, E., Sellitto, C., Milstone, L. M., & White, T. W. (2016). Connexin channels in congenital skin
disorders. Seminars in cell & developmental biology, 50, 4–12.
https://doi.org/10.1016/j.semcdb.2015.11.018
20. Mahfouz, M. S., Alqassim, A. Y., Hakami, F. A., Alhazmi, A. K., Ashiri, A. M., Hakami, A. M.,
Khormi, L. M., Adawi, Y. M., & Jabrah, A. A. (2023). Common Skin Diseases and Their Psychosocial
Impact among Jazan Population, Saudi Arabia: A Cross-Sectional Survey during 2023. Medicina,
59(10), 1753. https://doi.org/10.3390/medicina59101753
21. Magnavita, N., & Garbarino, S. (2017). Sleep, Health and Wellness at Work: A Scoping Review.
International journal of environmental research and public health, 14(11), 1347.
https://doi.org/10.3390/ijerph14111347
22. Misery, L., Schut, C., Balieva, F., et al. (2023). White paper on psychodermatology in Europe: A
position paper from the EADV Psychodermatology Task Force and the European Society for
Dermatology and Psychiatry (ESDaP). Journal of the European Academy of Dermatology and
Venereology, 37(12), 2419–2427. https://doi.org/10.1111/jdv.19427
23. Mossel, R. M., Naber, R. J., van Manen, B. C. T., & Rustemeyer, T. (2024). The prevalence of hand
dermatitis among intensive care unit nurses. Contact Dermatitis, 91(1), 30–37.
https://doi.org/10.1111/cod.14568
24. Omotosho, T. F., Omotosho, T. O. A., & Bass, P. (2025). Work-related stress and its associated factors
among nurses in public hospitals in the Greater Banjul Area, The Gambia. International Journal of
Africa Nursing Sciences, 22, 100842. https://doi.org/10.1016/j.ijans.2025.100842
25. Penzer-Hick, R., & Haddad, M. (2021). Assessing and managing mental health issues in people with
chronic skin conditions. Nursing standard (Royal College of Nursing (Great Britain) : 1987), 36(10),
71–76. https://doi.org/10.7748/ns.2021.e11744
26. Pondeljak, N., & Lugović-Mihić, L. (2020). Stress-induced Interaction of Skin Immune Cells,
Hormones, and Neurotransmitters. Clinical therapeutics, 42(5), 757–770.
https://doi.org/10.1016/j.clinthera.2020.03.008
27. Reebye, P. (2008). Psychodermatology: The psychological impact of skin disorders. Journal of the
Canadian Academy of Child and Adolescent Psychiatry, 17(3), 169–171.
28. Tan, I. J., Mehdikhani, S., Pappert, A. S., & Weber, P. F. (2024). Bridging the gap in dermatology and
psychiatry: A scientific rationale. Skin health and disease, 4(6), e456. https://doi.org/10.1002/ski2.456
29. Werke, E. B., & Weret, Z. S. (2023). Occupational stress and associated factors among nurses working
at public hospitals of Addis Ababa, Ethiopia, 2022: A hospital-based cross-sectional study. Frontiers in
Public Health, 11, 1147086. https://doi.org/10.3389/fpubh.2023.1147086
30. World Health Organization. (2021). The impact of COVID-19 on health and care workers: a closer look
at deaths. World Health Organization. https://iris.who.int/handle/10665/345300. License: CC BY-NC-
SA 3.0 IGO
31. Wu, H., Liu, L., Wang, Y., & Gao, F. (2021). Skin disorders in doctors and nurses: Prevalence and risk
factors. Contact Dermatitis, 85(3), 294–302. https://doi.org/10.1111/cod.13894
32. Zhang, H., Wang, M., Zhao, X., Wang, Y., Chen, X., & Su, J. (2024). Role of stress in skin diseases: A
neuroendocrine-immune interaction view. Brain, Behavior, and Immunity, 116, 286–302.
https://doi.org/10.1016/j.bbi.2023.12.005
APPENDICES
Appendix A.
Frequency and Severity of Reported Psychodermatological Symptoms (N = 92)
Skin
Condition
Eczema
Psoriasis
Hives
(Urticaria)
Acne
Seborrheic
Dermatitis
Chronic
Itching
(Pruritus)
Severity
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Mild
14 (15%)
18 (20%)
19 (21%)
18 (20%)
11 (12%)
15 (16%)
Moderate
23 (25%)
17 (19%)
20 (22%)
21 (23%)
17 (19%)
13 (14%)
None
14 (15%)
22 (24%)
21 (23%)
17 (19%)
18 (20%)
20 (22%)
Severe
20 (22%)
16 (17%)
14 (15%)
19 (21%)
22 (24%)
19 (21%)
Very Severe
21 (23%)
19 (21%)
18 (20%)
17 (19%)
24 (26%)
25 (27%)